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Sports Medicine & Shoulder Surgery Patient Guides
Patient
Guide to Shoulder Replacements
Edward
G. McFarland, M.D. - 410-583-2850
Steve A. Petersen, M.D. - 410-847-3517
When is a shoulder replacement indicated?
The
shoulder joint can be replaced by an artificial shoulder
or shoulder replacement for pain caused by arthritis or
when the shoulder is severly fractured or broken. Arthritis
is when the cartilage on the ends of the bones is gone
and there is bone rubbing on bone in the joint. Arthritis
can be caused by fractures, rheumatoid disease, torn rotator
cuff tendons or just by wear and tear over time (Figure
1).
What part of the shoulder is replaced?
The
shoulder is a ball and socket joint (Figure 2). The ball
is the upper part of the arm bone (humerus) and is called
the humeral head. The socket is smaller and is part of
the shoulder blade (scaptila). The ball is held in the
socket by ligaments and by the rotator cuff tendons. The
rotator cuff muscles start on the shoulder blade and turn
into tendons which attach to the ball. In shoulder replacement
surgery the ball is replaced with a metal ball attached
to a stem (Figure 3). The stem is inserted down the shaft
of the humerus. Sometimes cement is utilized to keep the
stem in place (Figure 4). The socket sometimes is replaced
with a plastic piece which is usually fixed to a groove
in the socket with cement. Whether a socket is used or
not depends upon how bad the arthritis is in the shoulder
and whether the rotator cuff tendons are intact.
How long does the surgery take?
The
surgery takes about three hours including time for anesthesia
to be done. Anesthesia is usually a general anesthetic
although local anesthetic can be used to numb the whole
arm. This is done by blocking the nerves as they come out
of the neck (scalene block). Most patients must have medical
clearance for surgery by their family doctor prior to surgery.
All patients must give a unit of blood a few weeks before
surgery which may be given back to them if needed after
surgery.
What is the recovery like?
Most patients are given a morphine pump after surgery so they can control their own pain medicine. After a day or so most patients switch over to pain medicine by mouth. The arm will be in a brace but it can be taken off to do therapy. Antibiotics are given by vein for a day to prevent infection. Physical therapy begins the day after surgery and begins with moving the fingers, wrist and elbow. Some motion of the shoulder is begun within a day or so after surgery. The physical therapist will show the patient a program of exercises to do at home. Most patients stay in the hospital from three to five days.
What happens once I go home?
The
exercises are to be done at least daily to prevent stiffness.
Cold therapy with cryocuffs or ice bags should be used
to keep down pain. The incision can get wet in the shower
but no baths are recommended for 3 weeks. The stitches
are removed one week after surgery. Physical therapy at
a physical therapy facility is begun seven to ten days
after surgery and continues for several weeks. The doctor
will see you in the office every few weeks for several
months. Most patients cannot drive for four to six weeks.
What are the results of surgery?
Shoulder replacement surgery is very successful for pain relief. Most patients are very satisfied with the degree of pain relief. However, these shoulder replacements are not perfect and may ache a little when the weather changes or if you are too active.
Range of motion and function can be improved by this surgery but the amount of change is less predictable than pain relief. How much motion increases depends upon many factors, such as how long the motion has been lost and whether the rotator cuff tendons are intact and working.
Most patients are very satisfied with the results of their surgery.
What are the complications?
Fortunately the complications rate after surgery is small (less than five percent). Infection is a concern but happens rarely since antibiotics are given to prevent it. Nerve or artery damage is very rare. Since the shoulder is a ball and socket, the ball can shift out of the socket (dislocate). Again, this is very uncommon. Lastly the components of the replacement can get loose from the bone over time, especially if the arm is used excessively. After ten years approximately 3 percent of the shoulders are loose, but revision surgery is rarely needed.
