How Do I Know If I’m Ready For Shoulder Replacement Surgery?

Dean W Ziegler, MD, Blount Orthopaedic Associates

How do you know if you need shoulder replacement surgery? It’s a tricky question and certainly not one to take lightly. Fortunately, with the many advances in shoulder replacement surgery, patients can expect a minimally invasive procedure and a quick recovery, provided they follow their physician’s instructions.

So should you consider shoulder replacement surgery? Your shoulder mobility is essential for many of your daily activities. Whether lifting objects or doing tasks like brushing your teeth, your shoulder lifts your arm to get the job done. That’s why it’s incredibly frustrating and potentially debilitating when chronic shoulder pain begins to limit your mobility.

When you first experience chronic shoulder pain, you may seek treatment from an orthopedic specialist or a physical therapist. If you’ve exhausted your nonsurgical options for treatment and your pain and mobility levels are still not optimal, you may be considering surgery. Today, Dean Ziegler, MD, of Blount Orthopaedic Associates and orthopedic surgeon at the Orthopaedic Hospital of Wisconsin, explains what to expect from shoulder replacement surgery.

Preparing for a Conversation About Shoulder Replacement Surgery

Almost every orthopedic intervention begins with a candid conversation between you and a trusted physician. Dr. Ziegler explains that it’s important to start a conversation with an orthopedic surgeon as soon as you consider shoulder surgery. 

“Should you consider shoulder replacement surgery? As a patient, this is the right question to ask, and the answer is very personal,” Dr. Ziegler said. “Make sure your surgeon understands your level of frustration with your shoulder and your goals for functional return.”

Recovering from chronic shoulder pain can be a daunting process to begin. Thankfully, the talented specialists at OHOW are here to help. When you start the conversation with your physician, you’ve likely already thought a lot about your shoulder discomfort. Here are some of the most common questions about shoulder replacement surgery to help guide you through the process.

Who Should I Talk to About Shoulder Surgery Options?

When you’re ready to address your shoulder pain and start an intervention, without question, the best source of information is your orthopedic surgeon. Whether a shoulder procedure or a total shoulder replacement surgery is the right solution, the conversation should begin with a surgical expert.

Make sure your surgeon also discusses nonoperative options with you. When you schedule a shoulder replacement, you should feel comfortable that you have explored other options. You should try any other nonsurgical treatments that might offer a reasonable chance of success. Again, your orthopedic surgeon is the person with the expertise to guide you. Many patients also find it helpful to talk to friends or family members who have had shoulder surgeries or replacements.

Patients who have had a previous shoulder replacement are excellent sources for information, but keep in mind that those sources are limited to an individual experience. On the other hand, your surgeon offers the knowledge and experience of working with many patients from all walks of life.

Dr. Ziegler states, “When discussing treatment options with my patients, I hope they will gain enough knowledge to become comfortable discussing their care, life situation, and goals. Their participation, knowledge, and understanding of the surgical process all contribute to a positive outcome.”

Skilled physicians are also well-versed in research from large and randomized high-quality medical studies. They use this valuable data to ensure they take the necessary planning steps for successful outcomes. Listen to your doctor’s advice and discuss your concerns.

Of course, it’s also essential that you connect with your doctor. Never be afraid to request a second opinion if you do not fully understand your surgeon’s explanations or even if your personalities don’t click. A professional, confident surgeon will have no concerns about you seeking another opinion. So, if your doctor is unhappy about it, consider it a red flag.

Is Shoulder Surgery Always the First Suggestion?

Contrary to what we might think, most surgeons don’t suggest surgery as the first intervention or way to address an injury. If your surgeon doesn’t recommend shoulder surgery right away, there could be many reasons.

You should be in good physical health before you undergo surgery. OHOW’s dedicated team of medical providers will assist you in reaching an optimal state for surgery. Secondly, your insurance company might require nonoperative treatment before approving a shoulder replacement surgery. Most commonly, insurance companies require patients try pain medicine first, like acetaminophen or anti-inflammatories (e.g., ibuprofen, naproxen). They may also recommend muscle-strengthening exercises and physical therapy.

Your surgeon will explore the root cause of your shoulder pain. Keep in mind that a significantly arthritic shoulder may become symptomatically worse with physical therapy. The physical therapists at OHOW see a high volume of patients with shoulder arthritis, are very skilled at treating it, and recognize when the exercises may be making your shoulder feel worse. Depending on your health, pain, and degree of injury or arthritis, your surgeon may encourage—or discourage—specific exercises or therapies.

