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SHOULDER REPLACEMENT SURGERY
A
stiff, painful shoulder can keep you from doing even simple things,
like dressing yourself or carrying groceries. But there is good
news. A worn out shoulder can be replaced, just as a bad hip or
knee can be. Shoulder replacement is safe and reliable. Surgery
relieves the pain and may let you return to many of your normal
activities.
During surgery, an orthopedic surgeon (a doctor who specializes in treating bone and joint diseases) replaces all or part of your problem shoulder with an artificial joint, called a prosthesis. The prosthesis replaces the rough, worn parts of your shoulder with smooth metal and plastic parts. Your artificial shoulder has the same parts as your own shoulder joint. Your surgeon picks the design that will work best for you.
HOW YOUR SHOULDER WORKS
Your shoulder -a ball-and-socket joint- is the most flexible joint
in your body. The ball, or head, of the arm bone (humerus) rests
against a small, shallow socket (glenoid). Muscles and other soft
tissue hold the ball in the socket and allow you to move your arm
up and down, to the side, across your body, and behind your back.
A Healthy Shoulder
When your shoulder joint is healthy, the ball glides smoothly in
the socket. That's because the ends of the bones are cushioned by
a smooth covering (cartilage), and tissue (synovium) lines the joint.
The muscles and tendons of the rotator cuff hold the head of the
arm bone firmly in the socket and give you strength and flexibility.
A Problem Shoulder
Arthritis, injury, bone disease, and torn muscles and tendons can
cause pain, stiffness, and sometimes swelling in your shoulder.
Then even simple movements become painful and difficult.
Deciding If Surgery Is Right For You
Replacement surgery is recommended only if other treatment options
do not relieve symptoms. Your orthopedic surgeon will discuss your
symptoms with you, examine your shoulder, and order tests determine
if replacement surgery is the best answer for you.
Your Medical History
Your medical history includes questions about where and when your
pain started, what activities make it worse or better, and what
other symptoms you have. Your surgeon will ask about your overall
health, including other bone and joint problems, about any other
prior injuries, and about any medications you take. Before surgery,
your doctor will also ask if you've had any problems in the past
with bleeding or anesthesia..
Your Physical Exam
Your surgeon examines your shoulder to see the condition of the
muscles and tendons and how much strength and movement you have
in the joint. He or she will check to see how far and in what directions
you can move your arm, and will feel the joint for swelling and
tenderness. Your doctor may also check your neck, arm, hand, and
fingers to be sure your shoulder problem isn't caused by a pinched
nerve or some other condition.
Diagnostic Tests
X-rays help your surgeon learn more about the exact condition of
your shoulder joint. Your doctor may order other imaging tests as
well.
X-rays
X-rays are pictures of your bones. They can reveal bone spurs, fractures,
or cracks in the ball or socket, and narrowing of the joint where
the cartilage or bone has worn away. X-rays also help your surgeon
choose the correct prosthesis for you. In some cases, a dye is injected
into the shoulder to outline the joint and surrounding tissue. This
kind of x-ray is called arthogram.
Other Imaging Tests
A CT scan (computed tomography) gives a more detailed image of the
bones in the joint. A scanner sends information to a computer that
produces cross-sectional pictures. A CT scan helps your surgeon
see where and how badly the ball or socket is damaged.
MRI (Magnetic resonance imaging) lets your surgeon look at the muscles and tendons of your rotator cuff. If the rotator cuff is not damaged, there is a good chance you'll recover strength and movement in your shoulder after surgery. An MRI also reveals any areas of dead bone.
Preparing for Surgery
Your surgeon may ask you to see your primary care doctor and dentist
before surgery. Some medical and dental problems, if untreated,
could cause an infection in your new shoulder. Your doctor may also
change your medications. Plan ahead for help with household chores
during your recovery.
Your General Health
Your primary care doctor will check your general health and may
order lab and other test, such as an ECG (electrocardiogram) to
measure your heart's electrical signals. Your doctor will discuss
any medical conditions that you'll need to take care of before you
have joint replacement surgery.
Your Dental Health
If your surgeon asks you to see a dentist, your dentist will look
for tooth or gum problems that need to be treated. Bacteria and
other germs in the mouth could make their way to your new joint,
causing an infection.
Storing Your Own Blood
In rare cases, a transfusion is needed to replace blood lost during
surgery. All donated blood is tested to reduce risk of transmitting
HIV, hepatitis, and other blood-borne diseases. However, you may
prefer to store one or two pints of your own blood before surgery.
