Shoulder
Total Shoulder Replacement
A total shoulder replacement resurfaces an arthritic shoulder with an artificial ball and socket, arranged the same way as the natural joint. It relies on a working rotator cuff to keep the new ball centred in the socket. A reverse shoulder replacement does not, and the state of the cuff is what decides which of the two operations suits a given shoulder.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
When to consider it
This is the operation for an arthritic shoulder whose rotator cuff still works. The pain is usually a deep ache and seldom sharp. It is worse with use and eventually comes on at rest too, and the shoulder gets steadily stiffer and more limited, especially in rotation.
It is likely to suit you when:
- Pain has stopped responding to physiotherapy, activity change and injections
- X-rays show joint space loss and bone spurring typical of arthritis
- The rotator cuff is intact or working well on examination and imaging
- Movement is limited enough to be affecting daily activity and sleep
If the cuff is torn beyond repair, a standard replacement is likely to fail, because nothing holds the ball centred. That shoulder needs a reverse shoulder replacement instead.
What the operation involves
Cuff repair and stabilisation are keyhole operations. This one is open, done through an incision at the front of the shoulder, usually under general anaesthesia with a nerve block for pain relief afterwards. The arthritic head of the upper arm bone is replaced with a metal ball on a stem, and the socket is resurfaced with a plastic component.
It takes roughly ninety minutes to two hours. The hospital stay is generally two to three days, and the arm is protected in a sling for the first few weeks.
Shoulder replacement of both kinds was part of Dr. Ishan Khanna's shoulder fellowship at Seoul National University Bundang Hospital, South Korea.
What to expect afterwards
Pain relief is generally excellent, and it comes early. Because the rotator cuff is intact and doing its job, rotation and overhead reach normally recover more fully than after a reverse replacement. In a reverse replacement those movements are limited by the design itself, and time does not change that.
That result depends on the cuff staying healthy. Cuff tears become more likely with age. If the cuff tears years later, a standard replacement can start to fail in the same way an untreated arthritic shoulder does, and revision surgery, sometimes to a reverse replacement, may be needed.
- Week 0 to 3. Sling, with gentle assisted movement as directed.
- Week 3 to 6. Out of the sling, active movement below shoulder height.
- Week 6 to 12. Movement overhead, light strengthening.
- Month 3 to 12. Steady improvement in strength and rotation.
Risks
The main general risks are infection, nerve injury, dislocation and loosening of the components over time. Two long-term problems set this operation apart from a reverse replacement. The classic one is the socket component wearing or loosening over the years. The other is the rotator cuff itself tearing later and undermining the result.
If revision is ever needed, it is more involved than the original operation. When the cuff turns out to be the problem, converting to a reverse replacement is a well-established procedure.
Common questions
How is this different from a reverse shoulder replacement?
This operation keeps the joint's normal arrangement (ball on the arm bone, socket on the shoulder blade) and relies on the rotator cuff to hold it centred. A reverse replacement swaps them around so the deltoid muscle can lift the arm instead; it is used when the cuff cannot do the job. Which one suits you depends on whether your rotator cuff is intact.
Will I get full movement back?
Rotation and overhead reach generally recover well, and more fully than after a reverse replacement, because the muscles that produce those movements still work. Some stiffness can remain; how much depends on how stiff the shoulder was before surgery.
What happens if my rotator cuff tears years later?
It can undermine the replacement, in the same way an untreated cuff tear affects a natural shoulder. If that happens, the shoulder is reassessed. Revision to a reverse replacement is often the answer, since a reverse implant does not depend on the cuff at all.
How long does the implant last?
Commonly fifteen to twenty years or more in a well-selected shoulder with a healthy cuff. But it depends heavily on the cuff continuing to work over that time, more so than with a reverse replacement.
Not sure this is your problem?
These pages start from the symptom. They cover what else can cause it and what is usually tried first.
Not sure whether you need this?
Ask it at a consultation, and bring your imaging and any plan you have already been given. Second opinions on surgery advised elsewhere are routine. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.