The People's Perspective on Medicine

How Risky Is Shoulder Replacement Surgery?

Shoulder replacement surgery is becoming far more common, but it carries more risk than most patients appreciate.
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Shoulder replacement surgery is becoming increasingly common. Now, researchers writing in The BMJ say that patients should be warned that the risks of this procedure are higher than doctors originally thought.

Risks of Shoulder Replacement Surgery:

The investigators reviewed hospital records relevant to 58,000 operations in the UK (Craig et al, The BMJ, Feb. 20, 2019). The records spanned the time frame between 1998 and 2017. During that time, the number of surgeries to replace arthritic shoulder joints increased more than five-fold.

Need for More Shoulder Surgery:

What the investigators found is sobering. One in four men between 50 and 59 will need further surgery on that shoulder within five years. That is a surprisingly high rate of repeat surgery.

Complications of Shoulder Replacement Surgery:

Like any surgery, shoulder replacement surgery carries risks of complications. The risk of a complication such as a blood clot or infection was 1 in 28 during the first post-surgical month.  In the first three months, the risk of problems including heart attacks was 4.6 percent. Women between 50 and 65 years old were 61 times more likely to develop a pulmonary embolism during the 30 days following surgery than women who’d had no surgery.

Complications in Older Patients:

In addition, people over 85 may be more likely to have severe arthritic damage to the joints, including shoulder joints. However, older people who underwent this kind of surgical procedure experienced high rates of serious complications. One in nine older women had an infection, major blood clot, heart attack or stroke or died within three months. The rate for older men was even more alarming, at one in five. The authors of the study encourage their colleagues to counsel patients about the risks as well as the benefits of this kind of surgery.

In their words: 

“Patients need to be informed of these levels and carefully counselled about the potential risks of serious adverse events. The alarmingly high rates of adverse events in elderly patients with comorbidities suggests that better approaches to patient selection, preparation, and postoperative care might be required.”

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    I had shoulder replacement surgery last October. I agree one must look at the side effects and risks of doing this procedure. However, my pain was so intense that I could not really function as I needed to do on a daily basis. NSAIDs were not strong enough to control the pain.
    Since I had surgery, I have NO shoulder pain, and I have almost complete ROM for my arm. I am a pleased patient.

    I had my right shoulder replaced about 15 years ago. I’m currently 68 years old. Since I had avascular necrosis (bone death) caused by a fracture of my humerus, I had no choice but to get the replacement. The surgery was a “hemi”, i.e. they replaced the ball, not the socket. Anytime I do any stressful activity, such as weight lifting or landscaping, the shoulder aches. About 4 years ago, the pain became terrible. I had to take a lot of pain killers just to wash or comb my hair. They aspirated the shoulder, but found no infection. Then, after 3-4 weeks, the pain mysteriously went away. Don’t know what caused the pain or why it went away.

    Do the concerns discussed in this article apply to the same degree to other joint replacements, such as hip or knee?

    [yikes…who knew…read excerpt 1/2 way down:
    ‘the stress of *ANY/ALL* surgery’ ]

    Surgery, The Ultimate Placebo: A Surgeon Cuts Through the Evidence
    by Ian Harris (Author)

    Here’s the blurb:

    ‘For many complaints and conditions, the benefits from surgery are lower, and the risks higher, than you or your surgeon think.
    In this book you will see how commonly performed operations can be found to be useless or even harmful when properly evaluated.

    That these claims come from an experienced, practising orthopaedic surgeon who performs many of these operations himself makes the unsettling argument particularly compelling…’

    It’s not just replacement. I had arthroscopic shoulder surgery almost 7 years ago. Not only did it not help, it made things worse, turning an intermittent problem into a continual one limiting my activities. I had a second surgery 5 years later to ‘fix’ it, which it did not. My advice is don’t do any shoulder surgery unless absolutely necessary, and then think twice.

    I had reverse shoulder replacement surgery 20 months ago. Afterwards the doctor told my husband that he hadn’t seen so many spurs in a long time. I did not have any pain – headache, etc. – for the first 18 months. I am now 77 years old. I took as much rehab as I could since my husband has back problems. I can lift my arm straight up in the air. My other arm is also affected, but I will not have it operated upon as I can use my good arm for whatever I need to do. However, I would have the operation again if I did not have the one good arm as I do not currently have constant pain in the other arm. The doctor told me right away that he was not God and he couldn’t give me a new arm, but he could help make this one feel better. He did.

    This article is sobering. I am glad that I have declined shoulder surgery and am instead working to improve muscles (tendons are shot). Physical therapy at Duke’s Sports Medicine Center for Living helped me a lot. It is the only place I have been where physical therapy was truly effective.

    * Be nice, and don't over share. View comment policy^