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Shoulder replacement is a surgical operation to replace damaged shoulder with an artificial joint made of metal and plastic. The most common reason for shoulder replacement surgery is osteoarthritis and rheumatoid arthritis.
Although shoulder replacement surgery is less common than hip or knee replacement, it is as safe and successful. Shoulder replacement surgery is used when other non-surgical treatments have failed.
You should consider a shoulder replacement surgery if you have these symptoms:
• persistent pain and stiffness in your shoulder that interferes with your daily activities and restricts your shoulder motion
• severe pain even when you rest and sleep
The operation can relieve pain, improve your mobility and the overall quality of life.
Who is it suitable for
✔ Patients diagnosed with osteoarthritis and rheumatoid arthritis
✔ People experiencing severe shoulder pain and stiffness
✔ People with a shoulder cartilage degradation, causing bones in the joint to rub against each other, generating persistent pain and discomfort
✔ Patients who have suffered a significant loss of motion in their shoulders, limiting their quality of life
✔ Individuals with a shoulder fracture which requires reconstruction of the shoulder joint
✔ A shoulder replacement surgery normally takes around 1-3 hours
✔ Most patients need to stay in hospital overnight
✔ The complexity and duration of shoulder replacement vary from patient to patient, depending on their individual situation
✔ After surgery you will need to undergo rehabilitation process including physiotherapy and occupational therapy, to strengthen the new joint and improve flexibility
✔ After about 3 months you should be able to get back to most of your normal activities
✔ For some people, it takes 6 to 12 months to feel the see the full benefit of the shoulder replacement
Types of shoulder replacement surgery
Your surgeon will have a conversation with you regarding what type of shoulder replacement you may need. There are generally five types of shoulder replacement surgery:
• Hemiarthroplasty - In this procedure only the ball and stem are replaced. The stem is connected to the ball and articulated with your natural socket.
• Resurfacing hemiarthroplasty - This involves replacing the joint surface of the humeral head with a cap-like prosthesis, without a stem.
• Anatomic total shoulder replacement - The arthritic joint is replaced with a highly polished metal ball attached to a stem on the humeral side, and a plastic cup on the glenoid socket.
• Stemless total shoulder arthroplasty - This is a bone-preserving version of the total shoulder arthroplasty where the metallic ball is attached to the upper arm without a stem.
• Reverse total shoulder replacement - In the reverse total shoulder replacement, the joint is literally reversed meaning the metal ball is placed where the glenoid socket was and a plastic cup is attached to the stem and is moved to the upper arm bone (humerus).
Before The Treatment
Shoulder replacement is a serious intervention and preparation is similar to any other surgery. Before the surgery you will meet your surgeon to discuss your surgery objectives and perform an examination:
• Goals and expectations - Your surgeon will likely ask you why do you want a surgery and what are your expectations. A surgeon should explain you potential risks, recovery and expected outcomes.
• Medical history - You should provide a complete medical history including your past and current medical conditions, chronic illnesses, previous surgeries, traumas and injuries. A surgeon will ask you about your shoulder function, pain and how it affects your daily life.
• Medication review - Prepare to provide a list of medications that you might be taking including prescription drugs, supplements, over the counter medication and anything else that you are taking regularly.
• Examination - A surgeon will examine your before surgery and assess shoulder motion, stability and the overall function.
• Diagnostics, tests and additional examination - It is likely that you will be asked to do an X-ray and/or MRI (magnetic resonance imaging) to determine the extent of the knee problem and it's deformity. Be prepared to undertake additional examination, diagnostics, a specialist consultation and blood tests if your surgeon requests before preceding with this treatment.
Before the surgery you will be advised by your surgeon how to prepare for this procedure, which may include dietary requirements and medication directions. It's recommended that you arrange for help during recovery and someone to drive you home from a hospital.
What does it involve?
There are different types of shoulder replacement, but generally the following is involved:
• This procedure is generally performed under general anaesthetic.
• The shoulder replacement procedure will start with making incisions around the treated area.
• Joint parts are then removed and artificial prothesis is placed. There are different types of prothesis available nowadays on the market, so you can discuss which kind of prosthesis will be placed in your case with your doctor before surgery.
• Drain tubes may be placed through the incision to drain any excess fluid and blood.
• At the end, sutures are applied to close the incisions.
• A bandage may be applied to reduce swelling and bruising.
A shoulder replacement surgery normally takes around 1 to 3 hours.
After the treatment
Depending on the complexity of the operation and your situation you may need to stay in hospital for 1 to 3 days. After surgery you will be placed in a post-surgery care unit where a medical team will be monitoring your vital signs and help you manage pain and any other post-surgery symptoms. You will most likely have dressing and a tube on your shoulder for drainage, which should be removed the day after surgery. Once you are in a stable condition you will be moved to an inpatient room for further recovery.
It is likely that after surgery you will need to wear an arm sling to give support and protection to your shoulder. It is common for patients to fell some pain after surgery. Your doctor will help you to reduce your pain by giving you necessary medication.
At the hospital you will be given advise about recovery and how to look after your shoulder. Your therapist will help you sit up, get in and out of bed, and show you specific exercises for your shoulder to continue doing them at home for further recovery. These exercises are fairly simple and usually require only a short amount of time. Bring loose-fitting clothing with you, as this will make dressing easier. You’ll be able to shower after 48 hours.
After 2 or 3 months most patients are able to resume everyday activities. A successful outcome to your total shoulder joint replacement depends heavily on the meticulous performance of your exercises. Through this structured exercise program, your muscles will be methodically and progressively stretched and strengthened over one year's time.
Shoulder replacement surgery is considered safe and effective. However, very rarely, complications can include:
• blood clots (deep vein thrombosis, or DVT)
• shoulder dislocation, especially in the first few months after surgery
• nerve and blood vessel injury
• swelling and stiffness
• continued pain
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