Information that patients want and need to know about shoulder joint replacement arthroplasty for arthritis

In addition to the answers to frequently asked questions below, please also see

Arthritis of the shoulder- what patients need to know about the symptoms, diagnosis and treatment of shoulder arthritis

Patients frequently use internet search engines (such as Google (www.google.com) and Bing (www.bing.com) to seek information on shoulder arthritis and shoulder joint replacement. However, internet searches do not yield information; instead they yield links to sites with content that may related to the search terms. It is up to the patient to select which sites to visit and to synthesize the information found. This is a daunting task: a search "how long does it take to recover from shoulder joint replacement" yielded 13,700,000 results with an admixture of commercial, lawyer, journals, academic, private practice, orthopaedic societies and government websites - each with its own biases. Synthesizing a meaningful consensus is overwhelming.

A better option for patients is ChatGPT, a interactive language model developed by OpenAI, that uses a deep learning framework to understand queries and to generate coherent, contextually relevant responses based on a set of books, websites, and texts selected by unbiased researchers at OpenAI.  ChatGPT is currently available free of charge, generating friendly responses to queries posed by patients anytime day or night. It is, of course, critical to remember that while ChatGPT responses present syntheses of information from its comprehensive sources, they cannot be used as specific medical advice and may not be applicable to an individual patient. Patients should consult medical professionals for the most current and accurate information on their specific conditions.

A recent article, Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum found that Chatbot responses were rated of significantly higher quality than physician responses, with 3.6 times higher prevalence of good or very good quality responses for the chatbot. Chatbot responses were also rated significantly more empathetic than physician responses with 9.8 times higher prevalence of empathetic or very empathetic responses for the chatbot.

We used ChatGPT, to generate responses to the most commonly asked questions regarding shoulder arthroplasty as identified in What patients want to know about shoulder arthroplasty: a Google search analysis and Internet search analytics for shoulder arthroplasty: what questions are patients asking? It is of interest that patients are asking similar questions about rotator cuff repair: What Are Patients Asking and Reading Online? An Analysis of Online Patient Searches for Rotator Cuff Repair

Click on each of the frequently asked questions (FAQ) below to see the ChatGPT response

Are there alternatives to shoulder surgery for arthritis?

How can I avoid shoulder surgery?

Can you wait too long for shoulder replacement surgery?

What is the average age for a shoulder replacement?

How long does a shoulder replacement last?

What is the success rate of shoulder replacement surgery?

Where is the incision for shoulder replacement?

How painful is total shoulder replacement?

Why is shoulder surgery so painful?

Which is worse knee or shoulder replacement?

Can you ice too much after shoulder surgery?

Can you lay flat after shoulder replacement surgery?

Why do you have to sleep in a recliner after shoulder surgery?

How long should you sleep in a recliner after shoulder surgery?

What happens if you don't wear your sling after shoulder replacement surgery?

Can you wear a bra after shoulder joint replacement surgery?

How do you go to the bathroom after shoulder replacement surgery?

What is the fastest way to recover from shoulder replacement surgery?

How long is physical therapy after shoulder joint replacement?

How long does it take to recover from a shoulder joint replacement?

How long should you take off work after shoulder replacement surgery?

What are the possible limitations after total shoulder joint replacement surgery?

What can you not do after total shoulder joint replacement surgery?

Can you play sports after shoulder replacement?

Can I have an MRI after shoulder replacement?

These responses by ChatGPT are reasonable and include the caveat that patients cannot use them as advice about their personal situation, but rather they should consult with their orthopaedic surgeon for guidance on the evaluation and management of their shoulder.

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link)

What patients should know about shoulder joint replacement arthroplasty - FAQs

Patients with shoulder arthritis want to and should be knowledgeable about their condition and how it might be managed.

Here are two videos that are helpful in understanding this condition

    Shoulder arthritis (see this link).

    What does shoulder arthritis look like on x-ray (see this link).

Here are four videos about the types of shoulder joint replacement that can be used to manage shoulder arthritis

    The total shoulder arthroplasty (see this link).

    The ream and run arthroplasty (see this link.

    The cuff tear arthropathy arthroplasty (see this link).

    The reverse total shoulder arthroplasty (see this link).

A recent article identified questions asked by patients with arthritis:

What Patients Want to Know about Shoulder Arthroplasty: A Google Search Analysis

These authors analyzed Google search queries to determine the most frequently asked topics and questions related to shoulder arthroplasty.

The most popular question topics concerned the timeline of recovery, ability to perform specific activities, technical details of surgery, and activity restrictions.  Frequently asked questions had to do with the fastest means of recovery, duration of physical therapy, sling use, time spent sleeping upright in a recliner, time off work, location of surgical incision, resumption of sports, and the ability to use the bathroom. 

