Total Shoulder Replacement

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What Is Total Shoulder Replacement?

Total shoulder replacement, also known as total shoulder arthroplasty, refers to a surgical procedure in which damaged shoulder joint bones are removed and replaced with artificial joint prostheses. The procedure is helpful in treating shoulder pain and restoring the joint function.

Why Might I Need a Total Shoulder Replacement?

The end of your arm bone is round in shape. This round end, also known as the ball, fits into your shoulder’s end opening. The opening is known as the socket; hence, the round end of your arm bone and the opening of the shoulder join to form a ball and socket shoulder joint. This joint renders your arm flexible, allowing it to move in multiple directions. When your shoulder joint gets damaged, you may feel severe pain, which hinders the normal functioning of the joint.

Conditions that may cause severe shoulder pain and necessitate total shoulder replacement include:

  • Rheumatoid arthritis
  • Shoulder tumor
  • Osteoarthritis
  • Failure of the shoulder to heal as a result of a failed previous surgery
  • Severely damaged shoulder tissues

Total shoulder replacement may not be appropriate for you if you have one or more of the following:

  • Serious mental dysfunction
  • Diseased shoulder skin
  • Infection history which might expose your shoulder to infection
  • Excessively weak shoulder rotator cuff muscles since they are difficult to fix through surgery

Types of Total Shoulder Replacement

Total shoulder replacement can be categorized based on the type of prosthesis or implant a surgeon uses. There are two types of implants: cemented implants and non-cemented implants. In a cemented implant shoulder replacement, the surgeon attaches the artificial stem to the humerus using fast-drying cement. In a non-cemented implant shoulder replacement, a specially designed stem is attached without the use of cement, and it is allowed to adhere to the humerus with time.

Dr. Hessing Orthopedic Surgeon

How to Prepare for Total Shoulder Replacement

Preparation is important because it assures you are in the best condition for the surgery. You will have to meet your health care provider and inform them of any medications and supplements you are taking.

Two weeks prior to the procedure, your surgeon may ask you to do the following:

  • Avoid taking blood thinning medications, including ibuprofen, naproxen, and aspirin. Blood thinners may cause severe bleeding during the procedure.
  • Stop smoking. Cigarettes contain chemicals that hinder faster bone and wound healing.
  • Stopping or reducing your alcohol intake.
  • Avoid eating or drinking anything twelve hours prior to the surgery.
  • Inform your surgeon of any allergic concerns.
  • If you have any conditions such as heart disease, lung disease, kidney disease, or diabetes, it is advisable to tell your doctor in advance. He will advise you on what to do.

Potential Complications of Total Shoulder Replacement

In most cases, total shoulder replacement has good results if it is performed with a competent and experienced surgeon. However, the procedure may lead to certain complications. For instance, it may cause wound infection, blood clots, severe bleeding, scarring, and allergic reaction to anesthesia medications. Other possible complications may include:

Glenoid Socket Loosening

This occurs when the cement used to attach the artificial joint parts weaken over time. You may also experience humeral loosening if you have a non-cemented implant.

Humeral Fracture

This may result from the impact of the artificial stem attachment.

Axillary Nerve Injury

Axillary nerves control your shoulder and arm muscles. During the surgery, they may get overstretched.

Subscapularis Tendon Rupture

This may occur before the shoulder tendon heals fully. It usually results from accidental falls or intense physiotherapy, which strains the tendon.

Loss of Full Motion Range of the Joint

This is due to stiffness and may result from a poor physical therapy program.

Damaged Blood Vessel

This is due to cuts made during the surgery.

To avoid or limit the complications, it is advisable that a well-trained and experienced surgeon performs the procedure. A competent surgeon will observe utmost care, which helps in reducing the chances of developing complications.

During the Procedure

Total shoulder replacement lasts between 1 to 3 hours. During the surgery, your surgeon will administer either local or general anesthesia. The type of anesthesia will depend on the extent of your shoulder damage. The procedure will proceed as follows:

  • The surgeon will access your shoulder joint by making an incision into your shoulder.
  • He will remove the top of your humerus and replace it with an artificial metal stem and head.
  • The old shoulder socket will be smoothed, and the surgeon will cement the new joint in place.
  • The surgeon will close the incision and dress the wound.
  • The surgeon may insert a drainage tube into your shoulder to eliminate any fluid that accumulates in the joint after the procedure.

Recovery of Total Shoulder Replacement

A hospital stay of 1 to 2 days may be necessary after the surgery. Before leaving the hospital, a physiotherapist will train you on how to handle your shoulder and arm. To prevent your shoulder from injurious movements, you will use a sling on your arm. The duration you will use the sling depends on your recovery speed. While some people use the sling for two weeks, others take up to 6 weeks. You may also be advised to take painkillers to relieve any pain. If you experience abnormal shoulder pain that fails to go away, this may be a sign of injury or relapse and you will need to contact your doctor.

During the first few weeks, therapy focuses on maintaining the normal motion range and preventing tendon stress. Your therapist will teach you specific shoulder exercises to perform at home. You will need to strictly follow the instructions to avoid a possible injury. Light activities such as walking are highly recommended soon after the procedure. Once you cease using the sling, you may use your arm for lighter activities, including holding a book, newspaper, and coffee cup.

After six to twelve weeks, your therapist will recommend exercises to restore strength to your arm. Exercises such as pulling, lifting, and pushing heavy objects may be necessary for strength. Typically, it takes 4 to 6 months to resume your normal activities following total shoulder replacement.

Orthopedic Specialists

Jeffrey Hessing, MD and Timothy Doerr, MD have a passion for helping others. They have a combined 50 years of orthopedic excellence dedicated to the people of the Boise area. All of our surgeons are board certified by the American Board of Orthopaedic Surgery.

Dr. Doerr Dr. Hessing

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