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More About Shoulder Replacement Surgery

The shoulder joint is a ball and socket type of joint. Shoulder replacement surgery involves replacing the damaged ends of upper arm bone (humerus) and usually the shoulder bone (scapula) and cap them with artificial surfaces. It is a successful procedure in relieving joint pain though not as common as knee or hip replacement. Total shoulder replacement, requires open surgery, with an incision along the front of the shoulder and upper arm.In other cases, minimally invasive shoulder arthroscopy procedure is frequently recommended and is amongst the most common and frequently indicated shoulder procedures. 

 

Indications for shoulder replacement 

  • Severe shoulder pain that interferes with everyday activities
  • Moderate to severe pain even while resting 
  • Loss of motion and/or weakness in the shoulder.
  • No marked improvement with other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.

 

Causes of Shoulder Replacement 

  • Osteoarthritis-Age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older, the cartilage that covers the ends of the bones wears away, it can result in bone rubbing on bone and produce painful bone spurs.
  • Rheumatoid Arthritis the synovial membrane becomes inflamed and thickened, causing damage to the cartilage and eventually cause cartilage loss, pain, and stiffness. 
  • Post-traumatic Arthritis-  following a serious shoulder injury
  • Rotator Cuff Tear Arthropathy
  • Avascular Necrosis - occurs when the blood supply to the bone is disrupted
  • Severe Fractures- A severe fracture of the shoulder is another common reason people have shoulder replacements. 
  • Failed Previous Shoulder Replacement Surgery


Symptoms

  • Shoulder pain 
  • Loss of motion 
  • Crepitations 

 

Tests and diagnosis

  • Presenting Symptom by a patient 
  • Physical examination to assess shoulder motion, stability, and strength.
  • X-rays imaging help to determine the extent of damage in your shoulder.  
  • Magnetic resonance imaging (MRI) scan or a bone scan may be needed to determine the condition of the bone and soft tissues of your shoulder.
  • Blood tests  

 

Types of Shoulder Replacement

  • Total Shoulder Replacement: The typical total shoulder replacement involves replacing the arthritic joint surfaces with a metal ball attached to a stem, and a plastic socket.
  • Partial shoulder replacement: only ball gets replaced 
  • Reverse Total Shoulder Replacement: In reverse total shoulder replacement, the socket and metal ball are switched. Useful in cases of Completely torn rotator cuffs with severe arm weakness, a previous shoulder replacement that failed

 

Procedure

Before Procedure

  • The orthopaedic surgeon will evaluate and discuss the pros and cons of shoulder joint replacement 
  • Complete medical examination before surgery
  • Blood examination to check for normal parameters 
  • Some medications may need to be stopped before surgery. Non-steroidal anti-inflammatory medications, such as aspirin, ibuprofen, blood thinners. 

During Procedure

Most of the procedures are performed through shoulder arthroscopy. However, severe cases treated by partial or total shoulder replacement surgery. Recovery time for shoulder surgery generally ranges between 6 and 12 months.

  • The procedure to replace your shoulder joint with an artificial device usually takes about 2 -3 hours.
  • It is performed under General Anaesthesia. 
  • The surgeon either replaces part or all of shoulder joint 
  • An incision is made over the front shoulder, the surgeon views the damaged cartilage 
  • Damaged upper arm bone (humerus) is removed and prepared for implant 
  • Bone socket exposed and damaged cartilage removed, the hole made for the implant 
  • The surgeon inserts the implant socket, ball, and stem components and Closes the incision 
  • A bandage is applied as a temporary covering 


After Procedure

  • Antibiotics to prevent infection. 
  • Painkillers prescribed to combat pain
  • There may be staples running along your wound. The staples will be removed several weeks after surgery. 
  • You will need the sling to support and protect your shoulder for the first 2 to 4 weeks after surgery.
  • Avoid soaking the wound in water 
  • Physical therapy begins on the first postoperative day, following x-rays documenting that the implant is properly positioned.
  • Rehabilitation-Proper and extensive post-operative rehabilitation is important to the success of a shoulder replacement. 

 

Complications of surgery

As with any operation, there is a risk of complications.They include:

  • Infection 
  • Stiffness 
  • Pain 
  • Loosening of the replacement parts 
  • Fracture of the bone during or after surgery 
  • Poor healing of the wound 
  • Wound haematoma 
  • Damage to nearby nerves 


Factors affecting the Cost Of Treatment Of  Shoulder Replacement

Cost to the patient depends on a variety of factors like :

  • The hospital patient chooses 
  • Fees for the surgeon 
  • Cost of the prosthesis  
  • Cost of tests and diagnostic procedure
  • Cost of surgery
  • Cost of follow -up care required. 
  • Cost of physiotherapy

Frequently Asked Questions Involving open reduction of fracture

Q: What is the anatomy of shoulder joint? 
A: Shoulder joint is made up of three bones: upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone, fits into a shallow socket in your shoulder blade. 

 

Q: What happens in shoulder replacement surgery?
A: In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis.
The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket. 

 

Q: What is the prognosis for shoulder replacement?
A: After one year, 95% of TSA patients enjoy pain-free function. The pre-surgical condition of the shoulder muscles and tendons play a big role in the patient’s outcome. If their muscles and tendons are in good shape, rehab will be easier and rapid.

 

Q: When can I resume work after shoulder replacement surgery?
A: Can usually return to desk work within 2-4 weeks from the time of surgery but that heavier work is restricted for four months or more, depends on the strength,  progress of the shoulder.

 

Q: Which patients are not suitable for shoulder replacement?
A: The patients not suitable are:

  • Patients experiencing loss or paralysis of both rotator cuff and deltoid muscles
  • Patients with active infection
  • Some patients with a progressive disease of the nervous system 
     

Q: When do I need a shoulder replacement?
A: You may need a joint replacement if your pain can't be reduced by treatments such as drugs, injections and physiotherapy; and it's affecting your quality of life.

 

Q: What are the advantages of shoulder replacement?
A: Shoulder replacement can lead to reduced joint pain, improved range of movement and a better quality of life. It may be several months before you notice the full benefits of the surgery.

 

Q: What are the disadvantages of a replaced joint?
A: Its disadvantages are:

  • A replacement joint can never be as good as a normally-functioning natural joint. 
  • The range of movement will be less than with a healthy natural joint. Some movements, such as reaching above your head, may not be possible
  • Replacement joints will also wear out after a time. 

 

Q: What are the options other than shoulder replacement surgery?
A: The available options are:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Steroid Injections
  • Physiotherapy

 

Q: How long will the artificial joint last?
A: Usually, it is observed that shoulder replacement lasts for around  10 years or more, after this time it may loosen or wear out.