Shoulder Replacement Surgery

Common Causes

• Osteoarthritis. The most common reason for a shoulder replacement in older patients. The protective cartilage covering the ball and socket surfaces wears away over time, leaving the bones to grind against each other and causing deep pain and stiffness.

• Rotator cuff arthropathy. In a rotator cuff injury, the tendons can be irreparably torn and the muscles can no longer hold the ball of the shoulder joint in its correct position. Over time, the resulting abnormal movement damages the joint surface, leading to a specific pattern of arthritis.

• Rheumatoid arthritis. The immune system's chronic attack on the joint lining can cause significant destruction of the cartilage and bone in the shoulder, particularly in patients who have had the condition for many years.

• A previous fracture. A severe break to the top of the arm bone can damage the joint surface beyond repair, or cause the bone to heal in a way that leads to arthritis over time.

Benefits

• Pain relief. Shoulder arthritis can make basic arm movements like reaching forward, getting dressed, or sleeping on the affected side intensely painful. Replacement surgery addresses the source of that pain directly.

• Improved movement. Most patients regain a significantly improved range of movement, allowing them to use the arm freely in everyday life.

• Better sleep. Shoulder pain is notoriously disruptive to sleep, particularly when it prevents comfortable positioning at night. Resolving the pain typically leads to a noticeable improvement in rest.

• Restored independence. Tasks like reaching, lifting, and carrying become possible again without assistance.

• Lifestyle benefits. Improved quality of life, improved physical health, better independence and return to certain sports that were stopped due to pain or stiffness.

Common Shoulder Replacement Procedures

Total Shoulder Replacement

The damaged ball and the socket are both replaced with prosthetic components. A rounded metal ball is attached to a stem inserted into the arm bone, and a smooth plastic socket is fixed into the shoulder blade. This is the standard procedure for straightforward shoulder arthritis where the rotator cuff is still intact.

Reverse Total Shoulder Replacement

In a reverse shoulder replacement, the ball and socket are switched. The ball is placed on the shoulder blade side and the socket on the arm bone side. This design allows the deltoid muscle (the large muscle at the top of the arm) to do the work that the rotator cuff would normally perform. It is the preferred option when the injury causes the rotator cuff to be severely or irreparably damaged, or when a previous shoulder replacement has failed. The technique was specifically developed for these situations and produces reliable, durable results.

Revision Shoulder Replacement

Revision surgery is required when a previous shoulder replacement has worn out, loosened, or become infected. It is more complex than the original procedure. Dr. Barrett will ensure the patient is fully informed about what is involved and what the recovery will look like.

What to Expect Prior to Surgery

1. A pre-operative assessment. Dr. Barrett will review the patient's shoulder through examination to confirm the diagnosis and plan the surgery. General health is also assessed to make sure the patient is fit for the operation and anaesthetic.

2. A medication review. Patients may be asked to stop certain medicines (such as blood thinners or anti-inflammatory drugs) in the days before surgery.

3. Final surgery preparation. The patient may be asked not to eat or drink for several hours before the operation. It is also worth preparing the home environment before surgery, such as everyday items within easy reach to make the early days of recovery more comfortable.

What to Expect During Surgery

Shoulder replacement surgery is performed under either a general anaesthetic (the patient is fully asleep) or a regional nerve block (the arm is numbed while the patient remains comfortable). Dr. Barrett will advise on the most appropriate option. The procedure typically takes between 1.5 and 2.5 hours.

1. The patient is carefully positioned to give Dr. Barrett optimal access to the shoulder joint.

2. An incision is made at the front of the shoulder to access the joint. The damaged surfaces are carefully removed.

3. The prosthetic components are positioned and fixed securely in place.

4. Before closing, Dr. Barrett checks the movement and stability of the new joint. A sling is fitted before the patient leaves the theatre.

What to Expect During Recovery

Recovery from shoulder replacement is gradual, and the timeline depends on the type of procedure performed. The following is a general guide:

Days 1 – 5

The patient will wake up in a sling, due to the regional block. However, the sling will already be taken off during the day to start active movement from day one. Small tasks can be achieved already at this early stage.

Weeks 1 – 6

The sling is worn on and off for the first 4 to 6 weeks to protect the healing joint. Physiotherapy begins with gentle, guided movements aimed at restoring range of motion without placing stress on the repair.

Weeks 6 – 12

As the shoulder continues to heal, physiotherapy progresses to more active strengthening exercises. Most patients notice a meaningful and progressive improvement in both comfort and movement during this period.

Months 3 – 12

Full recovery, particularly for reverse shoulder replacement, typically takes between 6 and 12 months. The shoulder continues to improve gradually throughout this time, and physiotherapy remains important in achieving the best long-term outcome.