Shoulder Replacement: Indications & Procedure

Shoulder replacement surgery is a procedure used to help patients with pain, or reduced mobility in their shoulder joint. Annually 53,000 Americans undergo shoulder replacement surgery. The shoulder joint is a ball and socket type of joint and formed by the humerus, scapula, and clavicle. The humerus is bone present in your upper arm, the scapula is the bone that forms your shoulder blades and the clavicle is popularly known as the collar bone. The head of the humerus forms the ‘ball’ and the ‘socket’ is formed by the surface of scapula called the glenoid cavity. This joint is stabilized by a set of ligaments and muscles.

Procedure of Shoulder replacement

Shoulder replacement surgeries are of multiple types:

• Total shoulder replacement: the shoulder joint is replaced with a metal ball attached to a stem, in place of the head of humerus, and a plastic socket, in place of the glenoid cavity.
• Stemmed hemiarthroplasty: a metal ball attached with a stem is implanted into the humerus. The glenoid cavity is left the way it is.
• Resurfacing hemiarthroplasty: similar to stemmed hemiarthroplasty wherein the glenoid cavity is left unchanged. For this process only a metal ball is used to replace the head of the humerus, the ball in not attached to a stem.
• Reverse shoulder replacement: an innovative technique in with the position of the ‘ball’ and ‘socket’ are reversed. A socket is introduced in the humerus in place of its head and a ball is introduced in the place of the glenoid cavity.

On reaching the hospital you will be admitted and prepped for the surgery. This surgery is performed under the effects of anaesthesia, either general or regional. The choice of anaesthesia will be decided by your doctor and you before the surgery during a visit to prepare for the surgery. After the effects of anaesthesia set in, your surgeon will make an incision on your skin and proceed to dissect carefully to reach the joint. The surgeon will then replace your bone with the implants. The skin is then closed with the help of staplers on the skin or sutures under the skin. If your skin has been closed with the help of staplers you will have to get them removed after your skin has healed.

Indications for shoulder replacement

Shoulder replacement surgery is the suggested for patients who haven’t experienced an improvement in their shoulder pain and disability after medical and physical therapy. Conditions which lead to such situations are:

• Reactive arthritis
• Osteoarthritis
• Rotator cuff tear leading to arthritis
• Avascular necrosis
• Severe fracture.

Preparation for shoulder replacement

Your healthcare provider will like to have a complete history of your illness followed by a through physical examination. Depending on the findings, tests like x ray and CT scan of your joint will be ordered to assess the extent of disease in the joint more accurately. After reviewing the results from the test ordered your doctor would like to discuss the options that you have for the shoulder replacement surgery. Alternative treatment modalities in the form of physical rehabilitation and medications will also be discussed.  Once you and your doctor have decided to go for the surgery, your doctor would like to review the list of medications that you’ve been taking. You will be requested to stop taking the blood thinning medications and the non steroidal anti inflammatory drugs like aspirin before the surgery.

After the surgery you will not be able to lift your arm to an overhead position, hence it is advisable to make suitable changes in your home to ensure that you are comfortable at home after the surgery. Changes like, shifting the essential daily routine objects from overhead storage to a lower surface will be helpful following the surgery.

Complications of shoulder replacement

Shoulder replacement surgery has a few complications associated with it which occur with a low frequency:

• Infection which may be superficial, at the site of the sutures or stapler; or deep infections, in the bone. The infection may occur immediately after the surgery or may be even years later.
• Dislocation of prosthesis
• Wear and tear of prosthesis
• Nerve injury: nerve surrounding the joint may get injured during the surgery leading to numbness and reduced movement in the muscles the nerve supplies. These injuries generally improve with time.

Recovery from shoulder replacement

Following the surgery you will be monitored as the effect of anaesthesia wear off. You will be allowed to return home a day or two after the surgery. It is advisable to arrange for someone to drive you home as you won’t be allowed to drive for a few weeks after the surgery. During your stay at the hospital you will be given antibiotics to reduce the risk of infections at the site of surgery. Feeling pain after the surgery is normal, you will be prescribed painkillers in the form of NSAIDs and opioids to manage your pain. Talk to your doctor if the pain doesn’t improve a few days after the surgery. Physical rehabilitation is one of the most important parts of recovery. It is extremely important that you diligently perform the exercises recommended by your doctor 2 to 3 times a day for more than a month to ensure that you regain proper mobility in the replaced joint. After being discharged from the hospital your doctor will give you some instructions for wound care. You will be advised to keep the wound clean and dry at all times. Wearing a sling for support for the first two to four weeks after the surgery helps in the healing process. Most of the individuals are able to perform normal daily activity like grooming and eating on their own, two weeks after the surgery. You will be advised to avoid lifting anything heavier than a glass of water for the first two weeks after the surgery. Driving a car is permissible about four weeks after the surgery. It is strongly advisable to not overstrain your arm for the first six weeks after the surgery; try not to lift your arm overhead or behind your body until the joint has fully recovered.

Sources

• AAOS guidelines