What is a shoulder replacement?

A shoulder replacement is one of the surgeries that can be done to eliminate the cause of pain and dysfunction by substituting damaged parts of the joint with artificial parts, which are known as prostheses. Common causes for a shoulder replacement are osteoarthritis, also known as rotator cuff tear arthropathy, avascular necrosis, or rheumatoid arthritis. Treatment aims at relieving your pain, improving strength, enhancing your range of motion, and allowing you to use your shoulder and arm functionally.

How joint is shoulder replacement surgery?

Over 70,000 individuals have this procedure performed in the United States annually.

What are the prostheses made of?

Instead of the humeral ball, a metal ball made of special-grade stainless steel is attached to a stem usually made of titanium to keep attaching the ball to your arm. At the same time, a polyethylene cup replaces the glenoid socket.

Why a shoulder replacement is done?

Shoulder replacement is often offered as an alternative to alleviate the discomfort and other effects of damage to the shoulder joint.

Some disorders could compromise the joint, including:

• Osteoarthritis: This is also known as wear-and-tear arthritis, in which osteoarthritis breaks down the cartilage at the end of bones and lines the joint, making it easier for sliding.
• Rotator cuff injuries: The rotator cuff is a group of muscles and tendons surrounding the shoulder joint. Rotator cuff injuries sometimes cause damage to the cartilage and bone within the shoulder joint.
• Fractures: Fractures of the proximal humerus may require replacement, directly as a result of the trauma or when previous surgery for fracture fixation has failed.
• Rheumatoid arthritis and other inflammatory diseases: Inflamed rheumatoid arthritis results from an overactive immune response that destroys cartilage and, at times, the bone beneath in the joint.
• Osteonecrosis: Certain disorders affecting the shoulder can compromise the blood supply to the humerus—a condition in which a bone is deprived of its blood supply and may collapse.

What happens before the procedure?

Always follow your surgeon's instructions regarding bathing, diet, and medicines the day before and the day of surgery.

How do I prepare for my shoulder replacement surgery?

The patient is usually prepared beforehand so that he can make arrangements regarding getting discharged home and special care that may be required. An exercise partner to assist with exercises and to accompany the patient through the rehabilitation during the stay in the hospital is essential. Most patients stay overnight before surgery at home or a local hotel and report to the hospital for admission the following morning. Many pre-operative tests take place one to two weeks before surgery, including blood tests, an EKG, and a visit with the provider. Several medications will need to be stopped due to problematic complications of surgery, and anti-inflammatory medication needs to be stopped a week prior to surgery.

Such patients are advised to withhold oral/liquid intake one day before surgery at midnight. According to the physician and anesthesiologist, anesthesia can be offered in the form of general or regional or block anesthetic combined with postoperative pain.

Under regional anesthesia that lasts through long pain relief, a patient can have a typical dinner and walk to the bathroom after surgery. A relative may stay with the patient until surgery; all nail polish is removed. All jewelry, glasses, dentures, wigs, and contact lenses must be removed, and rings cannot be worn.

The nurses also prescribe pre-operative medications. Nurses will also take blood pressure, pulse, and temperature and give all pre-operative medications. The patient may have an IV or intravenous line for fluid, medication, and antibiotics before being taken to the operating room. Patients ride on a cart to the OR. Staff will ask about the name, ID bracelet, and shoulder to be operated on. Once the procedure is completed, the surgeon will call the waiting area and advise the family of how things are going.

What are the various types of shoulder replacement?

Your surgeon will discuss which type of shoulder replacement you might be a candidate for. There are four:

• Hemiarthroplasty: The only thing that is replaced in this procedure is the ball and stem. It articulates to your own socket, with which it is attached to, and the rest of it is the ball.
• Resurfacing hemiarthroplasty is a procedure in which the joint surface of the humeral head is replaced by a cap-like prosthesis that does not have a stem.
• Anatomic Total Shoulder Replacement: This is one in which, on the humeral side, a very polished metal ball attached to a stem replaces the arthritic joint, while a plastic cup replaces the glenoid socket.
• Stemless Total Shoulder Arthroplasty: A bone-preserving version of the total shoulder arthroplasty in which the metallic ball does not come with a stem attached to the upper arm.
• Reverse Total Shoulder Replacement: The reverse total shoulder replacement literally reverses the joint. That is, the metal ball will be placed where the glenoid socket was, and a plastic cup will be attached to the stem and moved to the upper arm bone (humerus).

What happens during the shoulder replacement surgery?

Nurses, physicians, technicians, and anesthesiologists will be seen in the operating room. The room will be very bright and very cool. Blankets are available to keep you warm. Because of the volume of people working, the room will appear very busy and somewhat noisy. You will then be transferred to the operating table and prepared comfortably. Sterile surgical draping will be draped to shield and protect the surgical site. The anesthesiologist will stay with your head throughout the whole surgery and monitor your condition.

What happens after the procedure?

After the surgery, you'll be taken to the recovery area for a while. X-rays will be taken. Your shoulder is immobilized. Do not try to move your shoulder unless you're given specific instructions not to.

How long do you stay in after surgery?

That will vary with individual needs, but most people can go home the same day.

How long will the shoulder replacement surgery last?

The surgery will take about two hours. It will be longer for your family members because it will take about an hour after your goodbye to them for surgery to start, and it will be about one to two hours after surgery for you to fully recover from general anesthesia and be able to see them again.

Will I be asleep during the shoulder replacement surgery?

You will receive general anesthesia to keep you asleep.

How long does it take to recover after shoulder replacement surgery?

Reattachment periods vary with every individual and also depend on the type of surgery you underwent. Usually, you can use your arm for waist-level activities on the first day after surgery. You should be able to dress and feed yourself within a week. Be cautious when driving. You should resume driving only when you are sure that you can drive without endangering yourselves or other road users.

When to call your provider?

You should call your surgeon's office if you have any problems or even if you have questions or concerns. Some of the following are red flags: fever, erythema, edema, sudden increase in discomfort, or change in arm movement or sensation after your nerve block has subsided.

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