How Dr Brumby-Rendell performs shoulder replacement

1. 3D planning from a CT scanA CT scan of your shoulder is used to build a 3D model. The size, angle and position of the implant are planned on it before the day of surgery.
2. Mini incisionThe operation is performed through a minimally invasive approach with an incision of about 5 cm, which aims to limit disruption to the surrounding muscle.
3. Robotic assistance for reverse replacementsFor reverse replacements, the Mako robotic arm helps prepare the shoulder socket to the 3D plan. Your surgeon performs the operation.
4. Bone-preserving implantsDr Brumby-Rendell uses a bone-preserving mini reverse replacement, a stemless anatomic implant and a pyrocarbon humeral head, chosen to suit your shoulder.
5. X-ray before you leave theatreAn X-ray is taken at the end of the operation to check the position of the implant.

Which type of shoulder replacement?

The most important question is whether your rotator cuff tendons are working. About three in four primary total shoulder replacements in Australia are now reverse replacements.¹

• Reverse shoulder replacement – the ball and socket swap places, so the deltoid muscle lifts the arm. Used for arthritis with a damaged rotator cuff, large tears that can’t be repaired, many fractures and revision surgery, and sometimes for arthritis with a healthy cuff. Read more about reverse shoulder replacement.
• Stemless anatomic replacement – recreates the normal ball and socket. Used for osteoarthritis when the rotator cuff is healthy.
• Pyrocarbon hemiarthroplasty – replaces only the ball and keeps your own socket. An option for some younger, active people with a healthy rotator cuff.
• Replacement after a fracture – for some complex fractures of the top of the arm bone, a reverse replacement with a stem designed for fractures. See proximal humerus fractures.

See which shoulder replacement is right for me? for a fuller comparison.

Who might need a shoulder replacement?

Shoulder replacement is usually considered when pain, particularly at night, and loss of movement limit daily life, and non-surgical treatment such as physiotherapy, injections and medication has stopped helping. Common reasons include:

• Osteoarthritis of the shoulder
• Rotator cuff arthropathy – arthritis that follows a long-standing rotator cuff tear
• Rheumatoid and other inflammatory arthritis
• Avascular necrosis, where loss of blood supply causes the ball of the shoulder to collapse
• Complex fractures of the top of the arm bone, particularly in older people

You can use the shoulder pain self-assessment before your consultation.

In hospital

Shoulder replacement is performed at Eastwood Private Hospital under a general anaesthetic, combined with an ultrasound-guided nerve block by an experienced regional anaesthetist for pain relief after surgery.

• Day of surgery – rest on the ward.
• Morning after surgery – a physiotherapist sees you to start your exercises.
• Day two – most patients go home once they can manage comfortably in the sling.

Recovery

• Before surgery – exercises before the operation (prehab) are encouraged, and you’ll be given a skin preparation pack to use beforehand.
• Wound – a waterproof dressing stays on. The skin stitch is removed by the practice nurse at 10 to 14 days.
• Sling – usually worn for 2 to 4 weeks.
• Driving – usually avoided for several weeks. See driving after surgery.
• Heavy lifting – usually from 8 to 12 weeks or more.
• Follow-up – a review with the nurse practitioner at 2 weeks, an X-ray and review with Dr Brumby-Rendell at 6 weeks, and a review with an X-ray at 12 months.

Rehabilitation after an anatomic or pyrocarbon replacement is a little slower than after a reverse replacement, and each has its own rehab plan. See rehabilitation plans and post-surgery care.

Costs and cover

A referral from your GP or another specialist is needed to claim a Medicare rebate for your consultation. For surgery, Medicare and your private health fund cover part of the surgical fees, and there is usually an out-of-pocket gap.

Once your operation is booked, you’ll receive a financial consent document setting out the fees and your out-of-pocket costs. See quality and fees.

Risks

All surgery carries risks, including infection, dislocation, fracture, loosening of the implant, stiffness and nerve injury. Dr Brumby-Rendell will go through these with you in detail at your consultation, including how they apply to your shoulder.

Frequently asked questions

Do I need a referral?

Yes. A referral from your GP or another specialist is needed to claim a Medicare rebate for a specialist consultation. Once you have one, you can book online or call (08) 7077 0101.

How long will I be in hospital?

Most patients stay two days. A physiotherapist sees you on the morning after your operation to start your exercises.

Is shoulder replacement done robotically?

Reverse shoulder replacements can be performed with Mako robotic assistance at Eastwood Private Hospital. Anatomic and pyrocarbon replacements are still planned in 3D, but don’t currently use the robotic arm.

Which type of shoulder replacement will I need?

It depends mainly on whether your rotator cuff is working, the shape of your socket, your age and your goals. Dr Brumby-Rendell will go through this with you after examining your shoulder and reviewing your scans.

When can I drive after a shoulder replacement?

Driving is usually avoided for several weeks. Dr Brumby-Rendell will advise you when it is safe to start again at your follow-up.

What will it cost?

Medicare and your private health fund cover part of the fees, and there is usually an out-of-pocket gap. You’ll receive a financial consent document with the fees once your operation is booked.