What is arthritis?

Arthritis is a group of conditions that cause damage to one or more joints.

The most common type of arthritis is osteoarthritis, where there is gradual wear and tear of a joint.

Some other types of arthritis are associated with inflammation of the joints that can eventually lead to severe joint damage.

Arthritis eventually wears away the normal cartilage covering the surface of the joint and the bone underneath becomes damaged. This causes pain and stiffness in the joint, which can interfere with normal activities.

What are the benefits of surgery?

You should get less pain and be able to move your arm more easily.

Are there any alternatives to surgery?

Simple painkillers such as paracetamol and anti-inflammatory painkillers such as ibuprofen can help control the pain of arthritis. Regular moderate exercise can help to reduce stiffness in your shoulder.

A steroid injection into your shoulder joint can sometimes reduce pain and stiffness for several months.

All these measures become less effective if your arthritis gets worse and this is when your surgeon may recommend a shoulder replacement.

What will happen if I decide not to have the operation?

Arthritis of your shoulder usually gets worse with time. Arthritis is not life-threatening but it can be disabling.

What does the operation involve?

Various anaesthetic techniques are possible.

The operation usually takes 1 to 2 hours.

Your surgeon will make a cut on the front of your shoulder and remove the damaged ball (head of the humerus). They will examine the socket which lies on your shoulder blade.

They will replace the ball and sometimes also the socket. The new ball is made of metal and the socket is usually made of plastic.

Your shoulder replacement is fixed into the bone using a special coating or acrylic cement.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Venous thromboembolism (VTE). This is a blood clot in your leg (deep-vein thrombosis – DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection. You may need antibiotics and physiotherapy. Your risk will be lower if you have stopped smoking and you are free of COVID-19 (coronavirus) symptoms for at least 7 weeks before the operation.
• Heart attack. A heart attack can sometimes cause death.
• Stroke. A stroke can sometimes cause death.

Specific complications of this operation

• Damage to nerves around your shoulder, leading to weakness, numbness or pain in your shoulder or arm. This usually gets better but may be permanent.
• Infection, which can result in loosening and failure of your shoulder replacement.
• Severe pain, stiffness and loss of use of your arm and hand. Your arm and hand can take months or years to improve. Sometimes there is permanent pain and stiffness.
• Loosening without infection. You may need another operation to do your shoulder replacement again.
• Rotator-cuff tears.
• Dislocation of your shoulder replacement.
• Stiff shoulder. You should get more movement than you had before the operation but sometimes movement does not improve. It will never feel quite the same as a normal shoulder.
• Surgery to redo (revise) the shoulder replacement. Between 8 and 9 in 10 shoulder replacements will last 15 years.
• Difficulty passing urine. If it gets worse (bladder retention) you may need to go home with a urinary catheter and come back to hospital to have it removed around 2 weeks later.

Consequences of this procedure

• Pain.
• Unsightly scarring of your skin.

How soon will I recover?

You should be able to go home after 2 to 3 days.

You will need to keep your arm in a sling for up to 6 weeks to keep the tension away from your shoulder joint.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery, have less pain, and can move about better.

An artificial shoulder never feels quite the same as a normal shoulder and it is important to look after it in the long term.

A shoulder replacement can wear out with time.

Summary

Arthritis of your shoulder can cause severe pain, stiffness and disability. A shoulder replacement should reduce your pain and help you to move your shoulder more easily.

IMPORTANT INFORMATION

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