The easiest way to prevent shoulder pain is adjusting your lifestyle to avoid painful activities, but understandably it isn’t easy or realistic to give up a favorite pastime like golf or tennis. Talk to your surgeon about the activities you want to do after a shoulder replacement. They can help you explore what’s possible based on the type of shoulder replacement you are considering. Most surgeons recommend avoiding activities that may put too much stress on your replaced shoulder.

“Activities that you should avoid after shoulder replacement surgery include extreme heavy lifting, jarring activities such chopping wood, or full-contact sports,” Dr. Ziegler said. “However, if full contact activity is something you desperately want to return to, we can make modifications to get you there. Your surgeon needs to know your goals before surgery.”

Do Cortisone Injections Work for Shoulder Pain?

Cortisone or corticosteroid injections have a long track record of providing at least some temporary relief for some types of shoulder arthritis and pain. Many patients experience up to six months of pain relief with a good injection result, and they can help worsening symptoms calm down. In addition, cortisone shots might allow patients to be comfortable enough to perform light muscle strengthening exercises, resulting in more stability and even longer-lasting pain relief.

However, corticosteroid injections are not a cure, and if they are not giving long-lasting relief, it may be time to consider surgical management. Doctors have used hyaluronic acid, a gel-type lubricant, for knee arthritis with variable results. However, medical experts do not indicate hyaluronic acid injections for shoulder injuries or arthritis.

There are other injections, such as stem cell therapies, but the American Academy of Orthopaedic Surgeons (AAOS) has closely looked at stem cell injections or biologics, and they have recommended against their use except within research settings and clinical trials. The FDA doesn’t regulate these treatments, and mishandling of them can cause disastrous infections.

Preparing for Shoulder Replacement Surgery

If your x-rays demonstrate a need for shoulder replacement surgery and your surgeon has discussed the procedure, risks, recovery, and rehab process with you, it may be the right step.

At OHOW, you will receive specialized, one-on-one education from a nurse practitioner, nurse educator, and physical therapist before your surgery. Write down any questions to discuss during your OHOW comprehensive educational visit, so staff can help you feel at ease before the procedure. You should feel comfortable about surgery and thoroughly understand what you are about to undertake.

A surgeon will guide a patient towards shoulder replacement as an early intervention in some cases. When this happens, the surgeon likely believes that the patient may be doing more harm than necessary by delaying a shoulder replacement surgery, such as when patients have bone-on-bone arthritis. If their arthritis worsens, their shoulder motion continues to decline, or the bone-on-bone wear causes significant shoulder deformity, it might make the recovery after a total shoulder replacement longer, more difficult, and ultimately not as successful.

Another example might be a patient experiencing pain even while sitting, sleeping, or resting. This pain level causes considerable stress on patients’ day-to-day lives, and if other nonoperative treatments have failed, shoulder replacement might be the best option. Also, doctors sometimes recommend shoulder replacements for diagnoses other than arthritis–for example, avascular necrosis, certain fractures, or massive, irreparable rotator cuff tears that significantly limit shoulder function.

What is Shoulder Replacement Surgery?

There are two main types of shoulder replacement surgeries. 

Anatomic shoulder replacement, which has been in use since the 1970s, is for patients with significant cartilage loss or deformity of the ball and socket of the shoulder joint and a functioning rotator cuff.

Reverse shoulder replacement is a procedure in which a ball is placed on the socket side, and a socket is placed on the ball side. The reverse replacement has been done in the US since the early 2000s and was created for people with irreparable rotator cuff tears, with or without shoulder arthritis, who have difficulty actively elevating their shoulders.

“Reverse shoulder replacement is an excellent procedure for those patients who need it and is certainly the greatest advance in shoulder surgery since starting my career 25 years ago,” Dr. Ziegler said.

The right timing for shoulder replacement surgery is up to each patient. Deciding to undergo surgery requires a strong relationship between the patient and surgeon. Patients should feel they are fully aware of all options and expected outcomes. They should have an open discussion with their doctor about their goals, lifestyle, and post-surgical activities.

“X-rays and diagnostics are important, but your lifestyle and goals also play a huge role,” Dr. Ziegler said.

You may hear from friends and family that shoulder surgery is very difficult to recover from. However, many people mistake a shoulder replacement with a rotator cuff repair.

“Shoulder replacement is the best surgical procedure I do,” Dr. Ziegler believes. “Anatomic shoulder replacement is less difficult to recover from than a rotator cuff repair, and the recovery from reverse shoulder replacement is even better.”

Whether you’re ready for a shoulder replacement right now or hope you are years away, it’s best to contact an OHOW specialist at 414-961-6880 to discuss the entire spectrum of treatment that can start to set you on the path of recovery.