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Arthritis: Should I Have Shoulder Replacement Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Arthritis: Should I Have Shoulder Replacement Surgery?
Get the facts
- Have shoulder replacement surgery.
- Don't have surgery. Instead, manage your osteoarthritis with medicine, exercise, physical therapy, and other treatments.
Key points to remember
- Most people can manage osteoarthritis pain with medicine, exercise, and other treatments that don't involve surgery.
- Surgery may be an option if your pain is very bad, you can barely move your arm and shoulder, you have lost a lot of cartilage, and/or other treatments haven't helped.
- After surgery, your shoulder won't move as far as it did before. But it should help your pain.
- Artificial shoulder joints usually last 10 to 20 years. You may need to have surgery again if the joint wears out.
- You'll need several months of physical therapy to get the best use of your new joint.
Osteoarthritis is a painful problem with the cartilage in the joints. It occurs when the cartilage that cushions your joints breaks down and wears away. When this happens, the bones rub together and cause damage and pain. In most cases, it takes years for cartilage to break down.
As your arthritis gets worse, you may not be able to fully rotate, flex, or extend the joint that hurts. Or you may not be able to use the joint at all.
In shoulder replacement surgery, the surgeon removes the ends of the damaged upper arm bones and replaces them with plastic or metal pieces.
Most people are able to get out of bed with some help on the day of surgery and go home 1 to 3 days later.
You will start physical therapy right away and continue to do it for several months to get the best use of your new joint. A physical therapist will teach you how to use a pulley device so you can also do arm exercises at home.
- You may be able to go back to doing your normal activities with less pain. Many people are able to go back to playing sports such as golf, swimming, riding a bike, and cross-country skiing.
- Your shoulder won't move as far as it did before you started to have shoulder problems. How much you'll be able to move your shoulder depends on how much you could move it before you had surgery and whether the soft tissues around your shoulder were also damaged.
Artificial shoulder joints typically last 10 to 20 years. You may need to have another surgery if the new joint becomes loose or wears out. Your new joint may last longer if you don't do hard physical work or activities that put a lot of stress on the joint.
Shoulder replacement surgery has some risks. They include:
Most people can manage their symptoms with treatments that don't involve surgery. These may include:
- Medicine. If your pain is mild, over-the-counter pain medicines may help. These include acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs, such as ibuprofen (for example, Advil, Motrin), naproxen (for example, Aleve), and aspirin (for example, Bayer, Bufferin). But if these don't get rid of your pain, you may need a stronger prescription medicine.
- Exercise. It can help keep your muscles strong and your joints moving well.
- Physical therapy. This includes specific exercises that can help you stretch and strengthen your shoulder muscles and reduce pain and stiffness.
- Heat. It can reduce pain and stiffness and can help you loosen up before an activity.
- Ice. It can help reduce pain and swelling and is a good pain reliever after an activity.
- Pain-relieving gels or creams, such as capsaicin, or shots of medicine may also help.
Some other things that may help relieve your symptoms include:
- Acupuncture. It involves putting very tiny needles into your skin at certain places on your body to relieve pain.
- Diathermy. It uses heat to increase blood flow throughout the shoulder for pain relief and quick healing.
- Pulsed electromagnetic field therapy. It uses magnets to produce an electrical pulse that may help cartilage grow.
- Transcutaneous electrical nerve stimulation, or TENS. It uses a mild electrical current to reduce pain.
- Relaxation and breathing exercises, such as meditation, guided imagery, and yoga. These can help reduce stress and relax your mind and muscles.
Your doctor might recommend shoulder replacement if:
- You have very bad pain.
- You can barely move your arm and shoulder.
- You have lost a lot of cartilage.
- You have tried medicine and other treatments, but they haven't helped.
- Your health is good.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You may be asleep during the surgery. Or you may be awake, but the area around your arm and shoulder will be numb so you won't feel any pain.
- You may spend 1 to 3 days in the hospital.
- You will take antibiotics to prevent infection and medicine to treat pain.
- You will start physical therapy right away.
- You may have less pain.
- You should be able to do your daily activities more easily.
The risks of surgery include:
- Infection and problems with wound healing.
- Injury to the nerves or blood vessels of the shoulder.
- Lack of good range of motion.
- A dislocated shoulder.
- A fracture of the upper arm bone.
- An unstable or wobbly joint.
- A blood clot.
- Problems from general anesthesia.
- You may need another surgery if the new joint becomes loose or wears out.
You can try other treatments to help relieve your symptoms, such as:
- Pain medicine.
- Physical therapy.
- Heat and ice.
- You avoid the risks of surgery.
- You avoid the cost of surgery.
- You avoid several months of physical therapy.
- If your symptoms don't improve with medicine, exercise, physical therapy, or other treatments, you can decide later to have surgery.
As your osteoarthritis gets worse:
- You may have severe pain.
- You may not be able to do your daily activities.
