Shoulder Replacement Surgery Cost and Procedure Guide

Goals of the surgery

Shoulder replacement surgery aims to repair the ball (known as the ‘humerus’ or ‘humeral head’) and socket (the ‘glenoid’) of the shoulder joint. This is achieved by replacing the ball and socket with an artificial joint (a ‘prosthesis’), typically made of metal and plastic.

There are two types of shoulder replacement surgery: total shoulder replacement surgery and reverse total shoulder replacement surgery.

In total shoulder replacement surgery, the ball and socket at the top of the arm are removed and replaced with an artificial joint called a prosthesis. This is usually a metal ball against a plastic socket.

In reverse shoulder replacement surgery, as the name implies, the ball at the top of the arm is actually replaced with a socket. The socket of the shoulder is then replaced with a ball component. Depending on the patient’s injury, reverse shoulder replacement surgery may be more suitable. This type of shoulder replacement surgery is normally used only for patients over the age of 70 years and where some or all of the muscles around the shoulder are weak or torn. The surgery team will discuss with the patient whether it may be the preferable choice.

The surgery team will discuss the options for prostheses with the patient ahead of any decision to undergo surgery. Options depend on the patient’s quality and quantity of bone and the strength of the muscle around the shoulder joint.

Most shoulder replacements last longer than ten years, and patients can expect long-lasting improvements in pain reduction, strength, range of movement and ability to complete everyday tasks.

Cost of shoulder replacement surgery

The price of shoulder replacement with a private orthopaedic surgeon begins at around £10,000 and can cost as much as £14,000. Prices can change depending on pre-existing health conditions, the surgeon's expertise, the type of prosthesis used and at which highly rated CQC hospital the procedure takes place.

After the consultation with the surgeon, patients will be given a tailored price for their surgery.

Ideal candidates for shoulder replacement surgery

Typically, patients requiring shoulder replacement surgery are people aged 70 years or older, often with arthritis. Over 7,000 shoulder replacement surgeries are performed in the UK per year. Very few shoulder replacement surgeries are essential, and some patients may be able to manage their symptoms with painkillers and occasional steroid injections. Their muscle functioning can sometimes be improved with physiotherapy exercises.

The surgery team will discuss the risks and benefits of the surgery with the patient and advise whether shoulder replacement surgery is right for them.

Shoulder replacement surgery procedure

On the day of the surgery, the surgeon and anaesthetist will complete a final check that the patient is ready for surgery and answer any questions that the patient may have. The patient will then sign a form giving consent to the operation.

The consultant and assistants carry out the surgery and may include other members of the surgical shoulder and elbow team, including a Clinical Nurse Specialist. The general nursing staff will look after the patient on the ward.

The procedure is normally carried out under general anaesthetic, meaning the patient is asleep throughout the operation. In addition, the patient will receive an injection of a local anaesthetic around the nerves that connect to the arm (called an ‘interscalene block’). This is to provide pain relief from the operation.

When the patient wakes up from the general anaesthetic, the shoulder and upper arm will likely be numb. The surgery team may discuss other options for pain relief with the patient.

After the surgery, the patient will be discharged from the hospital approximately three days after the surgery, though it's not uncommon for this to be after just one night. The surgery team will check several things with the patient before discharge is possible, including that the patient can move around safely, that they have adequate social support, the pain is managed with effective pain relief, and that the post-operative x-ray is satisfactory.

What will happen at an initial shoulder replacement repair consultation?

The surgeon will discuss the patient’s symptoms and examine their shoulder during the consultation. The surgeon may ask the patient to perform some exercises to help pinpoint the symptoms. The surgeon will also discuss what treatments patients have tried before and if they have had any scans or tests. Patients are encouraged to bring any test or scan results with them to the appointment.

Before the operation, the patient will be asked to attend a pre-assessment anaesthetic and medical screening. In some cases, a second pre-assessment appointment may be necessary if further discussion with the anaesthetist is required.

Certain patients may also see an occupational therapist in person or virtually (online or via a phone call). This would be to discuss any functional concerns and how best to manage daily life after surgery.

Preparing for shoulder replacement surgery

It is important that the surgery team know about all the medicines the patient takes. This includes over-the-counter medicines such as ibuprofen or aspirin. If the patient is taking the contraceptive pill or hormone replacement therapy (HRT or tamoxifen), the surgery team may discuss the patient stopping these medications six weeks before surgery.

