Shoulder Replacement

Why is a shoulder replacement done?

Patients with joint dysfunction may opt for shoulder replacement surgery. There can also be avascular necrosis or rheumatoid arthritis, or (rarely) for those who have suffered a severe fracture. In general, physical therapy and medications are considered after all other treatment options.

The following symptoms may indicate that you need shoulder replacement surgery:

• Daily activities such as washing, dressing, and reaching into a cabinet are challenging because of shoulder pain.
• There is a loss of motion in the shoulder.
• You are having weakness in the shoulder.
• Your pain is so bad that you find it difficult to sleep.
• There have been no results from anti-inflammatory drugs, cortisone injections, or physical therapy.
• In the past, you have undergone arthroscopic surgery, rotator cuff or fracture repair that did not relieve your symptoms.

What are the types of shoulder replacements?

If you need a shoulder replacement, your surgeon will discuss what type you need with you. The following options are available:

Hemiarthroplasty:

The ball and stem are the only components replaced in this procedure. It articulates with the natural socket of your hip and is connected to the ball.

Resurfacing Hemiarthroplasty:

A cap-like prosthesis is used to replace the joint surface of the humeral head.

Anatomic Total Shoulder Replacement:

A highly polished metal ball is attached to a stem on the humerous side, as well as a plastic cup on the glenoid socket, to replace the bad joint.

Stemless Total Shoulder Arthroplasty:

A stemless arthroplasty is one that preserves bone by attaching the metal ball directly to the arm.

Reverse Total Shoulder Replacement:

The concept of a reverse total shoulder replacement is the same as a total shoulder arthroplasty in that the ball and socket are reversed with a plastic cup attached to the stem and moved upward to the arm bone (humerus).

Shoulder replacement surgery: what are the preparations?

In preparation for surgery, your orthopaedic surgeon will ask that you complete a physical examination, including checking for chronic medical conditions with your primary care physician; treatment for any skin infections or irritations; and blood donations. If necessary, it may include medication review and management, dental evaluation, urinary evaluation, and various tests, including blood and urine samples, electrocardiograms (EKGs), and chest X-rays.

You will have difficulty reaching high shelves and cupboards for weeks after surgery, so make sure to come through your home and place any items you will need afterward on lower, easier-to-reach shelves. You will need some help in the first few weeks after you return home from the surgery center with daily activities such as cooking, shopping and bathing. You can make advance arrangements for assistance at home through your orthopedic surgeon, your social worker, or the discharge planner at the surgery center. When you are recovering, you may wish to stay in an extended care facility until you are more independent.

What happens during the surgery process?

For your surgical procedure, wear loose clothing and a button-front shirt. The surgical procedure will result in you wearing a sling and having limited arm function. An anesthesia specialist will evaluate you once you are admitted to the surgery center. Generally, patients undergo general or regional anesthesia (they are put to sleep), or a combination of both (they are awake but numb around their surgical site). Based on your input, the anesthesia team will determine the best option for you. Before surgery, your surgeon will inspect your shoulder and sign the area where the surgery will take place. It takes about two hours to perform the surgery itself. The environment will be noisy and crowded since so many people are working. The operating table will then be brought to you and you will be made comfortable. The surgical site will be shielded and protected with sterile surgical drapes. As your anesthesiologist monitors your condition during surgery, he or she will remain at your side.

As soon as you wake up from anesthesia, you will be taken to a recovery room for monitoring. The surgery center will take you to your room as soon as you are awake. It is likely that you will spend a few days in the surgery center. The pain you feel after surgery will be controlled by the medications your surgeon and nurse will provide for your comfort. In order to get your strength back faster, pain management is essential to your recovery. Less pain allows you to move more easily. Contact your surgeon if you experience post-surgical pain.

Recovery

Your arm will be in a sling when you leave the surgery center. Your shoulder will have to be supported and protected for two to four weeks following shoulder replacement.

In order for your shoulder replacement to be successful, you must follow a well-planned rehabilitation program. Soon after an operation, gentle physical therapy begins. You will receive a home exercise program designed to improve the strength and flexibility of your shoulder from your surgeon or physical therapist.

In several weeks, stitches or staples will be removed from the wound. Under the skin, there is no need to remove a suture. The wound should not be immersed in water until it has completely dried and sealed. You may continue bandaging the wound until the skin is no longer sensitive to clothing or support stockings.

Exercising is an essential component of home care, particularly during the first few weeks after surgery. Your surgeon or physical therapist can provide you with a home exercise plan to help you regain your strength.

Typically, patients are able to resume basic daily activities after two weeks, such as eating, dressing, and grooming themselves. For several weeks or longer, some pain or discomfort is common during activity and at night. Typically, returning to driving after surgery takes two to four weeks.

During your exercise program, you should perform: a graduated walking program to increase your mobility gradually, initially indoors and later outdoors; resuming daily household activities, such as sitting and standing; and exercises for restoring mobility and strengthening your shoulder. It may be necessary for you to see a physical therapist in the first few weeks following surgery at home or at a therapy center.

Complications

Shoulder joint replacement surgery carries a number of risks and complications, including those related to the surgery itself and those that are likely to arise over time. Your orthopedist will discuss these with you during your consultation. The majority of complications can be successfully treated.

• An infection, minor or severe, can occur in the wound or around the prosthesis, whether it occurs during surgery or afterward. It is important to contact your doctor as soon as you suspect an infection in your body might spread to your joint replacement.
• Problems with the prosthesis–Despite improvements in both materials and surgical techniques, there is always the possibility of loosening and dislocating your prosthesis in time. If you suffer excessive wear, loosening, or dislocation you may need additional surgery (revision surgery).
• During joint replacement surgery, nerves may become damaged in the vicinity of the joint. In the long run, these injuries often heal completely.