- You may not be able to fully rotate, flex, or extend your arm and shoulder. Or you may not be able to use them at all.
The pain medicine you take:
- May not relieve your symptoms.
- May cause side effects, such as upset stomach, ulcers, stomach bleeding, and skin rashes. Stronger pain medicine, such as opioids, may cause constipation, confusion, drowsiness, and nausea and vomiting.
Personal stories about shoulder replacement surgery
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I’ve always been active. I used to play golf a few days a week. But the pain in my shoulder had gotten so bad that I could barely swing a golf club. It was even hard for me to lift my arm over my head to wash my hair or carry a bag of groceries. I tried different kinds of prescription pain medicine, but they didn’t help. And the side effects bothered me a lot. My doctor suggested that I have surgery to replace my shoulder joint. After weighing the pros and cons of surgery, I decided to have it done. And I’m glad I did. I may not be able to hit a golf ball like I used to, but I can get out on the course and enjoy a game without pain.
Roberta, age 72
At first, I would only feel pain in my shoulder after I'd exercise or do household chores like mowing the lawn. I would ice my shoulder and rest it, and that seemed to help for a while. Then I started to feel pain even when I wasn’t doing anything. And I would wake up really stiff in the morning and would have a hard time moving my arm. I couldn’t even lift my little girl up to give her a kiss goodbye before she went off to school. An X-ray showed that the cartilage in my shoulder is badly damaged. I know that surgery is an option, but I don’t want to have it yet. I’m only in my 40s, and I’m afraid that I might need another surgery later on if the new joint wears out. I’m going to try physical therapy and medicine first to see if they will help me.
Darnell, age 47
I’ve had pain in my shoulder for as long as I can remember. I just deal with it the best I can. On some days, the pain and stiffness get so bad that I can’t reach up to grab a bowl out of the cabinet or pull a jug of milk out of the fridge. But on other days, I’m okay. I still hurt, but not as much. I think the exercises that my physical therapist showed me are helping me stay as loose as possible. I've noticed that when I do my exercises, I can move my shoulder a lot more than I can if I don't do them. And the pain medicine and supplements that I’ve been taking seem to keep my pain under control. As long as I can find relief with these things, surgery won’t be part of my future.
Janet, age 66
I’ve done construction work all my life. So the aches and pains I would feel after a long day on the job didn’t worry me. I would take a couple of Advil and be okay to go to work the next day. But after years of lifting, sawing, and hammering, I could feel my right shoulder starting to give out. I would have pain all the time—even at rest. And I started to lose strength in my arm. When I started to miss work because of the pain, I knew I needed to do something about it. After talking with my doctor, I decided to have shoulder replacement surgery. The recovery from surgery was long and hard, but I’m back on the job. I even feel good enough on the weekends to make tree houses for the neighborhood kids.
Alex, age 55
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have shoulder replacement surgery
Reasons not to have surgery
I'm comfortable with the idea of having surgery.
I just don't like the idea of having surgery.
My symptoms are so bad that I can't do my daily activities.
I'm still able to do my daily activities.
I've tried medicine and other treatments, but they don't help that much.
Medicine and other treatments keep my symptoms under control.
The side effects of pain medicine bother me a lot.
The side effects of pain medicine don't bother me.
I'm not worried about how much surgery may cost.
I don't have insurance, and I can't afford to pay for the surgery myself.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT having surgery
What else do you need to make your decision?
Check the facts
For mild to moderate osteoarthritis, medicine and other treatments that don't involve surgery can help relieve my symptoms.
- TrueThat's right. Most people can manage their pain with medicine, exercise, and other treatments that don't involve surgery.
- FalseSorry, that's not right. Most people can manage their pain with medicine, exercise, and other treatments that don't involve surgery.
- I'm not sureIt may help to go back and read "Get the facts." Most people can manage their pain with medicine, exercise, and other treatments that don't involve surgery.
My artificial shoulder joint will last forever.
- TrueSorry, that's not right. Artificial shoulder joints usually last 10 to 20 years. You may need to have surgery again if the joint wears out.
- FalseThat's right. Artificial shoulder joints usually last 10 to 20 years. You may need to have surgery again if the joint wears out.
- I'm not sureIt may help to go back and read "Get the facts." Artificial shoulder joints usually last 10 to 20 years. You may need to have surgery again if the joint wears out.
After surgery, my shoulder will work better than it did before I started to have shoulder problems.
- TrueSorry, that's not right. After surgery, your shoulder won't move as far as it did before you started to have shoulder problems. But it should help your pain.
- FalseThat's right. After surgery, your shoulder won't move as far as it did before you started to have shoulder problems. But it should help your pain.
- I'm not sureIt may help to go back and read "Get the facts." After surgery, your shoulder won't move as far as it did before you started to have shoulder problems. But it should help your pain.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Stanford M. Shoor, MD - Rheumatology|