What Are The Risks Of Shoulder Surgery?
Shoulder replacements have been highly successful for years. Many people who have suffered from shoulder pain and arthritis have experienced relief and restored motion through total shoulder replacement. And because new materials and procedures are always being developed, the results continue to get better. The complication rate following total shoulder replacement is low. Serious complications, such as shoulder-joint infection, occur in fewer than 1.9% of patients.1 Major medical complications, such as heart attack or stroke, occur even less frequently. (Of course, chronic illnesses may increase the potential for complications.)
Every surgical procedure has some risks and benefits. Your individual results will depend on your personal circumstances, and recovery takes time. While there can be no guarantee of success, benefits can include pain relief and return of normal use of the shoulder.
Each of the following reactions or complications can occur during and after surgery and may require medical attention (such as further surgery) and implant removal:
Infection is a risk with any surgical procedure. According to a recent study, less than 1.9% of patients get an infection in the first two years.1 When infection occurs after total shoulder replacement, it is most commonly caused by bacteria that enter the bloodstream during dental procedures or from urinary tract, skin, or fingernail infections. Although uncommon, when these complications occur, they can delay full recovery.
For the first two years after your shoulder replacement, you must take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream. Generally, talk to your orthopedist and your dentist to see if you still need preventive antibiotics before other procedures.
The bone next to the shoulder implant may break down (called osteolysis) because of your body’s reaction to particles that may be caused by:
- Direct contact of the metal and plastic components
- Contact between the shoulder components and the bone cement
- Contact between the shoulder components and the natural bone particles that exist between the shoulder’s moving parts, which can cause more particles or damage to the implant components
Implant fracture has been reported following total shoulder replacement. This is typically caused by:
- Patients with extreme performance expectations
- Heavy and/or overweight patients
- Physically active patients
To minimize the possibility for implant fracture, it is important to follow medical instructions and to avoid excessive or inappropriate activity.
- Removal and/or replacement of the device system or its components may be necessary at some point in the future
- Although rare, metal-allergy reactions from shoulder implants have been reported. Inform your doctor if you have any allergy symptoms
- Dislocation can result from improper positioning of the implant components or falling down and landing on your shoulder or elbow
- Implant components can loosen or move due to improper cementing or shock from falls or collisions
- Cardiovascular disorders associated with the use of bone cement include blood clots, decreased blood pressure, heart attack, and in rare instances, death
When shoulder replacement surgery is not appropriate
Given the risks, your doctor may decide that shoulder replacement surgery is not appropriate if among others:
- You have an infection or a history of infection
- You don’t have enough bone or the bone is not strong enough to support your new shoulder
- You have injured nerves in your shoulder area
- You have injured or nonfunctional shoulder muscles
- Your shoulder is severely unstable
- Your bones are not fully grown or developed
- You have noticeable bone loss or a severe decrease in bone mass (osteoporosis)
- Your shoulder joint has been previously fused and is stable, functional, and painless
- You have rheumatoid arthritis and active/history of skin lesions (because of increased risk of infection)
- J Bone Joint Surg [Br] 2004;86-B:65-9.
Received 13 December 2002; Accepted 2 May 2003