So how might theses questions be answered? Below are our best general answers to these frequently asked questions, recognizing that the specific answers for each patient will vary for each patient depending on their specific problem, procedure, and surgeon. Patients should discuss these and other questions with their surgeon when considering shoulder joint replacement. The details and  post operative course for a reverse total shoulder (see this link) are often different from that after an anatomic total shoulder (see this link)  or ream and run procedure (see this link).

I. Activities

    A. Can you play sports after shoulder replacement?  

    *Many sports, such as golf, tennis, swimming, hiking, and rowing are well tolerated in most cases. For patients having total shoulder arthroplasty, we advise against heavy impact (wood chopping, boxing) and heavy load (bench press with heavy weights). These restrictions may not apply to patients having the ream and run procedure.

    B. How do you go to the bathroom after shoulder surgery?

    *Often the ability of the arm having surgery to reach behind for wiping is limited for 6 weeks or so. Alternatives are wiping with the other hand or reaching from the front. Practicing this before surgery is a good idea.

    

II. Timeline of Recovery

    A. How long does it take to recover from a shoulder

replacement?

    *For most anatomic shoulder joint replacements (anatomic total shoulder, ream and run), the focus for the first six weeks is on flexibility. Gentle strengthening exercises are started at 6 weeks and progressed slowly to allow the muscles the opportunity for a safe recovery. Shoulders continue to recover over the first year or so after surgery.

 

    B. How long should you take off work after shoulder surgery?

    *The answer to this question depends a lot on the type of work. We encourage return to office work at six weeks. Driving is discouraged until six weeks after surgery. Work requiring lifting, pulling and pushing is not resumed until the shoulder is comfortable and strong. The duration of this recovery may range from months to a year or more, depending on the type of replacement and the rehabilitation effort.

    C. How long should you sleep in a recliner after shoulder surgery?

    *Some patients do indeed find that it is more comfortable to sleep in a recliner, while others are able to sleep comfortably in their bed. Patients starting out in a recliner can transition to a bed when it is comfortable for them.

    D. How long is physical therapy (PT) after shoulder replacement?

    *Formal PT is an option after shoulder replacement. In our practice, an experienced therapist teaches the basic exercises to the patient prior to discharge from the hospital. In many cases, the patient does their own rehabilitation as long as it is progressing well (see sample rehabilitation programs in this link and this link. In other cases the surgeon or the patient may prefer "hands on" PT for a month or so after surgery.

    E. What is the fastest way to recover from shoulder surgery?

    *We have found that the fastest way to recover is to divide rehabilitation into two phases: the first 6 weeks being dedicated to flexibility followed by a progressive strengthening and activity program. Avoiding injury to the repaired tendons is very important as stressed in this link. 

III. Restrictions

    A. What are the limitations after shoulder replacement? What can you not do after shoulder surgery?

    *The first six weeks are the most critical. During this time the goal is developing an excellent range of motion while protecting the tendon repairs. Patients need to take every precaution to avoid falling, rotation out to the side, and lifting the arm by itself during this period. We discourage driving for the first six weeks. After the first six weeks these restrictions are lifted progressively as the shoulder gets stronger. For anatomic total shoulders and reverse total shoulders, patients are encouraged to avoid heavy lifting and activities involving impact. 

    B. Can you wear a bra after shoulder surgery?

    *Wearing a bra is usually well tolerated after a few weeks when the incision is healed. However, fastening the bra behind can be an issue, especially for the first month or so after surgery. Front fastening bras may be more convenient.

    C. Why do you have to sleep in a recliner after shoulder surgery?

    *We do not require patients to sleep in a recliner after shoulder replacement. Some patients do indeed find that it is more comfortable to sleep in a recliner, while others are able to sleep comfortably in their bed. Patients starting out in a recliner can transition to a bed when it is comfortable for them.

    D. Can you lay flat after shoulder surgery?

    *Laying flat is no problem as long as it is comfortable. 

    E. Can I take my sling off to sleep?

    *A sling can be used to keep the arm from getting into positions that may challenge the healing of the tendons. If the patient is a quiet sleeper, a sling may not be necessary. It is important to avoid rotating the arm further outward that the hand shake position. Excessive and early external rotation can jeopardize the healing of the subscapularis tendon.

IV. Technical Details

    A. Can I have an MRI after shoulder replacement?

    *An MRI of the shoulder after a shoulder joint replacement can be difficult to interpret because of the artifact from the metal. MRIs of other parts of the body are not generally a problem, but it is important to notify the MRI technologist of the presence of a joint replacement.

    B. Where is the incision for shoulder replacement?

    *The typical incision for shoulder replacement is on the front of the shoulder along a line from the middle of the collar bone to the middle of the arm.

V. Indications/Management

    A, How can I avoid shoulder surgery?

    *Shoulder joint replacement surgery is an elective procedure. It should only be undertaken if shoulder  arthritis is interfering substantially with the patient's quality of life and if the patient clearly understands the risks of surgery and the alternatives. A full discussion, including the non-operative management of shoulder arthritis can be found in this link. 

