What is shoulder replacement?
In shoulder replacement surgery, the painful surfaces of the damaged shoulder are resurfaced with artificial shoulder parts. The part that replaces the ball consists of a stem with a rounded metal head. The part that replaces the socket consists of a smooth plastic concave shell that matches the round head of the ball. When both sides of the joint are resurfaced, we call it a total shoulder replacement. However, your doctor may determine that only the humeral side of the joint (ball) should be resurfaced. We call this a partial shoulder replacement.
How do I prepare for shoulder replacement surgery?
If you and your surgeon decide that total shoulder replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will ensure that other health problems you may have, such as diabetes or high blood pressure, will be treated before surgery. Your doctor, or a staff ember, will advise you about the things you can do to prepare for your hospital stay, and your rehabilitation after surgery.
Who is a Candidate for shoulder replacement surgery ?
In a total or hemi shoulder replacement, the orthopaedic surgeon replaces the worn head of the upper arm bone or humerus with a metal ball mounted onto a stem. The socket or glenoid bone of the scapula may also be resurfaced with a polyethylene (plastic) component.
The primary goal of any shoulder replacement system is to relieve pain and regain motion to the shoulder joint. The Stryker Europe Shoulder replacement System was developed with this in mind. This comprehensive shoulder system gives your orthopaedic surgeon the ability to perform a total shoulder procedure (which includes a humeral and glenoid replacement) or a hemi shoulder procedure (which is a humeral replacement only).
What are the symptoms of severe arthritis of the shoulder?
Common symptoms of shoulder arthritis include:
- Pain with activities
- Limited range of motion
- Stiffness of the shoulder
- Swelling of the joint
- Tenderness around the joint
- A feeling of grinding or catching within the joint
What treatments are available for shoulder arthritis?
There are much more simple treatments for shoulder arthritis that should be tried before considering shoulder replacement surgery. Because the shoulder is not a weight-bearing joint (like the knees and hips), many patients can tolerate shoulder arthritis with some basic treatments and modifications of their activities. Read the following article on shoulder arthritis for more information about treatment ideas:
What is a total shoulder replacement?
Total shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with a metal and plastic implant. The shoulder joint is a ball-and-socket joint, much like the hip joint. The ball is the top of the arm bone (the humerus), and the socket is within the shoulder blade (scapula). This joint allows people an enormous range of motion at the shoulder.
When shoulder replacement surgery is performed, the ball is removed from the top of the humerus and replaced with a metal implant. This is shaped like a half-moon and attached to a stem inserted down the center of the arm bone. The socket portion of the joint is shaved clean and replaced with a plastic socket that is cemented into the scapula.
How do I know if I am ready for shoulder replacement surgery?
Patients who have tried the usual treatments for shoulder arthritis, but have not been able to find adequate relief, may be a candidate for shoulder replacement surgery. Patients considering the procedure should understand the potential risks of surgery, and understand that the goal of joint replacement is to alleviate pain. Patients generally find improved motion after surgery, but these improvements are not as consistent as the pain relief following shoulder replacement surgery.
What is the Reverse Shoulder Prosthesis?
It’s a shoulder joint replacement that is implanted into a person’s body when their own shoulder no longer functions properly or causes pain. This procedure is designed for people who have exhausted all other means of repair. When a person gets to this stage of shoulder weakness and pain, changes must be made in the actual mechanics, or workings, of the shoulder.
What are the benefits of the Reverse Shoulder Prosthesis?
Patients see a drastic difference in their range of mobility, and their ability to perform daily activities, such as eating, drinking, combing their hair, etc.
Preparing for a total joint replacement begins weeks before the actual surgery date. In general, patients may be told to:
- Begin exercising under a physician's supervision— it is important to be in the best possible overall health to help promote the best possible surgical experience.
- Have a general physical examination— patients who are considering total joint replacement should be evaluated by their primary care physician to assess overall health and identify any medical conditions that could interfere with surgery or recovery.
- Have a dental examination— although infections after joint replacement are not common, an infection can occur if bacteria enter the bloodstream. Therefore, dental procedures such as extractions and periodontal work should be completed before joint replacement surgery.
- Stop taking certain medications— your orthopaedic surgeon can advise you which over-the-counter and prescription medications should not be taken before surgery.
- Stop smoking— a good idea at any time, but particularly before major surgery in order to help reduce the risk of post-operative lung problems and improve healing.
- Lose weight— in patients who are obese, losing weight will help reduce stress on the new joint.
- Arrange a pre-op visit— an important opportunity to meet with healthcare professionals at the hospital to discuss your personal hospital care plan, including anesthesia, preventing complications, pain control, and diet.
- Have routine laboratory tests— blood tests, urine tests, an ECG or cardiogram, and chest X-ray may be prescribed to confirm that you are fit for surgery.
- Evaluate post-surgical needs for at-home care— every patient who undergoes total joint replacement will need help at home for the first few weeks, including assistance with preparing meals and transportation.
Preventing Possible Complications of Surgery
The complication rate following joint replacement surgery is very low. Serious complications, such as joint infection, occur in less than 2% of patients. Nevertheless, as with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications— the vast majority of which can be successfully avoided and/ or treated.
Possible complications include:
Infection may occur in the wound or within the area around the new joint. It can occur in the hospital, after the patient returns home, or years later. Following surgery, joint replacement patients receive antibiotics to help prevent infection. For the rest of their lives, they may also need to take antibiotics before undergoing even minor medical procedures to reduce the chance of infection spreading to the artificial joint.
Pneumonia is always a risk following major surgery. To help keep the lungs clear of congestion, patients are assigned a series of deep breathing exercises.
Obtaining a Quality Diagnosis
The medical management of arthritis and joint degeneration may be handled by a family doctor, an internist, or a rheumatologist. However, when medical management is not effective, an orthopaedic surgeon should be consulted to determine if surgery is an option. In some cases, the orthopaedic surgeon may be the first physician to see a patient and make the diagnosis of arthritis.
In general, the orthopaedic evaluation usually consists of :
- A thorough medical history
- A physical examination
- Additional tests, as needed
A medical history is taken to assist the orthopaedic surgeon in evaluating your overall health and the possible causes of your joint pain. In addition, it will help him or her determine to what degree your joint pain is interfering with your ability to perform everyday activities.
What the physician sees during the physical examination, helps confirm (or rule out) the possible diagnosis.
The physical exam will also enable the orthopaedic surgeon to evaluate other important aspects, including:
- Range of motion
- Skin condition
After the physical examination, X-ray evaluation is usually the next step in making the diagnosis. The X-rays help show how much joint damage or deformity exists.
An abnormal X-ray may reveal:
- Narrowing of the joint space
- Cysts in the bone
- Spurs on the edge of the bone
- Areas of bony thickening called sclerosis
- Deformity or incorrect alignment
Following the orthopaedic evaluation, the orthopaedic surgeon will review and discuss the results with you. Based on his or her diagnosis, your treatment options may include:
- Physical therapy
- Joint fluid supplements
- Joint replacement
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