Although less common than knee or hip replacement, shoulder joint replacement is an option to use a prosthetic replacement in place of the natural bones, namely, the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). The process can be done under regional anesthesia (numbing the area between your neck and the end of your torso), general anesthesia, or a combination of both, and typically takes about 2 hours. It is performed as an outpatient procedure.
Total shoulder joint replacement consists of replacing the joint surfaces with a ball-and-socket prosthetic. In some cases, the orthopedic surgeon will only replace the “ball,” or “humerus,” in what is called a “stemmed hemiarthroplasty.” In an even less invasive procedure, physicians can do a resurfacing hemiarthroplasty, where the surface of the humerus is replaced with a cap-like prosthesis, which is not subject to the wear and tear of a traditional total joint replacement.
Finally, there is reverse total shoulder joint replacement. This procedure allows other muscles, such as the deltoid muscle, to do the work of the torn rotator cuff.
Who is a candidate?
Candidates should have severe shoulder pain that interferes with everyday activities, and should have exhausted nonsurgical pain management techniques such as rest, physical therapy, cortisone injections, and anti-inflammatory and pain medications.
Pain is typically caused by:
- Osteoarthritis (wear and tear of the joint due to age)
- Rheumatoid arthritis
- Rotator cuff tear arthropathy (a type of wear and tear that develops over time after the rotator cuff is damaged)
- Avascular necrosis (bone death due to lack of blood supply)
- Severe bone fracture in the shoulder
- Previous shoulder replacement surgery
Who is not a candidate?
Candidates who have not yet exhausted nonsurgical treatment options for severe shoulder pain are not good candidates for total shoulder joint replacement, as the procedure is a permanent surgical alteration. In general, younger patients are less suitable candidates, as they are likely to require revision surgery in their lifetimes.
Like other surgeries, shoulder joint replacement requires a complete physical examination with your primary care provider and/or orthopedic surgeon prior to surgery. You should inform your orthopedic surgeon of any medications or supplements you take, and comply with general surgery procedures such as preoperative blood testing and possible cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior to surgery. You may need to stop taking blood thinner medication if you are on a regular dose of drugs such as Warfarin (or other blood thinners). You will likely be asked to stop eating or drinking the night before surgery.
Shoulder joint replacement may require a short hospital stay. Immediately after your procedure, your doctor will prescribe medication for pain relief and possibly antibiotics to prevent infection from occurring. In the case of regional anesthesia (numbing the area between your neck and the end of your torso), you may not be able to move your shoulder and hand, your eyelid may droop, and you may feel numb in your shoulder and hand for 12-20 hours after the surgery. This is normal. In the first few days after surgery, keep your shoulder in the cuff or brace provided and apply ice to relieve swelling and prevent further inflammation. Ensure your incisions are kept clean and dry, and follow your surgeon’s instructions in regards to bathing, changing the dressing, and follow-up visits.
You can expect to wear a sling and refrain from driving for 2-4 weeks. Although you will be able to eat, drink and dress yourself, avoid making any abrupt movements with your shoulder. A formal physical therapy program (beginning a week after surgery) will also help you as you learn exercises to maintain a pain-free range of motion. Most physical therapy regimens last between 6 weeks and 3 months. After about 6 weeks, you will most likely be able to return to work and resume most normal activity, depending on the level of physical activity involved in your job.
As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. Other known complications include blood clots, shoulder instability, rotator cuff tearing, fracture, and loosening of the prosthesis, although these are relatively uncommon. Although joint replacement can provide 10-25 years of use for a prosthetic joint, they do eventually wear out, and there is a chance that you will require revision surgery down the line (especially if you are younger).
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