Shoulder Replacement - BHA

Tuesday 22 August 2017 by Graciela Rojas

What is shoulder replacement?

A shoulder replacement removes a damaged or diseased shoulder joint and replaces it with an artificial joint. It is also called shoulder arthroplasty. Shoulder replacement allows you to move your shoulder joint without pain.
Your shoulder is a ball-and-socket joint critical for arm movement. It is made up of three bones meet—the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The ball portion of the joint is the head at the top of the upper arm bone. The socket portion of the joint is on the shoulder blade.
Types of shoulder replacement
The types of shoulder replacements include:
  • Total shoulder replacement replaces both the ball and socket. The ball is secured with a stem anchored in the upper arm bone. This is usually the treatment of choice for people with arthritis in which bone is rubbing on bone within the joint.
  • Stemmed hemiarthroplasty only replaces the ball portion of the joint. You may be a candidate for the stemmed procedure if only the ball is damaged and the socket portion of the joint is healthy.
  • Resurfacing hemiarthroplasty replaces the joint surface of the humeral head of the upper arm bone. This more conservative treatment may be an option for younger patients with partial joint damage who favor preserving as much humerus bone as possible. The surgeon removes the damaged part of the ball and covers it with a cap of artificial material. There is no stem into the arm bone.
  • Reverse total shoulder replacement replaces the ball and socket but switches the joint so the ball is attached to the shoulder bone and the socket to the upper arm bone. Good candidates for reverse shoulder replacement include people with a torn or weak rotator cuff (tendons that allow you to lift and rotate your arm in different directions). Conventional shoulder replacement does not work well because the rotator cuff cannot keep the artificial ball in position. Reverse shoulder replacement is gaining popularity because—for good candidates—it can provide a greater level of function compared to regular shoulder replacement.

Why is shoulder replacement performed?

Your doctor may recommend shoulder replacement to treat serious shoulder damage when symptoms are severe or preventing you from carrying out your normal day or being active. Symptoms include severe pain, deformity or disability, including shoulder weakness and instability.
Shoulder replacement treats severe or permanent shoulder joint damage due to:
  • Inflammatory forms of arthritis including rheumatoid arthritis
  • Osteoarthritis (degenerative joint disease), which is the breakdown of cartilage and bones
  • Osteonecrosis (death of bone), a rare condition
  • Post-traumatic arthritis, which is arthritis that develops following a serious injury
  • Shoulder joint injuries including severe fractures and rotator cuff damage
Shoulder replacement is a common but major surgery with some level of risk and potential complications. Your doctor may only consider shoulder replacement if less invasive treatments, such as physical therapy, do not improve pain and joint function. Ask your doctor about all your treatment options, including the different types of shoulder replacement. Consider getting a second opinion before deciding on shoulder replacement surgery.

Who performs shoulder replacement?

Orthopedic surgeons perform shoulder replacement. Orthopedic surgeons are specially trained to treat conditions of the bones and connective tissues. Orthopedic surgeons often specialize in a particular area, such as the shoulder joint. When searching for an orthopedic surgeon, one of your top concerns should be the experience of the surgeon. Choose a surgeon who performs shoulder replacement surgery many times year at a hospital with an equally experienced surgical staff. 

How is shoulder replacement performed?

Your shoulder replacement will be performed in a hospital. It is an open surgery that involves making an incision along the front of the shoulder and upper arm to remove the damaged bones. Your surgeon shapes and prepares the remaining bone to hold the new joint, then places an artificial shoulder joint made of metal and plastic, tests the new joint, and secures it permanently in place.

Types of anesthesia

Your surgeon will perform your shoulder replacement using either a general anesthetic or a regional anesthetic. Most frequently, it will be a combination of both.
  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are not awake and do not feel any pain during the surgery. You may also have a peripheral nerve block infusion in addition to a general anesthetic. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have a sedative with a regional anesthetic to keep you relaxed and comfortable.

