Shoulder surgery for osteoarthritis: Expected outcomes, advantages, potential complications
For individuals suffering from osteoarthritis in the shoulder, two main types of surgery may be recommended by doctors: arthroscopy and total shoulder replacement. These procedures offer relief for those whose symptoms do not respond to nonsurgical treatments, and whose condition shows progressive stiffness and a grinding sensation in the bone, with well-functioning rotator cuff muscles and minimal glenoid wear.
Arthroscopic Surgery
Arthroscopy is a minimally invasive operation that involves making a small incision, inserting a camera, and manipulating tissue to remove loose cartilage or bone fragments. This procedure is particularly beneficial in milder cases of arthritis and can help reduce pain.
The steps of arthroscopic surgery include: 1. Performing the procedure using small incisions with a camera to guide repair or clean out the joint. 2. Targeting partial or moderate ligament/cartilage damage or loose bodies.
Recovery from arthroscopic surgery typically takes weeks or months for the shoulder joint to recover completely.
- First week: Pain and swelling are controlled with cold therapy and mild pain meds, and arm use is limited in a sling.
- 2–4 weeks: Begin passive and assisted range-of-motion exercises.
- 4–8 weeks: Transition to active motion and gentle strengthening.
- 3–4 months: Resume most daily activities.
- 6 months and beyond: Return to high-impact sports or demanding physical work.
Benefits of arthroscopy include smaller scars, less blood loss, and faster healing compared to open surgery.
Total Shoulder Replacement
Total shoulder replacement surgery involves replacing the arthritic ball and socket with metal and plastic implants. This open surgery offers a long-term solution for severe osteoarthritis.
The steps of total shoulder replacement surgery include: 1. Open surgery to remove damaged joint surfaces. 2. Implant a prosthetic joint to replace the shoulder joint. 3. Protect rotator cuff repair with a sling.
Recovery from total shoulder replacement surgery is a more prolonged process.
- Sling use for about 6 weeks to protect tendon repair.
- Up to 6 weeks: Soreness and limited range of motion are expected.
- By 12 weeks: Improved range of motion; start strengthening exercises.
- Full recovery between 6 to 12 months, including return to strenuous activities and sports.
Most patients experience significant pain relief and improved function, especially relief of night pain.
A Comparison
The steps and recovery periods for arthroscopic surgery and total shoulder replacement differ mainly in invasiveness and rehabilitation duration. Arthroscopic surgery offers faster recovery and less invasiveness, suitable for less severe damage. Total shoulder replacement provides a long-term solution for severe osteoarthritis with a longer recovery period but greater pain relief and joint function restoration.
| Aspect | Arthroscopic Surgery | Total Shoulder Replacement | |-------------------------|-------------------------------------|------------------------------------| | Procedure type | Minimally invasive, small incisions | Open surgery, joint replaced | | Initial immobilization | Sling for limited use | Sling worn 6 weeks | | Early rehab | Passive/assisted motion in 2-4 weeks| Limited movement, gentle rehab | | Strengthening begins | 4–8 weeks | Starts ~12 weeks | | Return to daily activities | 3–4 months | By 12 weeks improved; full by 6 months | | Full recovery | Around 6 months or more | 6 to 12 months | | Best use case | Mild to moderate ligament/cartilage damage | Severe arthritis or joint damage |
In select cases, reverse shoulder arthroplasty may be performed, where the anatomical positions of the artificial ball and socket are reversed. Additionally, it's essential to inform doctors about any medications and supplements taken for advice on stopping them before surgery. Possible complications of shoulder surgery for osteoarthritis include infection, problems with prosthetics, bleeding, adverse anesthetic events, nerve damage, and blood clot formation. Tests before osteoarthritis shoulder surgery may include blood tests, electrocardiogram (EKG), and chest X-ray. A doctor can provide information about any special preparation required for osteoarthritis shoulder surgery, such as stopping eating or drinking at a certain time.
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