Shoulder surgery for shoulder arthritis: Explore your options

Shoulder surgery may be an option if more conservative approaches aren't working for your shoulder arthritis. Explore your shoulder surgery options and talk to your doctor.

If you have shoulder arthritis, you know how painful it is and how much the loss of motion in your shoulder can interfere with your life. Your shoulder is usually the most mobile of all your joints. And when its range of motion is limited, simple tasks, such as reaching for an object in front of you, pulling your shirt over your head or scratching your back, can become difficult or even impossible.

If you've tried medications and exercises for your shoulder and haven't had much luck, you're probably thinking about shoulder surgery. Although joint replacement isn't the only surgical procedure available, it is the most common one for shoulder arthritis. Review your options with your doctor. Shoulder surgery can reduce your pain and increase the range of motion in your shoulder.

How your shoulder works

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Shoulder joint

Three joints form your shoulder. Working together, they allow you to move your arm. The largest joint — and the one most often affected by arthritis — is the glenohumeral joint. This joint is formed where your upper arm bone (humerus) meets the glenoid cavity, which is part of your shoulder blade (scapula). Most of your shoulder movement occurs here.

How arthritis affects your shoulder

Various types of arthritis can affect your shoulder. The most common types include:

Osteoarthritis. Osteoarthritis usually affects the shoulder of the arm you use the most. It causes severe pain and sometimes causes extreme loss of motion in your shoulder.
Rheumatoid arthritis. Rheumatoid arthritis isn't as common in the shoulder as it is in other large joints, such as your knees and hips. But when it does occur, rheumatoid arthritis often causes pain and weakness in both shoulders.
Rotator cuff tears and arthritis. Sometimes arthritis damages your shoulder joint enough to cause tears in your rotator cuff — the muscles that surround your shoulder joint and help you move your arm. This is most common with rheumatoid arthritis, but occurs in other types of arthritis as well. Rotator cuff tears that go unrepaired can also lead to arthritis.
Other types of arthritis. If you have other types of arthritis in your shoulder, such as post-traumatic arthritis and avascular necrosis, surgery may help improve pain and loss of motion.

Doctors usually recommend daily exercises or medications initially to help your shoulder. If pain and lack of motion persist after you've tried other options for your shoulder, it may be time to consider shoulder surgery.

Total shoulder replacement: The most common surgery for shoulder arthritis

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Shoulder joint replacement (arthroplasty)

If your doctor has advised surgery for your arthritis, you may have discussed total joint replacement (arthroplasty). It's the most common surgery for shoulder arthritis. Total joint replacement can increase the range of motion in your shoulder, making it easier to move your arm. It also improves strength and reduces pain in your shoulder.

During total joint replacement, your surgeon removes the damaged parts of the bones that make up your shoulder joint and replaces them with metal and plastic parts (prostheses). These parts replace the ball-shaped top of your upper arm bone (humerus) and the socket-shaped glenoid cavity of your shoulder blade. Your surgeon might also clean up the area around your shoulder joint by removing any bone spurs (osteophytes) and the tissue that surrounds your joint (synovium), which can become inflamed and painful.

Before proceeding with a total joint replacement, be aware of the commitment needed to recover from the surgery. Learning to use your new shoulder joint and recovering its strength may take several months. Fully regaining your strength and function may take up to a year.You have to diligently adhere to a prescribed set of exercises beginning the day after surgery. Not sticking to the exercise program can lead to stiffness or instability and dissatisfaction with your new shoulder joint.

Although modern shoulder replacement surgery has been in common use for more than 30 years, recent advances in technology and technique have made the procedure fairly safe and predictable. As with any surgery, though, you face a risk of infection and bleeding.

Most people are happy with their new shoulder joints, but complications can arise. A small number of total joint replacements may eventually need to be replaced. The parts can loosen, requiring refitting. Sometimes the shoulder becomes weak and unstable, which might require another joint replacement surgery.

Other types of surgery for shoulder arthritis

Joint replacement isn't necessarily your only option. In certain instances, your doctor might recommend another type of surgery for your shoulder arthritis, including:

Arthrodesis. Also called joint fusion, in arthrodesis your surgeon uses pins to hold your joint in one position. Because the fusion doesn't allow your joint to move, the procedure significantly reduces your ability to use your shoulder. You might be interested in arthrodesis if damage from arthritis makes it impossible for the muscles and tendons in your shoulder to support and hold an artificial shoulder joint in place.
Hemiarthroplasty. Hemiarthroplasty is a version of total joint replacement. Rather than replace both the top of your upper arm bone and your glenoid cavity with prostheses, in hemiarthroplasty your surgeon replaces only the top of your upper arm bone. Your surgeon might also smooth out the glenoid cavity of your shoulder blade, though a prosthesis isn't inserted. You might consider hemiarthroplasty if you're younger and plan to use your shoulder more vigorously than you'd be able to with a complete joint replacement. If you have a painful rotator cuff tear in addition to arthritis, you might also consider hemiarthroplasty, provided that you have good range of motion in your joint.
Reverse shoulder replacement. People who have rotator cuff tears in addition to severe shoulder arthritis and who have limited range of motion in their shoulders might consider a reverse shoulder replacement. This procedure is very similar to a shoulder replacement, except that the ball-and-socket joints are reversed. In a reverse shoulder replacement, your upper arm bone is replaced with a cup-like socket, while a ball-like part is inserted into your glenoid cavity. You might also consider reverse shoulder replacement if a previous shoulder replacement has failed.
Osteocapsular arthroplasty. During osteocapsular arthroplasty, your surgeon removes bone spurs (osteophytes) and reshapes and smooths your shoulder joint's surfaces. This makes it easier for the bones in your shoulder to move without friction and pain. Your surgeon may perform this surgery arthroscopically. To do this, your surgeon inserts a tiny camera (arthroscope) and special instruments into your joint through small incisions. While watching a monitor in the operating room, he or she uses these instruments to operate on your joint.
Synovectomy. The synovium surrounds your shoulder joint and, in rheumatoid arthritis, can become inflamed, causing pain and stiffness. A synovectomy removes the inflamed synovium. Your synovium can grow back and become inflamed again, but medications can usually prevent that from happening. If the bones in your shoulder joint aren't damaged, a synovectomy might be all you need to restore motion and reduce pain. Synovectomy can be done with either open or arthroscopic surgery.

Prioritizing shoulder surgery

Osteoarthritis or rheumatoid arthritis usually affects several joints in your body. The order in which you replace your affected joints depends on what other joints are involved and the amount of pain you have in each one. In general, you'll need to wait at least three months after your shoulder surgery before having surgery to replace any joints in your lower body. Crutches and walkers — common tools for getting around after knee or hip replacement — can't be used until your shoulder is completely healed.

Discuss your options with your doctor. Together you can decide which surgery is best for you and which will give you the greatest relief from pain and immobility.