Shoulder Replacement – All You Need to Know

We are all familiar with knee and hip replacement surgeries and their benefits in facilitating a good quality of life. Shoulder replacement surgeries are less common but in no way less beneficial.

It is only when we have debilitating shoulder pain do we realize how much we are dependent on our shoulder joints for normal activities. Whether we want to reach overhead to get something or just simply slide open a door, our shoulder joint’s role in these everyday activities often goes unnoticed, till a problem crops up.

If all other non-invasive options for shoulder joint pain treatment have been exhausted, your orthopedic doctor will suggest shoulder replacement surgery as an option.

Understanding the Anatomy of the Shoulder Joint 

• A joint is the meeting place of two or more bones.
• The shoulder joint sees the meeting of three bones – the upper arm bone, the shoulder bone and the collar bone.
• The upper arm bone ends in a ball which fits into the socket of the shoulder blade forming the shoulder joint.
• The ends of the bones near the joint are encapsulated in a thin cartilage to allow smooth joint movement.

Shoulder Pain – Possible Causes

A person may suffer from shoulder pain due to a number of causes, a few of which are listed below:

• Osteoarthritis: An age-related condition, osteoarthritis results when the cartilage covering the bones degenerates. As a result, the bones rub against one another and cause pain. Osteoarthritis usually affects adults aged over 50 years; rarely younger people are affected.
• Rotator Cuff Injuries: There are a group of tendons and ligaments that surround the shoulder joint and support it. They are collectively called the rotator cuff and injuries to this rotator cuff can also affect the shoulder joint and cause pain.
• Rheumatoid Arthritis: An autoimmune condition in which the body’s immune system attacks its own tissues, RA can affect the cartilage of joints and sometimes the bone itself leading to pain.
• Osteonecrosis: When the supply of blood to the bones is cut off, starved of oxygen, the bone cells die leading to osteonecrosis. When the shoulder bones are deprived of blood, osteonecrosis of shoulder happens leading to shoulder pain.
• Fractures: When the shoulder bone is subjected to severe trauma, the bones might be so badly broken that it may not be possible to set them right. In such a case, shoulder replacement might be suggested.

 Factors That Lead to Shoulder Replacement

A surgery is always the last option suggested only when other non-invasive options have failed to reduce pain and allow mobility. A patient will decide to go ahead with shoulder replacement when:

• The pain is so bad that it continues even when the shoulder is immobile.
• The pain affects a person’s sleep.
• The pain makes normal routine actions a challenge.

Lead up to Surgery 

• The orthopedic doctor will start by reviewing the medical history of the patient.
• He will examine the patient to determine the range of movement of the shoulder joint.
• Investigations like x-ray will be done to determine bone damage.
• Additionally, blood investigations, MRI etc. may also be done. An MRI will help determine the strength of the bone and will also show any problems with the ligaments and bursae.

Based on the investigation results, the doctor will discuss the viability of surgery with the patient.

Types of Shoulder Replacement 

Shoulder replacement surgery involves removing the damaged part of the bone and replacing it with artificial implants. Depending on the amount of damage suffered by the bone, one of the following procedures will be done.

• Total Shoulder Replacement: Here, both the ball and socket of the shoulder joint are replaced with implants.
• Reverse Total Shoulder Replacement: In this case too, the ball and the socket are both replaced but their positions are reversed i.e., the ball implant is placed at the shoulder bone and the socket is placed at the end of the upper arm bone.
• Partial Shoulder Replacement: When the ball end of the upper arm bone alone is damaged, that alone is replaced with an implant. The socket is left as it is.

Surgery – What to Expect 

• It is important to reveal to the doctor any medication the patient might be on as it might be necessary to stop some of these a few weeks prior to surgery.
• The patient will be checked by the anesthetist to decide on the type of anesthesia to be administered.
• Admission to the hospital will be on the day of surgery and the entire surgical procedure will take a maximum of two hours.
• After surgery, the patient will be given antibiotics to prevent infection.
• It is important to remember that for a few weeks after surgery, daily tasks which involve the shoulder might be painful. So, prepare ahead by moving essential articles to accessible places so that after surgery some degree of independence is retained.
• Involving friends and family in the rehabilitation is important as the patient will initially need help after surgery.
• The patient may need to stay 1-2 days at the hospital as advised by the doctor.
• Pain after any surgery is expected. The doctor will prescribe pain medication to handle it.
• Physical therapy will be started after surgery. If the pain is too intense and the patient is unable to perform physical therapy, the doctor should be consulted for any change in medication.
• Physical therapy is crucial for successful shoulder mobilization and should not on any account be taken lightly.
• The doctor will advise the patient on how to take care of the wound after discharge. Usually, the wound will have to be kept dry until it has healed completely.

At Home 

These are some of the instructions that will be given on discharge:

• Any kind of heavy lifting is to be avoided.
• Avoid applying pressure on the shoulder.
• Absence of pain does not mean the operated shoulder should be pushed more. Slow and steady progress is always best.
• Contact sports are also to be avoided.
• Avoid awkward positioning of arm or shoulder.

Shoulder replacement surgeries have a high success rate. Patients regain functionality of their shoulders and also experience great improvement in pain. As a result, their quality of life is greatly enhanced and their mental health too improves.