The shoulder joint is one of the most complex joints in the body. It has a greater range of motion than any other joint and is a ball and socket type joint. It is made up of bone, cartilage, tendons and muscles, all of which are affected to differing degrees by different forms of arthritis.
Arthritis is a degenerative condition where the lining of the joint (the articular cartilage) wears away, leaving a rough and worn joint surface. Chronic (ongoing) shoulder pain and / or loss of movement are the most common reasons for shoulder replacement surgery and are usually age related. Due to similar age related changes, the muscles about the shoulder (the rotator cuff) may tear as well. This reduces the power and movement of the shoulder. Unfortunately this is a progressive disease and it is not reversible.
Early in the disease anti-inflammatory medications, physiotherapy and a reduction of activities may relieve the symptoms of the arthritis. As time goes by the pain and stiffness eventually become unbearable and it is then time to consider a shoulder replacement.
During surgery the damaged parts of the shoulder are removed and replaced with artificial parts (components) called prostheses.
One reason why this type of surgery is not recommended early in the disease process or at a young age is that the artificial shoulder only has a life span of 10 to 15 years. Unless there are exceptional circumstances, shoulder replacement is not recommended in patients under 50 years of age
There are many varieties of shoulder raplacement. This depends on the age, activity level and tye type of arthritis (disease) and the status of your rotator cuff muscles. The prostheses are made of metal and ‘plastic’. These can be ‘cemented’ into place or “press fitted” with screws but the technique will vary depending on the patient’s quality of bone, whether their rotator cuff is intact or torn and whether they have problems with other joints in the body.
Major varieties of replacement are:
Total (anatomical)shoulder replacement
Reverse shoulder replacement
Most patients experience good pain relief. If your rotator cuff muscles are functioning well you should expect to be able to comfortably get your hand over your head. Most people have a good range of motion following surgery but few people ever regain a full range of movement. Success story: Shoulder Replacement
The operation takes about two hours and a cut is made on the front of the shoulder extending into the upper arm. As indicated earlier, the operation involves cutting out the damaged ball and socket and inserting the artificial components with or without repair of the rotator cuff muscle.
When you wake up you will find your arm in a sling and have a drain coming out of the wound. You will most likely be given enough pain killers to keep you comfortable. The drain will be removed and a waterproof dressing will be placed on the shoulder. You are then able to shower but must leave your arm adjacent to your body even when the sling has been removed. It is very important that you do not lift or rotate the arm at any time.
On the second day after the surgery you will start an exercise program under the supervision of a physiotherapist. This is for PASSIVE movements only and are performed with the unoperated arm lifting the operated arm over the head, while lying down. This protects the muscles in the operated shoulder from contracting and potentially disrupting the surgical repair. The shoulder takes about six weeks to heal and the exercises are started early to avoid stiffness following the operation.
Approximately four days after the surgery you may be discharged from hospital. The exact timing of the discharge will depend on your pain level, your progress with the exercise program and your home situation.
Once you get home you will need to do exercises four times a day for six weeks. These are passive exercises only and you will not need to see a physiotherapist during this time unless you have difficulty doing the exercises yourself. You will be seen approximately two weeks after the surgery for your stitches to be removed and your movements checked. If the movements are a little slow you will see a physiotherapist but if you are making satisfactory progress your physiotherapy will not start for six weeks. It is important to do your exercises at least four times a day, every day.
You may use your hand for gentle activities directly in front of you and may bend the elbow, wrist and hand but must never move the shoulder. It is best to avoid lying or turning onto the affected shoulder.
You should apply ice to your shoulder before and after exercises to reduce pain and swelling and must not use a heating pad as this will increase swelling around the joint.
At six weeks post operatively your sling will mostly likely be removed and formal active physiotherapy will be started. At six weeks you will be able to lift objects weighing less than two kilograms. You can move your arm in any direction you desire and your exercises and lifting limits will be upgraded from time to time.This will depend on your clinical progress.
It takes approximately six to twelve months for the shoulder to reach its full potential and the exercises are required for that period of time.
All operations have potential complications, but the rate of complications with this procedure is low. The common ones include but are not limited to infections, nerve and blood vessel damage, dislocations and bone fractures.