Shoulder Replacement

Shoulder Replacement Surgery

Shoulder replacement is a surgical procedure in which a complete or some part of the glenohumeral joint (shoulder joint) is replaced by a prosthetic implant. This surgery is also known as shoulder arthroplasty. The shoulder is an example of a ball and socket joint. The upper arm has a round head (ball) that fits into a shallow cavity in the shoulder. A ball and socket joint helps in moving the arm up and down, back and forth or in rotation. Damage or infection in the shoulder joint leads to pain, stiffness and weakness. Prosthetic implants are available in different shapes and sizes to facilitate replacement. 

Indications for shoulder replacement 

Shoulder replacement is done to relieve pain due to damage to the shoulder joint. 

The most common indications for shoulder replacement include-

• Osteoarthritis- Also known as wear and tear arthritis. It damages the cartilage located at the end of the bones.  

• Irreparable rotator cuff tears- The rotator cuff consists of muscles that surround the shoulder joint. Injuries in rotator cuffs damage cartilage and bone in the joint. 

• Proximal humerus fractures- Fractures of the upper or proximal end of the humerus can require the need for replacement due to an injury or failure of fracture fixation as a result of surgery. 

• Inflammatory diseases and rheumatoid arthritis- These conditions are caused by irregularities in the immune system. Inflammation due to rheumatoid arthritis deteriorates the cartilage and the bone in the shoulder joint. 

• Osteonecrosis- In this condition, osteoclasts or bone cells die due to a lack of blood supply. 

Types of shoulder replacement

There are several types of shoulder replacement surgeries, depending on the patient's condition and the extent of damage to the shoulder joint. The main types are:

• Total Shoulder Replacement (TSA): In this surgery, both the ball (humeral head) and the socket (glenoid) of the shoulder joint are replaced with artificial components. This is the most common type of shoulder replacement and is typically used for patients with arthritis or other conditions that affect both parts of the joint.
• Reverse Shoulder Replacement: In a reverse shoulder replacement, the ball and socket are switched. The ball is attached to the shoulder blade (scapula), and the socket is placed on the upper arm bone (humerus). This type of surgery is often used in patients who have severe arthritis along with a torn rotator cuff, a condition that prevents a standard shoulder replacement from being effective.
• Partial Shoulder Replacement (Hemiarthroplasty): This procedure involves replacing only one part of the shoulder joint. Typically, only the ball (humeral head) is replaced, while the socket remains intact. Partial replacement is often recommended for patients with arthritis or fractures that affect the ball but not the socket.
• Stemless Shoulder Replacement: This is a newer technique that uses a smaller, stemless implant for the ball of the shoulder joint. It’s an option for both total and partial replacements, and it helps preserve more of the patient’s natural bone. 

Risk factors of shoulder replacement

It may happen that shoulder replacement may not decrease the pain or vanish completely in some cases. The surgery may not restore the full movement or strength of the shoulder joint. Therefore, the patient has to go with other surgical processes. 

Risks of the shoulder replacement procedure include, 

• Dislocation- Chances are there that the replaced ball might come out of the socket. 

• Implant detachment- Though shoulder replacement implants are durable, they might detach due to loosening over time. In some cases, the patient may require another surgery to change the loose components. 

• Fracture- During or after the surgery, there are chances of humerus, scapula and glenoid fractures. 

• Rotator cuff failure- The shoulder surrounding muscles or rotator cuff can damage after a partial or total shoulder replacement. 

• Blood clots- After the surgery, clots can occur in the leg or arm veins. Clots are dangerous because if they break, a piece can travel anywhere in the body like in the brain, heart or lungs. 

• Nerve damage- Nerves at the site of an implant can damage during the process. This can cause weakness, numbness and pain. 

• Infection- Infections can occur in the deep muscles or at the site of the incision. Sometimes, surgeries are required to treat them. 

