When arthritis has damaged or destroyed the shoulder joint, it may be replaced with a metal ball and plastic socket. Although there are many different types of should replacements, the concept remains that the damaged surfaces of the bone are replaced. The surgical procedure is generally considered more difficult and complex and the rehabilitation program is prolonged. However, with a well done procedure, a motivated patient can return to such activities as golf, swimming and tennis with little difficulty.
Why is it done?
Total should replacement is most frequently considered with patients who have either osteoarthritis or rheumatoid arthritis. A physician should use all reasonable non-surgical alternatives of management before contemplating a joint replacement.
Trials of activity modification, gentle physical therapy to maintain muscle tone, anti-inflammatory medication and occasional pain medication may be sufficient enough to make symptoms tolerable. If, however, pain and disability cannot be managed with a non-operative program, total shoulder replacement can provide remarkable relief of pain and allow much improvement in activity.
What happens before surgery?
In addition to a complete medical history, the surgeon may perform a complete physical examination, including x-rays, to ensure that the patient is in good health before undergoing surgery. In addition, the patient may also meet with a physical therapist to discuss rehabilitation after the surgery and undergo blood tests (or any other ordered test).
How is the shoulder totally replaced?
In shoulder replacement surgery, surgeons replace the ends of the damaged upper arm bone (humerus) and usually the shoulder bone (scapula) or cap them with artificial surfaces lined with plastic or metal and plastic. Shoulder joint components may be held in place with cement, or they may be made with material that allows new bone to grow into the joint component over time to hold it in place without cement.
The top end of the upper arm bone is shaped like a ball. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone. Surgeons usually replace the top of the upper arm bone with a long metal piece, inserted into your upper arm bone that has a rounded head. If the cup-shaped surface of the shoulder bone that cradles the upper arm bone is also damaged, surgeons smooth it and then cap it with a plastic or metal and plastic piece.
Orthopedic surgeons often use general anesthesia for joint replacement surgeries, which means the patient will be unconscious during surgery. However, sometimes they will use regional anesthesia, which means the patient can't feel the area of the surgery and they are sleepy, but awake. The choice of anesthesia depends on the surgeon, anesthesiologist, the patient's overall health and, to some degree, the patient's preference.
When the patient wakes up from surgery, there will be a bandage on the shoulder and probably a drain to collect fluid, keeping it from building up around the joint. A compression pump (SCDs), which squeezes the patient's legs to keep the blood circulating, preventing blood clots, will be in place while the patient is in bed. The patient will be taught to do simple breathing exercises to help prevent congestion in the lungs while the activity level is decreased. This will be done with an incentive spirometer. The patient will also learn to move their feet up and down (ankle pumps) to flex the muscles and keep blood circulating.
A physical therapist may begin gentle exercises of the shoulder on the day of surgery or the day after. These exercises are just passive motion, which means the patient relaxes and lets the therapist move the patient's arm.
Most patients having a total shoulder replacement are able to sit up and get out of bed with some help later on the day of surgery.
Rehabilitation after a shoulder replacement starts right away. It is not too demanding early on, but it is very important for the patient to do it. Most surgeons will not allow the patient to use the shoulder muscle for several weeks after surgery. The main goal of rehab is to allow the patient to move their shoulder as far as possible so it is easier for the patient to do activities of daily living, such as dressing, cooking and driving. Most patients eventually regain about two-thirds of normal shoulder motion after surgery. Other things that may affect how much movement the patient gets after surgery are how much movement they had before surgery and whether the soft tissues around the shoulder were also damaged. It is very important that the patient take part in physical therapy both while in the hospital and after being released from the hospital to get the most benefit from surgery.
Most patients go home 1 to 3 days after surgery. During the hospital stay, a case manager will assess the patient and their goals for discharge. The case manager will help with equipment that may be needed at home, set up with a home health agency and inpatient rehabilitation if needed.