Has anyone had their shoulder replaced and/or resurfaced or an elbow replacement? If so, I'd like to hear from you. It seems shoulders aren't as long lasting as hips (about 10 years) and I was told by my surgeon yesterday there's a much higher infection risk - 30% as opposed to 1% for THR's!

X-rays revealed I have no cartilege left in my shoulder joints and only a small amount in my elbows. Radial head excision was mentioned last year but now he's seen my x-rays it will have to be full elbow replacements. Crikey, get all that done, plus my hips and neck, I could audition for the tin man at Christmas!

Hi Franky,

Last year, when talking about radial head excision, the same surgeon told me infection risk was high as there's not a lot of flesh covering an elbow, the metal work is only just underneath the skin, unlike a THR, and the slightest knock could open up the wound etc. I assume the same applies to shoulders? Then there's the lack of blood flow (immune system) over a prosthesis, to help zap any nasties.

I emailed NRAS as I couldn't find anything on shoulder replacements and they referred me to an ARC booklet and another website, neither of which say much about infection risk.

How long have you had shoulder problems? I've had mine for over 20 years and I have to say the pain was worse than a hip initially, but isn't as bad now which could be because I'm no longer working and not using it as much. I've lost quite a bit of movement, especially in the right, which he pointed out was tendon damage.

If the infection risk was minimal and they could guarantee improvement in range of movement, I'd have it all done tomorrow.

Hi Carol,

You must be feeling a lot stronger after all the THR problems to be contemplating more surgery! I am glad to hear it, though very sorry your shoulders and elbows are so bad.

My surgeons always say surgery is last resort, but on the other hand its best to operate when there is enough healthy bone to attach replacements to!

I had my shoulders replaced 25 years ago, a very long time and I believe the technique has come a long way since then. Neither op was straightforward due to my osteoporosis, but I still have the right shoulder joint in. The left had to be removed because of bone quality problems but I manage without a joint on that side, muscles compensate if you work hard on physio. I had no infection in either replacement.

My elbows were treated to radial head excision and rearrangement of ulnar nerve (20 years ago) and I was on the waiting list for replacements, but was told the movement would be more limited though pain relieved. I couldnt afford to lose more movement for just remaining independent for feeding, washing etc, so have stayed as I am for now. The elbow ops helped a lot. I have heard of infections with elbow replacements more than shoulders and think you are right, there is little around it to protect the elbow joint from friction. Shoulders are more protected.

I hadn't realised that in a bad flare the replacement joints get very flared too, or mine do anyway.

I realise that my surgery was a long time ago, but though I still have very aggressive RA, I am pleased with the results.

I do wish you luck with your decisions and do ask the surgeons loads of questions if you decide to go ahead. As always, the physio after surgery is crucial.

Take care and keep as well as possible,
Lizxx

Hi Liz,

I'm having my left hip replaced first, within the next 11 weeks and will allow another year to get over that and build up my leg muscles and walking.

I agree, surgery is a last resort and for 10 years I didn't really listen to my shoulder surgeon as I was too scared to think about surgery. However, 12 ops later, you do get used to it and I'm no longer frightened about surgery, just the infection risk.

I note you've had RA for approx. the same length of time as me so its interesting to hear what surgery someone else has had. As I mentioned above, my right shoulder started seizing up over 20 years ago and the slightest movement (I was typing all day) was excrutiatingly painful but I had to carry on to do my work.

How do you manage with no shoulder joint? Are you able to drive? I've read somewhere that a shoulder surgeon probably only does 10 replacements a year, suggesting the technology is a way behind hips and knees? I don't think I will rush into it just yet.

Take care

Hi Carol
you really are going through it at the moment
I hope things get better for you
I have not had any joints replased so I am sorry I cant help with that
take care will be thinking about you
Mary L

Thanks Mary & Sophie. It's not something I'm going to rush into, not until I'm at least one year post new THR. If I do go ahead, I'd only have one joint done at a time, to limit the infection risk.

Hello Carol,

I had a total elbow replacement a year ago. As I'm on Humira I had to stop it for 2 weeks before the op and for 2 weeks after. The surgeon gave me massive dose of antibiotics and it went well and infection free.

I am not able to straighten the arm but I couldn't before, I can now twist the arm whereas before I couldn't. So I have gained some, lost some. It apparently can still improve for another year according to the surgeon who I saw last week. He seemed pleased with the xrays which really do look strange.....it's a metal and plastic hinge!!!

Physiotherapists were useless as they had never seen anyone with a new elbow before, so it was just letting the arm do what it would and not forcing it straight.

I suspect that I will have to have the other elbow done at some stage, but will wait until it's a lot worse than at the moment.

Regards
Sandy

Hi Sandy,

I'm pleased your op went well and was infection free. I too think some physios are useless and tend to focus on one area, when with RA, its usually the whole body that needs it. Do you have a "floppy" hinge? I agree, only have surgery as a last resort, when the pain is too much.

Hi Carol,

I have had both a right shoulder and right elbow replacement (as well as R ankle and L knee). My shoulder was replaced 12 and a half years ago,- 7 and half years after my RA diagnosis (I have aggressive RA), and my elbow was done 8 and a half yrs ago. Although the range of movement I have is very limited, I have no pain at all from the shoulder and just some minor stiffness pain in the elbow- both joints are still doing as well as when they were first put in. I have had no infection problems after any of my ops, however I do not class either of these replacements as successful as my lower limb replacements, in terms of function. Apparently the elbow is considered one of the trickiest joints to operate on and I did have a minor-ish complication with that op as my medial epicondyle (sp?) fractured and chipped off during the op which meant I had to have plastercast on for several weeks after the op and perhaps as a consequence of this I never did regain the ability to straighten my arm. Mind you, it was stuck bent before the surgery anyway. I did not have any choice but to have the ops as the joints were basically destroyed by the time I had surgery and I am glad I did. The replacements will obviously be better now than they were when I had mine..I know the shoulder I have has a long stem (which also may have complicated the elbow surgery) and now they are much smaller and stemless I think. My elbow also has stem which again I think has improved to a stemless version now?
I would try to select an NHS surgeon who specialises only in the joint to be operated on...some claim to be experts in several joints but I feel that a surgeon who only does one joint has deeper knowledge and enhanced competence in that surgery.

Hope I haven't waffled on too much about myself...hard to know how much info to give or not. Good luck with your decision...feel free to ask any questions if you feel I can help.

Diane x

Thanks Diane. Are you able to drive? I'm finding with bent elbows, my arms are shorter and I have to bring the steering wheel forwards. I'd hate to go through surgery and then not be able to drive.

My surgeon does specialise in shoulders and elbows and doesn't do hips and knees, although he did a couple of my hip debridements last year. I probably ought to ask him how many shoulder and elbow replacements he's done.