Medical Edge Newspaper Column

Deciding Between Total and Partial Joint Replacement for Severe Shoulder Pain

September 4, 2009
Dear Mayo Clinic:
I'm 46 and was recently diagnosed with osteoarthritis. I've had three arthroscopic surgeries on my shoulder, but the pain is getting worse. My doctor says my next step is joint replacement. I'm a truck driver and would like to know more about the surgery and therapy that follows it.

Answer:
If other less-invasive therapies haven't worked, joint replacement can effectively treat osteoarthritis that causes severe shoulder pain. The two surgical options are partial or total shoulder replacement. The therapy and recovery time for both surgeries is about the same. But the long-term activity restrictions and pain relief are different.

Osteoarthritis occurs with deterioration of cartilage that cushions the ends of bones in the joints. The normally smooth surface of the cartilage becomes rough and causes irritation. Eventually, if the cartilage wears down completely, the result can be bone rubbing on bone. The joint surfaces of the bones become damaged, and, consequently, the joints become painful.

Osteoarthritis in the shoulder can be very debilitating. It often causes significant pain that interferes with daily activities and sleeping, and the pain gets progressively worse over time.

If you've already tried treatments such as lifestyle changes, medications and corticosteroid injections, and they haven't provided relief, surgery is usually the next option. You mention you've had arthroscopic treatment, which is a surgical procedure that involves removing loose pieces of cartilage and bone from around the shoulder joint to relieve pain. The problem with that procedure is that it doesn't eliminate bone-on-bone arthritis, so the pain often recurs.

I would agree with your doctor that joint replacement surgery appears to be the next step. The shoulder is a ball-and-socket joint, meaning the round end of one bone fits into an opening at the end of another bone. In a partial replacement procedure, a smooth metal ball is implanted in place of the round end of your arm bone. For total replacement, both the round end of your arm bone and the socket of your shoulder joint are replaced with an artificial joint.

Recovery time for both procedures is approximately the same. Typically, only a one-night hospital stay is required following surgery. At the hospital, you and a family member will work with a therapist to learn the physical therapy that's needed to recover. When you go home, that family member will need to help you with daily therapy for about three weeks. Thereafter, you can likely do the therapy on your own. In most cases, all the physical therapy required after shoulder joint replacement can be done at home.

After surgery, you'll need to wear a sling on your arm to rest your shoulder. The sling usually comes off after about six weeks, and at that point you'll be able to start raising your arm. You won't be able to lift anything with the affected shoulder for six weeks following surgery. After that period, patients are usually restricted to lifting no more than five to 10 pounds for several months. Then, the restriction is gradually decreased, so you can lift roughly 10 more pounds every six weeks. Full recovery takes about one year.

For partial replacement, the chance of good to excellent pain relief is roughly 80 percent, with no long-term activity restrictions. You could eventually return to your normal activities, including heaving lifting with the affected arm.

For total replacement, the odds of good to excellent pain relief are approximately 90 percent. But, you would be restricted to lifting no more than 25 pounds with that arm for the rest of your life.

To decide which procedure is appropriate for you, talk with your doctor about the demands you're going to place on the shoulder following surgery. You should discuss not only what's needed for your work as a truck driver, but also activities you enjoy in your free time.

The decision between partial or total shoulder joint replacement should be based on your activity level and what you need your shoulder to do, as well as the level of pain relief you are willing to accept. Those considerations will help guide you and your doctor as you decide what's best for your situation.

— John Sperling, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.