Shoulder Replacement

Overview of Shoulder Replacement in India

When the bones within the shoulder joint, as well as the surrounding soft tissues, have been damaged, they can be replaced by an artificial implant during shoulder replacement surgery (also known as shoulder arthroplasty). Shoulder replacement surgery has a high rate of success for individuals who have experienced severe pain and have little or no full range of motion due to their condition. If the bone has suffered extreme damage from an automobile accident, it may also be a reason for performing a shoulder replacement. There are many athletes who sustain shoulder injuries, and most return to full athletic competition within one year of having undergone a shoulder replacement.

Shoulder replacement surgery is normally performed when medications, injections, and/or physical therapy do not relieve the individual's pain and/or restore some degree of motion to the shoulder. Recovery time from a shoulder replacement can vary greatly, but may take several weeks to several months, depending on the patient's status prior to the procedure and how well they participate in rehabilitation exercises after the procedure. There is a risk of complications associated with shoulder replacement surgery that will need to be managed following the procedure. If there are any complications following shoulder replacement surgery, they may impede or delay the recovery timeline. There may also be instances where additional surgery is needed for revision of the original procedure.

What Is Shoulder Replacement Surgery?

The terms "total shoulder arthroplasty" and "shoulder joint replacement surgery" refer to the same procedure, i.e., the removal and replacement of your original shoulder joint (which consists of bones and connective tissues) with a prosthesis (artificial replacement joint). The prosthesis is composed of substances such as metal, plastic, etc., which will hold up under normal use when you use your shoulders.

When we refer to the shoulder joint, we are describing the articulation of an upper arm bone (the humerus) with a shoulder blade (the scapula). This ball-and-socket type of joint is made up of a ball-shaped head of the humerus articulating with a cup-shaped glenoid portion of the scapula.

Types of Shoulder Replacement:

After​‍​‌‍​‍‌​‍​‌‍​‍‌ evaluating the extent of joint damage and considering the patient's particular needs, doctors can select from the following shoulder replacement options:

Total Shoulder Replacement

Also referred to as anatomic shoulder arthroplasty, this is the predominant type of shoulder replacement surgery. The operation replaces the ball (humeral head) and the socket (glenoid) of the shoulder joint with a metal ball (fixed to a stem inserted into the humerus) and a plastic socket (fastened to the scapula). It is the kind of shoulder replacement usually used for people with osteoarthritis and rheumatoid arthritis.

Reverse Shoulder Replacement

In contrast to a standard shoulder replacement, where the ball-and-socket configuration is preserved, reverse shoulder replacement or reverse total shoulder arthroplasty changes the anatomy of the joint—the ball is fixed where the socket was, and the socket is fixed where the ball (humeral head) was. It is a surgical option for patients having cuff tear arthropathy with severe shoulder arthritis, and for those with massive rotator cuff tears.

Partial Shoulder Replacement

Hemiarthroplasty, or partial shoulder replacement, typically involves replacing the ball (the natural socket or glenoid is left intact). In cases of a traumatic humeral fracture, or when avascular necrosis (bone death due to lack of blood supply) occurs, this kind of shoulder replacement surgery may be suitable.

Shoulder Resurfacing

Shoulder resurfacing is one of the less drastic, less painful alternatives of total shoulder replacement. Instead of changing the whole humeral head, the procedure consists of putting a metal cap on the damaged part of the humerus. Apart from osteoarthritis, people who have post-traumatic arthritis or rheumatoid arthritis, yet have some healthy bones and ligaments, may be advised by their doctor to go for shoulder resurfacing.

Revision Shoulder Replacement

The cause of a failed shoulder replacement that may necessitate this type of shoulder replacement surgery includes infection, loosening of the implant, or mechanical failure. Performing the operation without delay may be able to keep the complications connected to a failed shoulder replacement at ​‍​‌‍​‍‌​‍​‌‍​‍‌bay.

Procedure:

A more seamless surgical procedure and a speedier recovery can be ensured with careful planning. Before undergoing shoulder replacement surgery, patients should be aware of the following.

Preoperative Evaluation 

Prior to undergoing a shoulder replacement, physicians will do several tests to help evaluate the severity of damage to the patient's shoulder and to assess their overall medical condition: 

Blood Tests- Allow physicians to identify inflammation levels, count white blood cells, red blood cells, and platelets present in the blood of patients, as well as ensure that clotting is occurring normally.

Imaging Tests- Including X-ray and CT scans, will enable the physician to evaluate an individual’s bone structure, evaluate the amount of bone loss and assess the presence of bone spurs.

Electrocardiograms- Helps evaluate a patient’s heart function and determine if arrhythmias or erratic heart rhythms are present, as well as any heart issues that may lead to complications in the future.

