Total Shoulder Replacement
What Is Total Shoulder Replacement?
Also known as total shoulder arthroplasty, total shoulder replacement is a surgical procedure where damaged shoulder joint bones are removed and replaced with artificial joint prostheses. The procedure aids in helping treat shoulder pain and restoring joint function.
Understanding the Types of Total Shoulder Replacement
There are two types of implants: cemented implants and non-cemented implants. Total shoulder replacement is categorized based on the type of prosthesis or implant a surgeon uses. A cemented implant shoulder replacement means the surgeon will attach the artificial stem to the humerus using fast-drying cement. In a non-cemented implant shoulder replacement, a specifically designed stem is attached without cement; it adheres to the humerus with time.
- Dr. Applonie, Orthopedic Surgeon
Who Might Need a Shoulder Replacement?
The ball and socket shoulder joint is known as where the round end of your arm bone and the opening of the shoulder joint. The end of your arm bone that is round in shape, the ball, fits into your shoulders end opening, the socket. This joint creates flexibility, allowing your arm to move in multiple directions. When the shoulder joint gets damaged, normal functioning is hindered often resulting in severe pain.
Conditions that may cause severe shoulder pain and necessitate total shoulder replacement include:
- Rheumatoid arthritis
- Shoulder tumor
- Failure of the shoulder to heal as a result of a failed previous surgery
- Severely damaged shoulder tissues
Total shoulder replacement may not be appropriate for you if you have one or more of the following:
- Serious mental dysfunction
- Diseased shoulder skin
- Infection history which might expose your shoulder to infection
- Excessively weak shoulder rotator cuff muscles since they are difficult to fix through surgery
Total Shoulder Replacement Preparation
Preparing for total shoulder replacement allows you to ensure you're in the best condition prior to your surgery. Before your procedure, you will meet with your health care provider and be asked about any medications or supplements you are taking. Two weeks before your surgery, your surgeon may ask you to do the following:
- As blood thinners can cause severe bleeding during a procedure, you may be asked to avoid taking blood-thinning medications. This includes ibuprofen, naproxen, and aspirin.
- Stop smoking. Cigarettes contain chemicals that hinder faster bone and wound healing.
- Reduce or stop your alcohol intake.
- Twelve hours prior to your appointment, you may be asked to avoid eating or drinking.
- Inform your surgeon of any allergic concerns.
- If you have any conditions such as heart disease, lung disease, kidney disease, or diabetes, it is advisable to tell your doctor in advance. He will advise you on what to do.
Potential Complications of Total Shoulder Replacement
If performed by an experienced and knowledgeable surgeon, in most cases, total shoulder replacement has good results. However, certain complications may be the result of the procedure. For example, it may cause severe bleeding, wound infection, scarring, blood clots, and allergic reaction to anesthesia medications. Other possible complications may include:
- Glenoid Socket Loosening - This happens when the cement used to attach the artificial joint parts weaken over time. If you have a non-cemented implant you may experience humeral loosening.
- Humeral Fracture - This may result from the impact of the artificial stem attachment.
- Axillary Nerve Injury - Axillary nerves control your shoulder and arm muscles. During the surgery, they may get overstretched.
- Subscapularis Tendon Rupture - This may occur before the shoulder tendon heals fully. It usually results from accidental falls or intense physiotherapy, which strains the tendon.
- Loss of Full Motion Range of the Joint - This is due to stiffness resulting from a poor physical therapy program.
- Damaged Blood Vessel - This is due to cuts made during the surgery.
Seeing a well-trained and experienced surgeon can help limit the complications. A dedicated and competent surgeon will help in reducing the chances of developing complications.
What Happens During Total Shoulder Replacement?
The surgery typically lasts between 1 to 3 hours. During the procedure, your surgeon will administer either local or general anesthesia, depending on the extent of your shoulder damage and the doctor's suggestion.
The procedure will proceed as follows:
- Making an incision into your shoulder, your surgeon will access your shoulder joint.
- He will remove the top of your humerus and replace it with an artificial metal stem and head.
- The surgeon will smooth the old shoulder socket and cement the new joint in place.
- The surgeon will close the incision and dress the wound.
- After the procedure, to eliminate any fluid accumulating in the joint your surgeon may insert a drainage tube into your shoulder.
How Long Does it Take to Recover from Total Shoulder Replacement?
After surgery, it may be necessary to stay at the hospital for 1 to 2 days. A physiotherapist will teach you how to handle your shoulder and arm before leaving the hospital. You will likely be instructed to use a sling, to prevent your shoulder from injurious movements. Depending on your recovery speed, patients are required to use a sling for different lengths of time. Your surgeon may also advise you to take painkillers as a source of pain relief. If you experience abnormal shoulder pain that fails to go away, this may be a sign of injury or relapse and you will need to contact your doctor.
During the first few weeks of your recovery process, your therapist will focus on helping you maintain normal motion range and prevent tendon stress. With the instruction of your therapist, you will perform daily exercises. It will be important you strictly follow the instructions to avoid possible injury. Walking and other light activities are highly recommended soon after the procedure. As you work your way through the sling, you may use your arm for lighter activities, including holding a book, newspaper, and coffee cup.
The following six to twelve weeks, your therapist will recommend exercises to restore strength to your arm. Commonly used exercises following Total Shoulder Replacement include pulling, lifting, and pushing heavy objects to increase your strength. In most cases, it takes 4 to 6 months to resume your normal activities.