I have many patients that avoid shoulder replacement every year because they are concerned about shoulder replacement recovery. So what should you expect? How long does it take to recover from a shoulder replacement? Is shoulder replacement surgery successful? Let’s dig in.
How Long Does it Take to Recover from a Shoulder Replacement?
Shoulder replacement recovery typically begins in the hospital with a stay of about 2-3 days. A Cryocuff icing device or ice packs are used immediately after the surgery and at home to help reduce swelling. Your arm will be in a sling for 4-6 weeks after surgery and during that time you need to make sure your sleep position doesn’t permit your arm to go backward. A gentle shoulder range of motion exercise program is usually started immediately. Physical therapy usually begins at 2-3 weeks post-surgery. Resumption of full shoulder range of motion and driving typically begins around 6 weeks.
For shoulder replacement recovery, expect to take a couple of weeks off work. In one study, 92% of patients were back to work by 2 months, but only about 2/3rds of those patients returned to heavy work (1). So if you’ve got a job using your arms, then time off work will be longer. It is important to note that for the long-term, only about 5% of patients were still using narcotics at 1-year after their shoulder replacement (2).
Types of Shoulder Replacement
Total Shoulder Replacement (aka Total Shoulder Arthroplasty) – The whole shoulder joint is removed and then an anatomically similar ball and socket joint is installed.
Reverse Shoulder Replacement – The whole shoulder joint is removed and then a reverse configuration device is installed where a ball is placed where the socket used to be and a socket is placed where the ball used to be.
Partial Shoulder (Hemiarthroplasty) – Only the arthritic humerus “ball” is replaced while the patient’s own socket is left in place.
Which works best? For shoulder arthritis, one very large study concluded that a total shoulder worked better than a partial shoulder replacement (9).
Is Shoulder Replacement Surgery Successful?
With all of this prolonged shoulder replacement recovery, it’s startling to consider that in one study, 22% of patients still had significant shoulder pain 1-2 years after a shoulder replacement (3). In fact, in that same study, 38% of patients still had a 4/10 or greater and 10% still had severe 8-10/10 pain. That means that only 6 in 10 patients had mild or no pain after their shoulder replacement surgery. In another study, only 20% of patients had moderate or more pain (10). Also concerning is a large UK study that showed that about 1 in 4 men aged 55-59 years needed a reoperation within 5 years (17). Finally, others have found that long-term, in younger patients, many devices are failing. For example, in one US study about 4 in 10 patients who were under 55 years of age had a failure of their shoulder device at 10 years (18).
Is Shoulder Replacement More Painful than Knee Replacement?
There seems to be no major difference between knee and shoulder replacement pain or effectiveness (12). Once the patient has healed from the initial procedure, for knee replacements, in one study 20% experience moderate or more persistent knee pain despite the surgery and that was similar to shoulder replacement (10). Who is more likely to experience severe pain after shoulder replacement or a very prolonged shoulder replacement recovery? Those with more allergies (likely due to rejection of the metal in prosthesis), patients who were on narcotics before the procedure, those with poor function before the procedure, and patients with depression (11).
How Dangerous Is a Shoulder Replacement?
A longer shoulder replacement recovery will happen if you happen to have a complication from the procedure. About 4% of shoulder replacement patients will get an infection that will need to be treated with at least 6 weeks of IV antibiotics and possible additional surgery (4). In fact, taking out the infected shoulder device and cutting out the infected tissue may be the most effective treatment in addition to antibiotics. Loosening of the implanted shoulder device (due to it’s failure to bond to the bone) happens about 6% of the time (6). Nerve injury happens in from 1-4% of shoulder replacement patients (7,8).
Will My Shoulder Rotator Cuff Muscles Work Normally?
The rotator cuff muscles move the shoulder joint and stabilize it. If you replace the joint and remove the bones, then these critical muscles can be damaged. Often these muscles are also torn and frayed in shoulder arthritis patients who get shoulder replacement, so there is a debate as to whether the surgeon should also repair these muscles. For example in one study, the conclusion was that the surgeon shouldn’t repair these muscles (15). Others have found that the shoulder is weaker in internal and external rotation following replacement, again due to the fact that the rotator cuff muscles often can’t be preserved (16).
Non-Surgical Shoulder Treatments to Avoid Replacement
We have helped many patients avoid shoulder replacement recovery by using the PSA, or Percutaneous Shoulder Arthroplasty procedure. This involves using the patient’s own concentrated bone marrow stem cells injected into the damaged rotator cuff, ligaments, bone, and joint. The success rate is usually about 80% in the right patients (13). This procedure has a much quicker recovery time without many of the same serious complications that accompany shoulder replacement (14). The rotator cuff muscles are preserved, so often these patients can keep their own anatomy. To see what one part of the procedure is like, check out the video below:
The upshot? Shoulder replacement is a big surgery. Regrettably, based on the research, about 20-40% of patients will still have moderate or more shoulder pain despite the surgery, recovery times are long, and complication rates are similar to other large joint replacements.
