Shoulder replacement: types, risks and recovery

The shoulder is a ball and socket. When the cartilage wears away, the bones grind, causing pain at night, stiffness and loss of function. Replacement is mainly about pain. It can also be offered after a bad fracture of the upper arm.

It is usually considered once medicines, injections and physiotherapy no longer control the pain. Smaller operations that do not involve a new joint may be appropriate if arthritis is limited or the problem is a tendon.

The type of replacement depends on bone quality and on whether the rotator cuff muscles work. RNOH explains the surgeon chooses the implant on that basis, and occasionally a custom implant is designed from CT images.

Pre-assessment includes bloods, heart and lung checks and a review of medicines, including hormone-based medicines and drugs for rheumatoid arthritis, some of which may need adjusting. The RNOH guide asks you to remove nail varnish, gel, acrylic or false nails, as they interfere with the monitoring clips, and rings on the operated side.

Prepare your home for the sling period: a recliner or pillows to sleep propped up, front-opening clothes and help with cooking, hair washing and shopping.

You will receive the nerve block first, then a general anaesthetic. In a total shoulder replacement the ball (head of the upper arm bone) and the socket are both replaced; in a reverse design the ball and socket are swapped around so that the deltoid muscle does more of the work, which suits people whose cuff tendons are not working.

You wake in a sling with a numb arm. RNOH describes a stay of typically one to two days, with therapists showing you what is safe to do.

RNOH lists infection, nerve or blood vessel damage (under 1%), dislocation, stiffness and blood clots. Shoulder replacements can loosen or wear with time, and there is a possibility of further surgery. Ask your surgeon how long the implant type being proposed is expected to last and what the experience in your hospital is.

The RNOH guide describes three stages: up to six weeks in the sling with no active movement and no weight through the arm; six to sixteen weeks of gradual weaning and light unresisted movements at waist level; and beyond sixteen weeks a return to normal activities within comfort.

The Cambridge leaflet adds that dressings are kept dry for ten to fourteen days, that shoulder precautions last six weeks, with limits on turning the arm outwards and nothing heavier than a cup of tea, and that driving may be possible sooner than six weeks if you can control the wheel.

RNOH quotes work at about six weeks, driving at about ten weeks and non-contact leisure activities such as gentle jogging and light swimming from three months. Those are typical and differ between surgeons.

• Excess wound redness, inflammation, heat or discharge: tell your GP or the ward team.

• Fever or feeling unwell.

• A sudden pop with severe pain and loss of movement.

• Calf pain or breathlessness: urgent help, 999 if severe.

• Total or reverse replacement, and why?

• What movement should I realistically expect afterwards?

• How long will the sling be needed day and night?

• Who will supervise my rehabilitation?

Implants and surgical technique do not depend on how the operation is funded. The practical differences are the wait, how much choice you have over the surgeon and the amount of therapy included. Shoulder replacement is done less often than hip or knee replacement, so asking how many your surgeon performs is sensible in either setting.