Risks matter as much as benefits
Understanding the risks of a total shoulder replacement is as important as understanding what it can offer. A decision made with only half of that picture is not really an informed one. Dr Kenneth Cutbush has recorded a discussion outlining the potential complications of shoulder replacement surgery, the steps taken to minimise them, and what patients should be aware of during recovery.
It is intended both for people considering the procedure and for those supporting someone who is.
Surgery is not always the answer
It is worth saying plainly that a shoulder replacement is not always necessary. Many people with shoulder arthritis manage well for a long time with analgesia, activity modification, physiotherapy and occasional injections, and replacement is generally reserved for shoulders where pain and loss of function are no longer acceptable despite those measures. If non-surgical treatment is still working for you, that is a legitimate place to stay.
The kinds of complication that can occur
Shoulder replacement is a well-established operation, but like any major surgery it carries risks. In general terms, the categories discussed with patients include:
- Infection, which is uncommon but can be serious and may require further surgery.
- Injury or irritation of nerves around the shoulder, which is usually temporary but can occasionally be lasting.
- Stiffness, or a range of movement that falls short of what was hoped for.
- Fracture of the bone around the implant, either during surgery or later.
- Instability or dislocation of the replaced joint.
- Loosening or wear of the components over time, which is the main reason a replacement may eventually need revision.
- Blood clots, and the general risks associated with anaesthesia.
- Ongoing pain despite a technically satisfactory operation.
How likely any of these are depends heavily on the individual: age, general health, bone quality, the condition being treated, whether the shoulder has been operated on before, and which type of replacement is used. For that reason the figures that matter are the ones discussed in your own consultation, not general ones. Individual results vary.
How risks are reduced
A good deal of the planning around a shoulder replacement is directed at reducing these risks: assessing and optimising general health beforehand, imaging and planning the implant position in advance, specific skin and nasal preparation to lower infection risk, careful handling of the soft tissues and nerves during surgery, and a structured rehabilitation programme afterwards. We have written separately about preventing infection in shoulder replacement surgery.
What to watch for during recovery
After discharge, the things worth reporting promptly rather than waiting for the next appointment generally include increasing rather than settling pain, fever or feeling unwell, redness, swelling or discharge from the wound, new numbness or weakness in the arm or hand, and calf pain or breathlessness. Clear instructions are given on discharge, and it is better to ask than to wonder.
Watch the discussion
The full discussion is available via this link: watch the video.
Further reading
Our anatomic total shoulder replacement and reverse total shoulder replacement pages explain the two main types and when each is used, and the shoulder arthritis page covers the condition itself. The surgery FAQs answer the practical questions, and you can arrange an assessment via the consultation page.