Stiff and painful shoulders may have damaged joint surfaces. This damage to the joint surface may have been acquired from injury or disease. Loss of a smooth cartilage surface can occur from osteoarthritis, rheumatoid arthritis, avascular necrosis or post-traumatic (injury) arthritis or occasionally other less common causes. Surgery is not always necessary. Glucosamine supplements can help. Medications can sometimes help and steroid or PRP (platelet rich plasma) injections into the joint can give relief as well. In some cases, therapy can help too but if the arthritis is already very severe then therapy is not often very helpful.
If treatment without surgery fails, most patients can be effectively treated with partial or total shoulder replacement. Occasionally if the arthritis is not so severe, arthroscopic treatment to remove debris and smooth the joint surfaces may provide some relief in young patients. Anatomic shoulder replacement (arthroplasty) means replacing the bearing surfaces (joint surfaces) with an artificial metal ball and, when necessary and appropriate, a plastic socket. These surgical procedures usually restore comfortable motion to the shoulder.
In some less common circumstances when the rotator cuff is badly torn or in some cases of severe fractures, “reverse” shoulder replacement is done. That means that a ball is attached to the socket and a socket to where the ball would normally be on top of the humerus. Reverse shoulder replacement changes the natural anatomy but can help compensate for chronic large cuff tears that are not repairable.
The most dependable benefit of shoulder joint replacement is pain relief. Motion and strength are often greatly improved, but never truly normal. Joint replacement can be done for adults of any age, if your medical condition is satisfactory. Good motivation and general health is more important than age in determining who is a good candidate for this procedure.
Preparation for surgery:
The preparation for surgery begins with your primary physician by making sure you are healthy as possible by physical examination and lab testing as needed based on your health problems. Your body must be free of all infection (for example in your skin, teeth, or urine), and your general health at its best. You should also make arrangements for assistance at home after your shoulder replacement.
Surgical Procedure:
Shoulder replacement is often possible as an out-patient procedure. . The operation is undertaken after you have been given a light general anesthetic and a nerve block to numb your shoulder and arm completely. The nerve block is generally an interscalene block done by injecting local anesthetic between you neck and shoulder that can provide excellent relief for up to 2-3 days. The operation takes approximately two hours. You can expect to be in the recovery room for one hour after surgery.
Risks:
Specific risks of shoulder replacement include bone fracture, tendon injury, joint dislocation, improper placement, and loosening or wear of the artificial parts. These can result in pain, weakness and need for further surgery.
General risks rarely associated with shoulder replacement are infection, bleeding, numbness, weakness, and loss of movement. Heart, lung, and kidney failure occur even more rarely in susceptible patients. Although these risks are frightening, fortunately, it is very unusual for anything to happen. However, it is our responsibility to inform you of all possibilities. We will work with you to minimize the risk of complications and attempt to correct any problems if they occur.
After Surgery:
Before surgery we will instruct you how to perform your motion exercises and provide you with illustrations of the rehabilitation program.
Often if you are in good health, you may be able to go home the same day after surgery since you will likely still be very comfortable from the nerve block. If you stay overnight in the hospital, you will be released from the hospital when you are medically stable- most often the next morning. Within days after surgery you may use your hand in front of you for light activities such as reading and eating.
For the first six weeks, you must avoid forceful rotation of your arm toward your body. You may be out of your sling for light activity in front of your body within a few days from surgery. Otherwise, we encourage both assisted and unassisted motion as instructed by our therapist.
If you have outpatient surgery you will usually have a follow up office appointment with us within a few days. For all shoulder replacement patients, there will be an approximately two weeks after surgery to check your shoulder motion and to check your wound. Depending on how things are going, we may start an outpatient physical therapy program then. There should be no driving for at least one month post-op depending on your progress. Approximately six weeks after surgery, we begin more exercises. You must maintain a daily home exercise program for about 6 months after surgery. Outpatient physical therapy usually lasts about 2-3 months after surgery.
We will see you in the office frequently as you recover from surgery. We will also arrange a follow-up visit at one year after the operation. You should return anytime if you develop pain or irregular motion, such as clunking. If you begin having shoulder pain along with a fever or redness about the shoulder, call or come to our office or to the Emergency Department if the office is closed. Remember, the best possible results occur only with close cooperation between you and your treatment team. Your own personal dedication to post-operative rehabilitation after shoulder replacement is critical to your recovery.
Sports such as swimming, golf, tennis, and bowling should not be started until you have your surgeon’s approval. Falls, repetitive heavy loads, sudden loads and contact sports could loosen or wear your replacement parts and should be avoided.
It is important for you to remember you have an artificial joint, which needs to be protected. If you have medical conditions that cause you to get infections easily such as diabetes, you should discuss this with your dentist and consider preventative anti-biotics before dental procedures.
Please contact my office if you have questions about this information. It is very important that you understand clearly both the risks and the clear benefits of this procedure.