Preparing for Surgery

Preparing for shoulder replacement surgery is essential for a successful outcome. Here’s a guide to help you get ready for the procedure:

• Consult with Your Surgeon:
  • Meet with your surgeon to discuss the details of your surgery. Understand the type of shoulder replacement you will be having (total, reverse, partial, or stemless).
  • Ask about the expected recovery process, possible risks, and what you should expect before, during, and after the surgery.
• Pre-Surgical Assessments:
  • You may need to undergo physical exams, blood tests, or imaging studies (like X-rays or MRIs) to assess the condition of your shoulder and overall health.
  • Discuss your medical history, any medications you're taking, and any allergies with your healthcare provider.
• Stop Smoking:
  • Smoking can hinder the healing process, so it's advised to stop smoking at least a few weeks before surgery and after the procedure.
• Medications:
  • The doctor will give instructions on which medications to stop or continue taking before surgery. For instance, blood thinners or anti-inflammatory drugs may need to be paused for a few days to reduce the risk of bleeding.
  • Take any prescribed antibiotics or pain medications as directed by your healthcare provider.
• Prepare Your Home:
  • Make your home safe and accessible for when you return after surgery. Consider placing frequently used items within easy reach, clearing clutter, and ensuring there are no tripping hazards.
  • Arrange for someone to assist you with daily activities, especially during the first few weeks post-surgery.
• Follow Fasting Instructions:
  • The surgeon will advise you not to eat or drink anything for a certain period before the surgery, typically 8-12 hours, especially if you're receiving general anesthesia.
• Physical Therapy:
  • Before surgery, your doctor may suggest pre-surgical physical therapy to strengthen the muscles around your shoulder, which can help speed up recovery.
  • You may also receive post-surgery physical therapy exercises to regain shoulder movement and strength.

Shoulder replacement procedure

At CARE Hospitals, we follow the given procedure for shoulder replacement.

• Before the surgery- A series of post-operative tests are scheduled before the surgery. These include blood tests, and electrocardiograms to evaluate the patient's heart electrical activity to make sure he is ready for the procedure. Further, patients are given instructions regarding the continuation or discontinuation of certain medicines.
• During the procedure- The patient is given general anaesthesia and a nerve blocker intravenously to keep him relaxed during the process. General anaesthesia puts the patient in deep sleep. On the contrary, nerve blockers numb the shoulder so he can control pain in his conscious state. The surgery can last for one to two hours.
• After the procedure- The patient rests in a recovery room for a short time after surgery. X-rays are taken out to check for any other complications. The patient should not move his shoulder until and unless he is told to do so. It should be kept stable. Further, postoperative hospital stay depends on the patients' requirements. Usually, most people can go home on the same day.
• Shoulder replacement outcomes- Most people experience less pain after the surgery. Some of them might not have pain. This surgery improves the strength and the range of motion of the shoulder joint.

Recovery

Recovering from shoulder replacement surgery is a gradual process that involves rest, rehabilitation, and careful attention to your body’s healing. Here's  what to expect during your recovery:

• Rest and Pain Management: Immediately after surgery, you'll need to rest and wear a sling. Pain medication will help manage discomfort, and ice can reduce swelling.
• Physical Therapy: Start gentle exercises early on to improve movement and prevent stiffness. Your doctor or therapist will guide you through this.
• Gradual Activity: Over the next few weeks, you can gradually begin using your arm for light activities like eating or dressing. Avoid heavy lifting or intense movements.
• Ongoing Strengthening: By 3-6 months, continue strengthening exercises to regain full shoulder strength and mobility.
• Follow-Up Care: Attend follow-up appointments to track healing and adjust treatment if needed. It’s important to stay active with your therapy exercises to ensure the best recovery.

Do's and Don'ts

The success of your shoulder replacement surgery largely depends on how well you follow your orthopaedic surgeon's instructions during the recovery period. Here are some important do's and don'ts once you're back home:

• Do's:
  • Do stick to the prescribed home exercise routine, performing the exercises 2-3 times a day for several weeks, as recommended by your surgeon.
  • Do seek help if needed. If you lack home support, your physician might suggest a facility or agency to assist with your recovery.
• Don'ts:
  • Don't use your arm to push yourself up from a bed or chair, as this can strain your muscles.
  • Don't position your arm in extreme ways, such as extending it to the side or behind your body, during the first 6 weeks after surgery.
  • Don't overexert yourself! After experiencing pain-free motion, it can be tempting to do more than recommended, but overusing your shoulder too soon can limit your recovery.
  • Don't lift anything heavier than a glass of water for the first 2-6 weeks after surgery.
  • Don't engage in contact sports or repetitive heavy lifting following your shoulder replacement.

How can CARE Hospitals Help?

We at CARE Hospitals provide the treatment for joint-related problems including shoulder replacement. The surgery is performed under our best surgeons who use minimally invasive procedures for fast recovery. Our medical staff assist patients during the entire period of their treatment. We aim to provide the best medical facilities to our patients in order to improve their health.