SHOULDER REPLACEMENT
Total Shoulder Replacement is an operation used for people with arthritis of the shoulder. It is a highly technical operation which is best performed by a surgeon with expertise in this form of shoulder replacement.
In the normal shoulder, the rotator cuff muscles help balance the ball of the arm bone (humeral head) in the socket against the upward pull of the deltoid muscle. In the normal shoulder, the humeral head and glenoid are covered in a soft and very smooth surface (articular cartilage) that allows gliding movement in the shoulder. In arthritis, the articular cartilage is worn and thinned leading to the underlying bones rubbing together. This results in pain and stiffness in the joint. It can lead to the patient feeling a clicking in their shoulder. If the pain becomes severe and is impacting on the patients ability live their everyday life then shoulder replacement is an option to manage the pain.
A total shoulder replacement device mimics the normal anatomy of the shoulder: a plastic "cup" is fitted into the shoulder socket (glenoid), and a metal "ball" is attached to the top of the upper arm bone (humerus). It is an effective operation in treating arthritic pain in patients with a functional rotator cuff. A total shoulder joint requires a normal rotator cuff repair to enable good movement of the shoulder replacement. If the rotator cuff has a tear or is damaged then a reverse shoulder replacement provides an alternative option to treat the pain and improve function.
CANDIDATES FOR SURGERY
Total total shoulder replacement may be recommended if you have:
• Arthritis with a normal rotator cuff tear
• A previous fracture of the shoulder with ongoing pain
SURGERY
Total shoulder replacement is a highly technical procedure. Total shoulder replacement is usually a very successful operation and most patients are very happy with the result. As with any operation, there are risks associated with undergoing surgery. The risks of having any operation such as bleeding, nerve damage, clots in your legs or lungs, heart attacks or a reaction to the anaesthetic could occur but are usually very uncommon occurring in less than 1%. There is a risk with shoulder replacement that the shoulder could dislocate or come out of joint after surgery. There is a risk that infection could occur either in the wound or deep in the joint. With dislocation or deep joint infection, you are likely to require further surgery to address the issue. The rate of either of these complications is around 1%. Over time the shoulder replacement can loosen from the bone and may need revision surgery. Revision surgery may also be required if the polyethylene joint wears away with time due to the use of the replacement.
PREPARATION FOR SURGERY
Individuals should optimize their health so that they will be in the best possible condition for this procedure. Smoking should be stopped a month before surgery and not resumed for at least three months afterwards. Any heart, lung, kidney, bladder, tooth or gum problems should be managed before surgery. Any infection may be a reason to delay the operation. The area of the skin incision must be clean and free from sores and scratches. Individuals should also recognize that reverse shoulder replacement cannot restore normal function to the severely damaged shoulder.
The individual needs to plan on carefully protecting the arm for six weeks after the procedure. Driving shopping and performing usual work or chores may be difficult after surgery. Plans for necessary assistance need to be made before surgery. For individuals who live alone or those without readily available help arrangements for home help should be made well in advance.
RECOVERY
After surgery, you will have several doses of antibiotics to prevent infection, and pain medication to keep you comfortable. Most patients have a nerve block to help with pain management. Most patients are able to eat solid food and get out of bed the day of surgery. You will most likely be able to go home on the second or third day after surgery.
The shoulder will be protected in a sling for six weeks after surgery. During this time you will be able to temporarily remove the sling for meals, showering, exercises and small amounts of writing or computer work. The wound needs to be kept dry until it is healed and the dressing removed at the clinic appointment two weeks after surgery.
LONG-TERM OUTCOMES
After rehabilitation, you will most likely be able to lift your arm to just above shoulder height and bend your elbow to reach the top of your head or into a cupboard. Some people have difficulties getting their arm behind their back after surgery. Total shoulder replacement provides excellent pain relief and patient satisfaction is typically very high.