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References:
(1) Liu JN, Garcia GH, Wong AC, Sinatro A, Wu HH, Dines DM, Warren RF, Gulotta LV. Return to Work After Anatomic Total Shoulder Arthroplasty for Patients 55 Years and Younger at Average 5-Year Follow-up. Orthopedics. 2018 May 1;41(3):e310-e315. doi: 10.3928/01477447-20180213-08.
(2) Berglund DD, Rosas S, Kurowicki J, Horn B, Mijic D, Levy JC. Preoperative Opioid Use Among Patients Undergoing Shoulder Arthroplasty Predicts Prolonged Postoperative Opioid Use. J Am Acad Orthop Surg. 2018;27(15):e691–e695. doi:10.5435/JAAOS-D-18-00008
(3) Bjørnholdt KT, Brandsborg B, Søballe K, Nikolajsen L. Persistent pain is common 1-2 years after shoulder replacement. Acta Orthop. 2015;86(1):71–77. doi:10.3109/17453674.2014.987065
(4) Coste JS, Reig S, Trojani C, et al. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg (Br) 2004;86(1):65–9. https://www.ncbi.nlm.nih.gov/pubmed/14765868
(5) Sperling JW, Kozak TK, Hanssen AD, et al. Infection after shoulder arthroplasty. Clin Orthop Relat Res. 2001;382:206–16. doi: 10.1097/00003086-200101000-00028. https://www.ncbi.nlm.nih.gov/pubmed/11153989
(6) Norris TR, Iannotti JP. Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Should Elbow Surg. 2002;11(2):130–5. doi: 10.1067/mse.2002.121146. https://www.ncbi.nlm.nih.gov/pubmed/11988723
(7) Lädermann A, Lübbeke A, Mélis B, et al. Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am. 2011;93(14):1288–93. doi: 10.2106/JBJS.J.00369. https://www.ncbi.nlm.nih.gov/pubmed/21792494
(8) Lynch NM, Cofield RH, Silbert PL, et al. Neurologic complications after total shoulder arthroplasty. J Should Elbow Surg. 1996;5:53–61. doi: 10.1016/S1058-2746(96)80031-0. https://www.ncbi.nlm.nih.gov/pubmed/8919443
(9) Bryant D, Litchfield R, Sandow M, Gartsman GM, Guyatt G, Kirkley A. A comparison of pain, strength, range of motion, and functional outcomes after hemiarthroplasty and total shoulder arthroplasty in patients with osteoarthritis of the shoulder. A systematic review and meta-analysis. J Bone Joint Surg Am. 2005 Sep;87(9):1947-56. https://www.ncbi.nlm.nih.gov/pubmed/16140808
(10) Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. data from the national joint registry for england and wales . J Bone Joint Surg Br. 2007;89(7):893–900. https://www.ncbi.nlm.nih.gov/pubmed/17673581
(11) Menendez ME, Lawler SM, Ring D, Jawa A. High pain intensity after total shoulder arthroplasty. J Shoulder Elbow Surg. 2018 Dec;27(12):2113-2119. doi: 10.1016/j.jse.2018.08.001.
(12) Johns Hopkins Medical Institutions. “Shoulder Replacement No More Risky Than The Replacement Of Other Joints.” ScienceDaily. ScienceDaily, 27 March 2007.
(13) Centeno CJ, Al-Sayegh H, Bashir J, Goodyear S, Freeman MD. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis. J Pain Res. 2015;8:269–276. Published 2015 Jun 5. doi: 10.2147/JPR.S80872
(14) Centeno CJ, Al-Sayegh H, Freeman MD3, Smith J, Murrell WD, Bubnov R. A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions. Int Orthop. 2016 Aug;40(8):1755-1765. doi: 10.1007/s00264-016-3162-y.
(15) Giles JW, Langohr GD, Johnson JA, Athwal GS. The rotator cuff muscles are antagonists after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2016 Oct;25(10):1592-600. doi: 10.1016/j.jse.2016.02.028.
(16) Erşen A, Birişik F, Bayram S, Şahinkaya T, Demirel M, Atalar AC, Demirhan M. Isokinetic Evaluation of Shoulder Strength and Endurance after Reverse Shoulder Arthroplasty: A Comparative Study. Acta Orthop Traumatol Turc. 2019 Aug 19. pii: S1017-995X(19)30376-1. doi: 10.1016/j.aott.2019.08.001.
(17) Craig RS, Lane JCE, Carr AJ, Furniss D, Collins GS, Rees JL. Serious adverse events and lifetime risk of reoperation after elective shoulder replacement: population-based cohort study using hospital episode statistics for England. BMJ. 2019;364:l298. Published 2019 Feb 20. doi:10.1136/bmj.l298
(18) Denard PJ, Raiss P, Sowa B, Walch G. Mid- to long-term follow-up of total shoulder arthroplasty using a keeled glenoid in young adults with primary glenohumeral arthritis. J Shoulder Elbow Surg. 2013 Jul;22(7):894-900. doi: 10.1016/j.jse.2012.09.016.