If the patient takes medication to treat an inflammatory form of arthritis, such as disease-modifying antirheumatic drugs (DMARDs) or a type of biologic called TNF inhibitors, the surgery team, in consultation with a rheumatologist may discuss whether it is necessary to alter the dose prior to surgery.

Any nail varnish, decorations or false nails on the hands or feet should be removed prior to the operation. This is to reduce the risk of infection in the operating theatre.

The surgery team will also need to know about any recent changes in the patient’s health, for example, fever.

General Health

• Stop smoking
  • Smoking is shown to slow the healing of soft tissue and bones

Prepare the home

• The patient will need to restrict movement in their operated arm by wearing a sling for at least six weeks following surgery.
• The patient may want to stock up on groceries ahead of surgery
• The patient’s mobility will be affected, especially during the first few weeks. Having everything needed, such as crockery, in easy-to-reach places will help
• The patient may want to move any unnecessary appointments (such as hairdressers).

It is important to make sure that the patient has someone to pick them up from the hospital, as they will not be able to drive for several weeks after the surgery.

Planning childcare, pet care and time off work will allow patients to have a smooth recovery period and know that everything is being taken care of while they recover.

Shoulder replacement surgery aftercare and recovery

After the operation, the patient is transferred to the recovery room. Here, the nursing team closely monitor the patient while the general anaesthetic wears off.

There may be some pain and discomfort around the area that was operated on. The nursing staff may be able to provide some medication, such as painkillers, to help with this. If the patient received a nerve block anaesthetic, their arm may feel numb and heavy. This normally resolves in approximately 24 hours.

The shoulder may also be initially bruised, tender and swollen. If there is dressing on the wound, the patient should check with the nursing team that it is ok to shower – it may be necessary to avoid getting the dressing wet.

The patient will be required to wear a sling for approximately 16 weeks after the operation. This limits shoulder movement and reduces the risk of dislocation or infection.

In some cases, the patient may also have the following:

• Small drainage tubes coming from the wound
• A Patient Controlled Analgesia Device
• Oxygen mask
• A drip to replace any lost fluids.

These will be removed as soon as possible following surgery.

The nursing team will encourage the patient to start moving as soon as possible and can provide support if needed. This will reduce the risk of any post-operative complications.

Physiotherapy

After the procedure, a physiotherapist will discuss exercises and post-operative restrictions with the patient. Some patients may benefit from referral to an outpatient physiotherapist and may be able to choose where this takes place.

The physiotherapist will show the patient-specific exercises. It is important that the patient follows the physiotherapist’s advice and does not start exercising before having a discussion with the physiotherapist.

Exercises may include neck movements, shoulder shrugs, forearm rotations and moving the wrists and fingers.

Week 0 to week six after surgery

For the first six weeks, there may be limitations to the patient’s movement. The surgery team will recommend that the patient wears their arm in a sling and follow the physiotherapist’s advice and exercises. This will help the shoulder to heal correctly.

The physiotherapist may also recommend that the patient avoids various day-to-day activities that use the operated arm, if possible, such as bearing weight or placing the operated arm behind the back.

Week 6 to week 16 after surgery

From week 6 to week 16 after surgery, the patient will have fewer restrictions than the first 6 weeks post-surgery. The patient will still need to continue with physiotherapy and continue with their exercises. However, they may be advised that they can start to wear their arm out of the sling in some circumstances and slowly return to light, functional activities. It is essential that they continue to follow their physiotherapist's guidance.

Week 16+ after surgery

From week 16 onwards, the patient may be able to start to return to their pre-surgery arm movements, with care and consideration around engaging in activities above shoulder height or heavy tasks.

Returning to work

The patient will be off work for approximately six weeks, depending on their job. The surgery team will be able to discuss this with the patient in further detail.

Driving

The patient will need to arrange transport to and from the hospital pre-and post-surgery.

The patient will not be able to drive until they are no longer using their sling, any pain has subsided, and they feel confident in their ability to control their vehicle in the event of an emergency situation. This could be 10 weeks or more, and they should always check with their insurance provider before starting to drive again.

Playing sports and other leisure activities.

Being able to return to sports and other leisure activities depends on the amount of pain that the patient is experiencing, range of movement and strength. Non-contact activities such as gentle jogging or swimming, light gym work or light gardening may be resumed from 3 months onwards. This will vary from person to person, and we suggest that the patient discusses this with the physiotherapist and surgery team to work out what suits each person’s individual needs best.