Medication Adjustment

Patients will typically need to discontinue using blood-thinning medications (such as warfarin or aspirin) five days prior to undergoing shoulder replacement surgery. Patients who are currently taking diabetes medications (such as metformin) are generally advised to modify their dosages accordingly. Additionally, patients who use NSAIDs may need to stop using them 7-10 days prior to surgery.

Lifestyle Changes 

Smoking cessation is advisable for patients undergoing shoulder replacement surgery at the time of treatment, and should occur approximately 4-6 weeks prior to the procedure for increased chances of reduced complication rates following the procedure. Overweight patients should maintain an exercise regimen and improve their food choices, incorporating more active forms of physical activity, to achieve weight loss before surgery.

Patients should begin an exercise program that will prepare them for recovery by developing core muscle strength to achieve quicker recovery times after the procedure (ie, the ability to perform activities sooner after surgery).

Preparing for Recovery at Home 

Before having shoulder replacement surgery, patients should establish a recovery area within their home and eliminate any trip hazards, as well as put grab bars in the bathroom to assist with balance and bathing Assistance.

If you're living alone, then you should either hire a caregiver or find someone (family member or friend) who can stay with you while you recover from this procedure.

The Day Before Surgery

The day before your surgery, you should not eat or drink anything after midnight, so don't forget two things: pack a hospital bag with appropriate items (i.e., loose-fitting clothing, ID, and a list of medications) and wash yourself with an antiseptic soap before arriving to reduce your risk of infection.

If you are going to have a minimally invasive procedure and will be discharged the same day, you will want to make arrangements for someone (a family member or friend) to drive you to and from the hospital on the day of your surgery.

During Shoulder Replacement Surgery

Surgeons often lean on advanced, minimally invasive methods when they can, mostly to help the body bounce back fast after surgery and to make results more reliable. But in tougher situations, more invasive surgery might still be needed to clear out the damaged parts of the shoulder and swap them for artificial components, so the joint works again. If you’re wondering what happens in shoulder replacement surgery, here’s the gist of it:

Anesthesia administration — A licensed anesthesiologist (qualified and trained) provides general anesthesia or regional anesthesia to the patient.

Incision — A cut is made, usually around 4–6 inches, typically at the front or on top of the shoulder.  

Removal of damaged bone and cartilage — The surgeon takes out the damaged humeral head, the “ball” portion of the joint. In some cases, they also remove part of the glenoid, which is the socket. If there are bone spurs or worn cartilage, those are cleared out, too.

Implant placement — A metal or ceramic ball gets fixed onto the upper arm bone, also called the humerus. And when needed, a plastic or metal socket is fitted onto the shoulder blade area, the scapula.

Closing the incision — The surgeon closes the incision with stitches or staples, and may add a drain to help pull out extra fluid.

In general, shoulder replacement surgery takes about 1.5 to 3 hours, though it can vary with complexity and the kind of replacement used. If the approach is minimally invasive, some people may qualify for same-day discharge, but if it’s more invasive, expect a hospital stay of roughly 1–3 days or even longer.

Post Shoulder Replacement Surgery Care

Patients​‍​‌‍​‍‌​‍​‌‍​‍‌ will do well to keep to these post-operative guidelines to develop shoulder strength, enhance mobility, avoid complications, and recover quickly.

Pain Control

Patients should take their medications according to their physician’s instructions. If an individual experiences swelling due to inflammation, he or she should apply an ice pack to the shoulder for 15-20 minutes every couple of hours to alleviate pain and prevent swelling. Elevating the shoulder while resting also serves as an effective means to reduce swelling.

Healing the Wound

Those who undergo shoulder replacement surgery must keep the incision clean and dry and change dressings as per their doctor’s guidance. They have to be cautious about symptoms of infections such as redness, severe pain, pus, and fever and promptly consult a doctor if they do not feel right.

The Use of a Sling

Following shoulder replacement surgery, patients are usually instructed to employ a sling for 4-6 weeks in order to immobilise the shoulder. They should wear their sling even during sleep and should only take it off to bathe and exercise as instructed.

Consume Nutritious Foods

A nutritious and well-rounded diet rich in proteins, greens, and dairy (for calcium) is beneficial for physical recovery. Patients should ensure that they drink plenty of water throughout the day, as insufficient water intake may lead to complications and prolong the healing time. Given that some pain medicines may cause constipation, it is recommended for patients to consume foods that contain a lot of ​‍​‌‍​‍‌​‍​‌‍​‍‌fibre.

Avoid Activities that Place Too Much Stress on the Shoulders 

The following activities should be avoided by patients:

• Do not raise your arm above your shoulders or reach behind your back.
• Do not lift anything heavier than a cup of coffee for the next six weeks.
• Do not drive until you have been cleared to do so (generally 4–6 weeks after surgery).