Your doctor can discuss blood donation with you.
Medications
Be sure to tell your doctor about any medications you take. Some
medications can cause interactions with anesthesia. Others, such
as non-steroidal anti-inflammatory drugs (NSAID's) and aspirin,
can cause excess bleeding during surgery. Your doctor may tell you
to stop taking these medications a week or more before surgery.
Planning Ahead
The following tips can help make your home recovery go more smoothly.
- Ask your doctor how to prevent constipation after surgery.
- Arrange for help with dressing, cooking, and driving. You may find it hard to raise your arm very high for the first few weeks after surgery.
- Put things that you use regularly within easy reach. And stock up on canned and frozen foods.
Risks and Complications
Your doctor will discuss the possible risks and complications of
your surgery with you. These include:
- Reactions to anesthesia
- Infection
- Damage to blood vessels, nerves, or bones
- Loosening or failure of the prosthesis
Your Shoulder Surgery
You'll probably be asked to arrive at the hospital the morning of
surgery. You'll talk with the anesthesiologist, and the nurses will
get you ready for surgery. Then you'll be moved into the operating
room, where your surgery takes place.
Preparing for surgery
You will probably be asked to come to the hospital a day or two
before surgery to register and have test. You'll be told not to
eat or drink anything after midnight the night before your surgery.
You'll also be given a surgery consent form to sign. Be sure to
ask about anything you don't understand on this form.
On the day of surgery you need to arrive at the hospital in time to check in. Then you'll be taken to the pre-surgery area. An IV (intravenous) line will be inserted in your arm to give you fluids and medication. The anesthesiologist will discuss the type of anesthesia you'll be given to keep you free of pain during surgery. You may be given medication to help you relax. When your surgery team is ready, you'll be taken into the operating room, where your anesthesia is started.
Your Shoulder Replacement
Your surgeon may replace just the ball (partial replacement) or
both the ball and socket (total replacement). An incision about
six inches long is made from your collarbone to your arm. Once the
new joint is in place, your surgeon closes the incision with staples
or sutures (stitches).
Your Hospital Recovery
After surgery, you'll go to the recovery area. Once the anesthesia
has worn off and your condition is stable, you can be moved to your
hospital room on the third floor. During your hospital stay, your
healthcare team works to control your pain, get you up and walking,
and start you on an exercise program to gently move and strengthen
your new shoulder. You'll probably stay in the hospital 2-3 days.
Your arm may be in a sling or other support to protect your shoulder
and keep it comfortable. Your arm and shoulder may also be swollen
and bruised.
Your Recovery At Home
At home, your goal is to return safely and comfortably to your normal
activities. To get the most from your new shoulder, you need to
take an active role in your recovery. Be sure to continue your exercise
program and see your surgeon for follow-up exams.
The First Months
Remember that it takes 3-6 months for your shoulder to heal. Fractures
heal even more slowly. It may take up to a year to develop full
strength and motion. You will have some pain and swelling at first.
Your doctor may prescribe medication and suggest you use an ice
bag. You may also continue to use your sling. Your exercise program
will include more active use of your arm and shoulder. Do your exercises
exactly as directed to regain maximum strength and movement.
Checking Your Progress
Your sutures or staples will be removed 10-14 days after surgery.
Your surgeon may continue to check the range of motion and strength
in your shoulder for the first year after surgery. Be sure to keep
all your appointments and ask any questions you may have. Your doctor
may also recommend that you take antibiotics before you have dental
work or surgery.
Call Your Doctor If You Have
- Increased pain
- Drainage, redness, or swelling around the incision
- A fever over 101 degrees
Returning to Work
When you can return to work depends on your surgery and the type
of work that you do. You may be able to go back to a desk job within
a few weeks. Your doctor may tell you to resume some tasks gradually
or to avoid other tasks until your shoulder heals. You recovery
will take longer if your work is more physical. In some cases, your
doctor may advise you to change the kind of work you to and avoid
overusing your shoulder.
Back in the Swing
After shoulder replacement you can look forward to less pain and
stiffness. You may also have more strength and movement in your
shoulder and arm and be able to return to many of the activities
you enjoy-like golf, swimming, bowling, gardening, or playing with
your grandchildren.
If you follow your exercise program and protect your shoulder, you'll probably be back in the swing of things within a few months. But remember that your new shoulder is not designed for heavy impact. Think of it like the tread on a tire: It will wear out faster with hard use. So, you may want to make some choices about how you use your new shoulder.