Sleeping

The patient should avoid lying on their operated arm initially.

Possible Risks & complications of shoulder replacement surgery

It's important to note all operations carry risk. The surgery team, normally the anaesthetist, will discuss the anaesthetic options and associated risks before the patient chooses to proceed with surgery. The risks of general anaesthetic vary depending on the patient’s general health.

There are other surgical risks the surgery team will discuss with the patient. These include

• Infection: The surgery team take all possible precautions to minimise the risk of infection during the procedure. The patient’s skin is thoroughly cleaned with a disinfectant, and all clinical staff wear masks, sterile gowns and gloves throughout the procedure. If a skin infection occurs after the operation, it will be treated promptly with antibiotics.
• Bleeding: There may be some blood loss during the surgery. In some cases, the patient may need a blood transfusion.
• Nerve/blood vessel damage around the shoulder: The risk of nerve or blood vessel damage around the shoulder is less than 1%. If this occurs, the surgery team will carefully investigate how it occurred and what can be done to restore function.
• Dislocation: After the surgery, there is a small chance that the shoulder could dislocate where the prosthetic ball comes out of the socket. If this occurs, a doctor will be able to correct the orientation of the prosthetic ball. However, in some cases, further surgery may be required. The surgery team take precautions to minimise this risk by providing the patient with movement restrictions after the initial surgery. The patient will also be required to keep their arm in a sling for a short period following the operation. The surgery team will provide detailed guidance on how to do this safely.
• Stiffness: Stiffness is common after shoulder replacement surgery and is treated through a physiotherapy exercise programme.
• Fracture of surrounding bone: If a fracture of surrounding bone occurs during the operation, the surgery team will either treat it immediately during the surgical procedure, manage it after surgery with a brace, or in rare instances, schedule a second surgery.
• Loosening of prosthesis: The prosthetic shoulder replacement may become loose over time, and normal daily use and further surgery may be required to correct this.
• Deep vein thrombosis: Deep vein thrombosis (also referred to as ’DVT’) is a blood clot in the deep veins of the thigh or calf. The patient may be required to wear stockings or a special inflatable pad to wear around the legs while in bed to minimise the risk of DVT developing. The inflatable pads provide pressure at regular intervals, increasing blood circulation in the legs and reducing the risk of DVT occurring. Some patients may also be required to take blood-thinning medications, such as aspirin – however, this will vary from patient to patient, and the surgeon will advise whether this will be necessary. In extremely rare circumstances where a patient develops DVT, a part of the blot clot can break away and travel to the lungs – this is called a ‘pulmonary embolus’. This is potentially life-threatening, and so everything is done to prevent a DVT from developing.
• Sickness, nausea, heart problems, breathing problems and nervous system problems: These symptoms may be related to the anaesthetic. The nursing team will be on hand to support the patient should any of these develop.

All of the information found on our website is sourced from highly reputable experts and government-approved authorities and is widely used by healthcare professionals.

West Suffolk. NHS Foundation Trust. Patient Information. Shoulder Replacement Surgery. Available at: https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/TraumaandOrthopaedics/5055-7Shoulderreplacements.pdf Last accessed: 22 Nov 2022.

The Royal Orthopaedic Hospital. NHS Foundation Trust. Reverse Total Shoulder Replacement. Available at: https://www.roh.nhs.uk/patient-information/shoulders/1073-reverse-shoulder-replacement/file Last accessed: 22 Nov 2022.

The Royal Orthopaedic Hospital. NHS Foundation Trust. Patient Guide For Total Shoulder Replacement. Available at: https://www.roh.nhs.uk/patient-information/shoulders/35-217-total-shoulder-replacementv2/file Last accessed: 22 Nov 2022.

Oxford University Hospitals. NHS Foundation Trust. Reverse Total Shoulder Replacement. Information for patients. Available at: https://www.ouh.nhs.uk/patient-guide/leaflets/files/54167Pshoulder.pdf Last accessed: 22 Nov 2022.

National Institute for Health and Care Research. Most shoulder replacements last longer than a decade: patients can be reassured by new research. Available at: https://evidence.nihr.ac.uk/alert/most-shoulder-replacements-last-longer-than-a-decade-research-reassures-patients/ Last accessed: 22 Nov 2022.

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Before publishing, all the information is reviewed by a surgeon specialising in the relevant field.