There are two reasons people undergo shoulder replacement surgery. The first is to reduce long term pain. The second is to improve movement or function with daily activities and hobbies. This article describes the different types of shoulder replacement surgery, and the rehabilitation process that follows.
The shoulder is a shallow ball and socket joint, controlled by a group of small muscles. This design allows for the precise but varied movements the shoulder joint can perform.
Successful outcomes of shoulder replacement surgery are dependent on two things – the surgical procedure and the rehabilitation process.
Two surgical procedures are currently used to assist patients unable to reduce their pain or gain function with conservative management, such as exercise and physiotherapy. A number of factors are considered by the surgeon before deciding on the appropriate type of surgery. These include:
- The current state of the shoulder joint.
- The health of the muscles that control shoulder stability.
- The health of the bones and cartilage in the joint.
- The presence of other medical conditions that could influence healing.
- The patient’s goals.
- The patient’s ability to tolerate a long post-operative rehabilitation process.
The two different surgery options are:
Total shoulder replacement: During this procedure the surgeon replaces the ball (humeral head) and socket (glenoid) with a man-made version. This surgery requires the stabilising muscles in the shoulder to be reasonably healthy, and is usually performed to address pain and movement issues associated with osteoarthritis.
The surgery is performed over a few hours and the following day the patient is required to start moving the shoulder to prevent joint stiffness, and to help reduce swelling. Exercises are prescribed by the hospital physiotherapist.
Total shoulder replacement patients report no pain, or a substantial reduction in pain, two years after surgery. Forward movement of the shoulder generally increases to a functional over head height, although reaching to the side and behind the back can remain limited long term.
Reverse total shoulder replacement: This procedure is usually recommended if the muscles that support the shoulder joint are too damaged to recover from the surgery.
In order to stabilise the new joint, a man-made ball is placed where the socket normally sits and the new socket replaces the old ball. The reverse positioning of the ball and socket provides a good movement surface, and helps re-position the healthy muscles to take over movement of the shoulder.
Due to the changed mechanics in the shoulder the patient is asked to avoid moving their hand behind their back in the first phase of rehabilitation, until the muscles have learned their new stabilising role. Movements to prevent stiffness will be taught in hospital by a physiotherapist before going home.
Reverse total shoulder patients also report a reduction in pain and improvement in shoulder movement. Forward movement of the shoulder following a reverse shoulder replacement is often reduced compared to the unaffected side, and rotation out to the side and behind the back can be substantially limited.
There are four rehabilitation phases the surgeon and physiotherapist move through following shoulder replacement surgery. There will be individualised programs the patient will be required to perform at home on a regular basis.
Patients considering shoulder replacement need to discuss their long-term goals and expectations with their surgeon and physiotherapist. This will better define the rehabilitation focus, and also set realistic expectations for future use of the operative arm.
This phase is about protecting the joint and allowing healing, whilst preventing unnecessary stiffness and swelling. The exercises are very gentle and assisted with the non-operated arm.
This phase occurs at different times for each person, depending on the type of surgery you have. Rehabilitation will progress to challenging your arm to move into its stiff range. The physiotherapist will guide you through a progression of safe and comfortable exercises.
The strengthening phase! Gaining strength makes the arm feel less heavy and cumbersome when reaching and performing everyday tasks. Strengthening programs set by the physiotherapist will differ depending on the type of muscles required to use the replacement effectively.
In this phase progressive strengthening focuses on the functional goals determined by the patient prior to surgery. This is the longest phase as it takes months to develop the degrees of strength and precision required to feel comfortable in every day activities.
Patients often report that their shoulder begins to feel normal between nine and twelve months after surgery.
If you have any further questions regarding shoulder replacement surgery then please contact any of our clinics to speak to one of our physiotherapists. Contact details for all clinics can be found on the About page on our website.
Blacknall, J. Neumann, S. (2011) Rehabilitation following reverse total shoulder replacement. Journal of Shoulder and Elbow Surgery. 3,pp 232–24
Boudreau, S. et.al. (2007). Rehabilitation following reverse total shoulder arthroplasty. Journal of orthopedic and sports physical therapy Vol 37 no 12 pp 734 – 743
Gruber, S. et al. (2017) The reverse shoulder arthroplasty Delta Xtend: Mid-term results
Orthopade. 2017 Mar;46(3):222-226.
Sandow, M et al. (2013) Hemiarthroplasty vs total shoulder replacement for rotator cuff intact osteoarthritis: how do they fare after a decade? Journal of Shoulder and Elbow Surgery , Volume 22, Issue 7 , 877 – 885
Trail, A. Conlon, RA. (2009) Why and how we do total shoulder replacement. British elbow and shoulder society. Pp 123-128
About the Author:
Born in Tasmania Lauren studied at Sydney University, completing her Bachelor of Physiotherapy with first class Honours in 2013. Following this Lauren worked at a private rehabilitation hospital in Westmead, NSW, and spent a year working at Royal North Shore Hospital in Sydney.
Lauren has an interest in all musculoskeletal areas of physiotherapy including sports injuries, paediatrics and post-surgical rehabilitation. Lauren uses thorough assessment, education and individualized exercise programs to help patients achieve their physical and lifestyle goals.
Maintaining an active and productive life is Lauren’s priority for herself and her patients. Outside work Lauren spends her time horse riding, water skiing and swimming.