    B. Can you wait too long for shoulder replacement surgery?

    *Arthritic wear of the shoulder can be progressive. If patients elect non-operative management, we monitor their x-rays on an annual basis to make sure the wear does not advance to a state where joint replacement would be difficult.

    C. Are there alternatives to shoulder surgery?

    *Alternatives to joint replacement surgery are discussed at this link.

    D. What is the average age for a shoulder replacement?

    *Shoulder joint replacement can be considered for treating arthritis in individuals of any age. An average age is about 65 years.

    E. What happens if you don't wear your sling after shoulder

    *The sling is used to protect the healing of tendons after the surgery. It also signals to folks around the patient that the shoulder is healing. Not wearing the sling may increase the risk of tendon injury or non healing.

    F. Can you ice too much after shoulder surgery?

    *Too much ice can burn the skin over the shoulder.

VI. Risks and Complications

    A. Why is shoulder surgery so painful? How painful is total shoulder replacement?

    *Done properly, shoulder joint replacement is usually not more painful than other major procedures. Experienced surgeons are becoming better at setting exceptions regarding post operative pain and in implementing a program for minimizing postoperative pain. Many of our patients only require Tylenol or other light analgesics after shoulder replacement.

VII. Longevity

    A. How long does a titanium shoulder replacement last?

    *A rough estimate is that after 10 years, one out of ten shoulder replacements may require a revision procedure. Causes of failure can include poor surgical technique, failure of the rotator cuff, failure of the subscapularis, loosening of the glenoid component, stiffness and instability.

VIII. Evaluation of Surgery

    A. What is the success rate of shoulder replacement surgery?

    *For osteoarthritis, over 90% of patients having shoulder joint replacement surgery by an experienced surgeon are satisfied with the outcome.

    B. Which is worse knee or shoulder replacement?

    *On average, patients having shoulder joint replacement appear to have less pain than those having knee replacement.

Follow on twitter: https://twitter.com/shoulderarth

Follow on facebook: https://www.facebook.com/frederick.matsen

Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/

How you can support research in shoulder surgery Click on this link.

Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

Shoulder arthritis - x-ray appearance (see this link)

The smooth and move for irreparable cuff tears (see this link)

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

Shoulder rehabilitation exercises (see this link).

This is a non-commercial site, the purpose of which is education, consistent with "Fair Use" as defined in Title 17 of the U.S. Code.          

Note that author has no financial relationships with any orthopaedic companies.

Shoulder joint replacement for arthritis - when is the right time to have surgery? FAQ

We received this message on FaceBook today:

"Thank you for your blog,and the information you post here on Facebook.

I am 52 and can't play catch or shoot a basketball with my 14 year old son. I have to support my arm with my other arm in order to lift it over my head, or grab something from the back of the refrigerator.

I have bone on bone Arthritis, 1/2 inch bone spurs, and loose debris in my shoulder.

That being said, my Dr. has recommended Ream and Run for me. I like that it is not restrictive.

My fear is that although I can't through a ball or lift my arm over my head, I am still able to work good down low. I just baled and stacked 56'000 pounds of hay this week by hand. I need to be able to work and work hard.

I am worried about the what ifs... The information you have provided is great, and I am getting more jazzed about the surgery. But not totally sure yet if it is right thing to do.

If I wait to do the surgery, is there a chance of damaging my shoulder to the point, that I may not have the option to do ream and run?

Thanks again for your time,

K."

The answer is that there is never a perfect time to have an elective surgery, such as a shoulder joint replacement for arthritis. The surgery and recovery from it will interfere with work and activities of daily living for a substantial period of time. The time necessary for recovery will be determined by the severity of the arthritis, the excellence of the surgery, the commitment of the patient to the rehabilitation effort, and the activities the patient desires to resume after the surgery. See this post.

The other factor is that arthritis is a progressive process - it can lead to progressive bone loss that makes the surgery and recovery from it more difficult. See for example this post on the Bad Arthritic Triad. It is easy to see that once put in motion, the process of posterior glenoid destruction is likely to continue.

So what advice can be offered to K, who can work but can't play with his son and who needs to be able to 'work and work hard'. 

The most important thing is to assure that the shoulder and the patient are assessed by someone experienced with the ream and run. This assessment needs to include the condition of the shoulder by standardized x-rays as well as the needs of the patient with respect to work and the ability to take time off to dedicate to post surgical rehabilitation. If it is not clear that 'now' is the time for surgery,  we will often re-evaluate the shoulder at 6 month intervals to determine the rate of progression of the arthritis. During this period of monitoring we will suggest gentle range of motion exercises to preserve the flexibility of the joint along with activity modifications that might lessen the impact of the arthritis.

The choice to proceed with surgery needs to be one shared between the surgeon and the patient.  And, as we say, "the decision is often more difficult than the incision" . 

Be sure to click on this link to the Shoulder Arthritis Book.

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