Stiff and painful shoulders may have damaged joint surfaces. This damage to the joint surface may have been acquired from injury or disease. Loss of a smooth cartilage surface can occur from osteoarthritis, rheumatoid arthritis, avascular necrosis or post-traumatic (injury) arthritis or occasionally other less common causes. Surgery is not always necessary. Glucosamine supplements can help. Medications can sometimes help and steroid injections into the joint can give relief as well. In some cases, therapy can help too but if the arthritis is already very severe then therapy is not often very helpful.
If treatment without surgery fails, most patients can be effectively treated with partial or total shoulder replacement. Occasionally if the arthritis is not so severe, arthroscopic treatment to remove debris and smooth the joint surfaces may provide some relief in young patients. This means replacing the joint surfaces with an artificial metal ball with a stem going down into the humerus and, when necessary and appropriate, a plastic socket. These surgical procedures usually restore comfortable motion to the shoulder.
The most dependable benefit of shoulder joint replacement is pain relief. Motion and strength are often improved, but never truly normal. Joint replacement can be done for adults of any age, if your medical condition is satisfactory. Good motivation and general health is more important than age in determining who is a good candidate for this procedure.
Preparation for surgery:
The preparation for surgery begins with your primary physician by making sure you are healthy as possible by physical examination, blood testing and chest x-rays. Your body must be free of all infection (for example in your skin, teeth, or urine), and your general health at its best. You should also make arrangements for assistance at home after your shoulder replacement.
Shoulder replacement is performed on the same day of admission. The operation is undertaken after you have been given an anesthetic. Most commonly we use a general anesthetic (being put to sleep) although in some cases a regional block can be used with a numbing agent like Novocain between your neck and shoulder. The operation takes approximately two hours. You can expect to be in the recovery room for one hour after surgery.
Specific risks of shoulder replacement include bone fracture, tendon injury, joint dislocation, improper placement, and loosening or wear of the artificial parts
General risks rarely associated with shoulder replacement are infection, bleeding, numbness, weakness, and loss of movement. Heart, lung, and kidney failure occur even more rarely in susceptible patients. Although these risks are frightening, fortunately, it is very unusual for anything to happen. However, it is our responsibility to inform you of all possibilities. We will work with you to minimize the risk of complications and attempt to correct any problems if they occur.
A physical therapist will begin exercises on the first day after surgery. He/she will instruct you how to perform your motion exercises and provide you with illustrations of the rehabilitation program.
You will be released from the hospital when you have reached the goals we have set for your shoulder. Patients leave the hospital in an average of 2-3 days. Within days after surgery you may use your hand in front of you for light activities such as reading and eating.
For the first six weeks, you must avoid forceful rotation of your arm toward your body. You may be out of your sling for light activity in front of your body within a few days from surgery. Otherwise, we encourage both assisted and unassisted motion as instructed by our therapist.
The first follow-up appointment will be approximately two weeks after surgery to check your shoulder motion and to remove your sutures. You must keep your shoulder clean and dry with no bathing over the wound until the sutures are removed. There should be no driving for at least one month post-op. Approximately six weeks after surgery, we begin more aggressive and unrestricted exercises. You must maintain a daily home exercise program for about 6 months after surgery. Outpatient physical therapy is often used during the first 2-3 months after surgery.
We will see you in the office frequently as you recover from surgery. We will also arrange a follow-up visit at one year after the operation. If all is going well, we like to check your shoulder every five years or earlier if something changes. You should return if you develop pain or irregular motion, such as clunking. If you begin having shoulder pain along with a fever or redness about the shoulder, call or come to our office or to the Emergency Department if the office is closed. Remember, the best possible results occur only with close cooperation between you and your treatment team. Your own personal dedication to post-operative rehabilitation after shoulder replacement is critical to your recovery.
Sports such as swimming, golf, tennis, and bowling should not be started until you have your surgeon's approval. Falls, repetitive heavy loads, sudden loads and contact sports could loosen or wear your replacement parts, and should be avoided.
It is important for you to remember you have an artificial joint, which needs to be protected. For two years post-operatively your dentist should provide antibiotics for you. In some cases, antibiotics should be used during dental care for the rest of your life.
Please contact my office if you have questions about this information. It is very important that you understand clearly both the risks and the clear benefits of this procedure.