Shoulder replacement surgery offers relief from severe pain and improves function for individuals with significant shoulder joint damage. While it can dramatically enhance quality of life, not everyone is an appropriate candidate for this intricate procedure.
General Medical Conditions
A patient’s overall health plays a significant role in determining suitability for shoulder replacement, as certain systemic medical conditions can increase surgical risks or hinder recovery. Uncontrolled diabetes, for instance, poses a heightened risk of infection and can impair wound healing, potentially compromising the surgical outcome.
Severe cardiovascular diseases, such as advanced heart disease, can lead to complications during surgery due to the stresses of anesthesia and the procedure itself. Similarly, significant pulmonary conditions like chronic obstructive pulmonary disease (COPD) increase the likelihood of respiratory complications, including pneumonia and septic shock, during and after the operation.
Active widespread infections anywhere in the body are a contraindication, as the bacteria could spread to the surgical site and infect the new prosthetic joint. Severe kidney or liver disease can also complicate anesthesia management, drug metabolism, and the body’s ability to heal effectively. Furthermore, certain neurological conditions that severely impair muscle function or a patient’s ability to participate in rehabilitation, such as Charcot’s arthropathy or severe neurological pathologies affecting the shoulder, may make shoulder replacement unsuitable.
Specific Shoulder Conditions
Beyond general health, specific issues within the shoulder joint itself can make a patient an unsuitable candidate for replacement surgery. Severe bone loss or poor bone quality, for example, can prevent the secure fixation of the prosthetic components. Conditions like severe osteoporosis significantly increase the risk of periprosthetic fractures and prosthetic joint infections after shoulder arthroplasty.
Irreparable or severely damaged rotator cuff muscles are another consideration, especially for standard total shoulder replacements. The rotator cuff muscles are essential for the proper function and stability of the implant, and if they cannot be repaired, the outcome of a standard replacement may be poor. While reverse total shoulder arthroplasty can be an option for some patients with irreparable rotator cuff tears, it has its own specific indications and potential complications.
Active infection within the shoulder joint itself is an absolute contraindication, as implanting a prosthesis into an infected environment would almost certainly lead to a serious and difficult-to-treat prosthetic joint infection. Significant nerve damage around the shoulder, particularly to nerves that control the primary muscles responsible for arm movement, can also preclude surgery. If the arm would remain non-functional even after a successful joint replacement due to nerve issues, the surgery may not provide a meaningful benefit.
Patient Lifestyle and Adherence
A patient’s lifestyle and their commitment to the recovery process are significant factors in candidacy for shoulder replacement. Active smoking, for instance, impairs blood flow and the body’s healing capabilities, substantially increasing the risk of wound complications, infection, and implant failure. Quitting smoking, even a few weeks before surgery, can improve outcomes.
Severe obesity can also increase surgical risks, including anesthesia complications, longer operative times, and a higher incidence of infection and reoperation. While some studies suggest that functional outcomes for obese patients undergoing certain shoulder replacements can be similar to those with a normal weight, the increased risk of complications remains a concern.
Substance abuse can interfere with a patient’s ability to comply with medical instructions and participate in the rigorous post-operative physical therapy regimen. The success of shoulder replacement relies heavily on dedicated rehabilitation to regain strength and range of motion. Patients who are unwilling or unable to commit to this necessary physical therapy and adhere to activity restrictions may experience suboptimal outcomes. Unrealistic expectations about surgical outcome can also lead to patient dissatisfaction, even when the surgery is technically successful.