DEAR MAYO CLINIC: I have bad shoulder pain and have been told that I need a shoulder replacement. I have heard shoulder replacement is painful and may fail over time. Are there any new advances at Mayo Clinic that I can benefit from?

ANSWER: Shoulder replacement is a whole new operation compared to what medicine could offer in the past. Advances include contemporary replacement implants, individualized planning and execution, and comfortable recovery.

Shoulder replacement is one of the most successful orthopedic surgical procedures today, and it is commonly performed. In fact, 258 of every 100,000 people living in the U.S. have a replaced shoulder.

Shoulder replacement can be performed with anatomic or reverse implants. Prostheses implanted for anatomic replacement have the same shape as the bones of the human shoulder. In reverse replacement, the geometry of the joint is reversed. The round prosthesis is implanted on the socket side, and the bone in the arm, or humerus, receives a prosthesis with a dishlike plastic liner.

A reverse replacement is generally favored for shoulders with a torn rotator cuff or advanced bone loss, but many other factors need to be considered for implant selection. Mayo Clinic surgeons have gained significant insight to understand when it is better for you to undergo anatomic or a reverse shoulder arthroplasty, a procedure to restore the function of a joint by switching the natural position of the shoulder ball and socket.

Also, not all implants available for replacement are the same. Certain manufacturers have perfected prosthesis design to use high-quality materials for different types of procedures. So, it is important to discuss the details of the shoulder replacement procedure with your surgeon and learn about the pros and cons of different styles and prosthetic materials to ensure the best outcome to fit your needs.

A major advance in the field is the use of individualized planning and execution for shoulder replacement. Mayo Clinic surgeons use cutting-edge software to upload your CT scan in a program that allows your surgery to be planned virtually. Preoperative planning software ensures that you get the implants that best fit your shoulder, and in the position that provides the best motion and muscle function for you. In addition, the plan can be perfectly executed in the operating room with the use of plastic or metal guides specifically manufactured for each patient using 3D printing technology. Some Mayo Clinic surgeons also are using holographic mixed reality visualization to perform surgeries, and robotic shoulder replacement is around the corner.

In the past, shoulder surgery could be a somewhat painful procedure. That is not the case anymore. Most people who undergo shoulder replacement at Mayo Clinic can go home the same day of surgery thanks to advances in outpatient procedures.

Intimate collaboration between surgeons and anesthesiologists allows for a comfortable experience. Prior to surgery, local anesthetics are injected around the nerves to block any feeling from the shoulder to the brain. These nerve blocks can stay in place through a catheter for two days. By then, pain can be controlled without resorting to narcotics. Also, Mayo Clinic provides dedicated, individualized physical therapy sessions for all patients prior to surgery.

When you leave the hospital, you and your family will know exactly what to do to optimize your recovery. If you live far away and returning for follow-up appointments is inconvenient, telemedicine appointments enable you to receive personalized, high-quality care in the comfort of your home right from your smartphone.

The availability of anatomic and reverse prostheses; personalized tools to plan and perform your surgery, including robotic surgery soon; and the use of cutting-edge implants allows many patients to return to the practice of sports and other activities they wish to do.

Mayo Clinic is geared to cure disease, connect with patients and transform health care. Shoulder replacement at Mayo Clinic is a prime example of these goals. Your pain will be gone, you will return to a high level of function, and the procedure will be relatively comfortable while performed with sophisticated techniques and tools. After surgery, Mayo Clinic health care providers can see you in Rochester or in the comfort of your home.

Although no one wants surgery, if you need a shoulder replacement, Mayo Clinic can offer you a good pathway to a successful recovery. — Dr. Joaquin Sanchez-Sotelo, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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