What to expect the day of your shoulder replacement

The day of your surgery, you can expect to:
  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all necessary tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
  • A surgical team member will start an IV.
  • The anesthesiologist or nurse anesthetist will start your anesthesia.
  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia.
  • The surgical team will monitor your vital signs and critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of shoulder replacement?

As with all surgeries, a shoulder replacement involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery

The general risks of surgery include:
  • Anesthesia reaction, such as an allergic reaction and problems with breathing
  • Bleeding, which can lead to shock
  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of shoulder replacement

Problems with shoulder replacement surgery are not common but include:
  • Breakage or fracture of the new joint
  • Loosening of the new joint possibly requiring additional surgery to secure it
  • Nerve, muscle, bone, or blood vessel damage
  • Ongoing shoulder stiffness and pain
  • Wear and tear of the new joint requiring another replacement

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:
  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
  • Informing your doctor if you are nursing or if there is any possibility of pregnancy
  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
  • Taking your medications exactly as directed
  • Telling all members of your care team if you have allergies

How do I prepare for shoulder replacement?

The steps you take before surgery can improve your comfort and outcome. You can prepare for shoulder replacement surgery by:
  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
  • Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
  • Losing excess weight before the surgery through a healthy diet and exercise plan
  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.

Questions to ask your doctor

Considering surgery and planning for it can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your surgeon with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
  • Why do I need a shoulder replacement? Are there any other options for treating my condition?
  • What type of procedure do I need?
  • How frequently do you encounter complications from the surgery? Do you have outcomes data to share?
  • If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
  • How long will the surgery take? When can I go home?
  • What kind of restrictions will I have after the procedure? When can I return to work and other activities?
  • What kind of assistance will I need at home?
  • What medications will I need before and after the surgery? How should I take my medications?
  • How will you treat my pain?
  • When should I follow up with you?
  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after shoulder replacement?

Knowing what to expect can help make your road to recovery after shoulder replacement as smooth as possible.

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You can expect to stay in the hospital for 2 to 3 days after shoulder replacement. Some people may need to stay for a short time in a rehabilitation facility while they recover.
Shoulder replacement recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. You will have very limited shoulder movement immediately following shoulder replacement. Physical therapy is an important part of the recovery process. Gradually, you’ll regain shoulder mobility and strength. Most people are able to resume light daily activities within 2 to 4 weeks after surgery. Full recovery and use of your shoulder may take up to one year.
You won’t be able to drive for 2 to 4 weeks after shoulder replacement, so arrange for a ride to and from the hospital and for someone to drive you to and from follow-up appointments. You will need to wear a sling to support and protect your shoulder for the first 2 to 4 weeks after surgery. Ask someone to care for you and help around the house, well in advance of surgery. Also, before surgery, go through your home and place any items you may need to reach on low shelves.

Will I feel pain?

Pain control is important for healing and a smooth recovery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up and physical therapy appointments after shoulder replacement. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
  • Bleeding
  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
  • Change in alertness, such as passing out, unresponsiveness, or confusion
  • Chest pain, chest tightness, chest pressure, or palpitations
  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
  • Inability to urinate or have a bowel movement
  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
  • Numbness or tingling in the affected arm or hand
  • Pain that is not controlled by your pain medication
  • Unexpected drainage, pus, redness or swelling of your incision

How might shoulder replacement affect my everyday life?

Shoulder replacement may reduce your symptoms and improve shoulder function so you can enjoy an active life.
You will need to take measures to protect your new shoulder:
  • Avoid placing your arm in extreme positions, such as straight out to the side or behind your back until you are completely recovered.
  • Avoid repetitive, heavy lifting and contact sports.
  • Exercise regularly to maintain shoulder strength and flexibility.
  • Take special care to prevent falls and injuries. Place grab bars in the shower or tub, and secure or remove throw rugs to avoid tripping.
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Source: https://www.healthgrades.com/procedures/shoulder-replacement?cid=34-_-ACCOUNT_NAME-_-CAMPAIGN_NAME-_-POST_ID&linkId=41241152