The shoulder joint is very complex and involves three bones and more than one joint. These bones are the clavicle (collar bone), the scapula (shoulder blade), and the humerus (upper arm bone). Numerous muscles, ligaments, and tendons surround the joint. The upper end of the arm bone (humerus) and the outside edge of the scapula bone (glenoid) form a “ball-and-socket joint”. This joint is remarkable because it typically allows greater range of motion than any other joint in your body.
Shoulder replacement surgery is most commonly used for severe degenerative joint disease (osteoarthritis) or rheumatoid arthritis of the ball-and-socket joint. When the smooth surfaces (cartilage) of the ball and socket become rough, they rub against each other rather than glide. This rubbing causes pain and stiffness that limits daily activities, as well as interferes with sleep. Other indications that justifies shoulder replacement are severely communited fracture of proximal humerus which cannot be reconstructed and avascular necrosis of humeral head. A shoulder replacement is performed to alleviate shoulder pain. It also helps to improve the range of motion of your shoulder joint, which also improves your function and the quality of your life.
The most common types of shoulder replacement are:
Here, the ball (humeral head) of the shoulder joint is replaced with an implant that includes a stem with a smooth, rounded metal head. The socket (glenoid) is replaced with a smooth, specialized plastic that is cemented into place.
Where only the ball (humeral head) is replaced with metal stem and head.
Here, the normal structure of the shoulder is “reversed.” The ball portion of the implant is attached to the scapula (where the socket normally is) and the artificial socket is attached to the humeral head (where the ball normally is). This allows the stronger deltoid muscles of the shoulder to take over much of the work of moving the shoulder, increasing joint stability. A reversed procedure is use for patients with a severely torn and compromised rotator cuff. It is also commonly used in revision surgery cases.
In most cases shoulder replacement is very successful. Typically patients gain 50 degrees in forward elevation (raising the arm straight ahead). In other words most patients go from raising their arm at or below shoulder level to being able to raise the arm above the shoulder. Similarly, rotation out to the side improves on average by 30 degrees. Rotation behind the back also improves. The survival of the implant is 90 to 95% at 10 years after surgery and approximately 80% 20 years after surgery.
In partial replacements only the ball or just a portion of the ball is replaced. A partial replacement can be successful in select cases depending on patient age and the quality of the glenoid. However, the vast majority of patients will have a better outcome with partial shoulder replacement.
Most people know someone who has had a hip or knee replacement. Knee replacement is the most common replacement surgery performed. Hip is the next most common and shoulder is the 3rd most common. The results of shoulder replacement are similar to hip and knee replacement
Shoulder replacement is performed in the hospital with the help of an experienced, specialized surgical team. The procedure generally takes 2 hours. Afterwards patients stay in the hospital for 3-4 days. To get to the shoulder joint an incision is made on the front of your shoulder. After exposing the shoulder joint, the damaged ends of the bone (humerus and glenoid) are removed. The bone is prepared for the replacement with the artificial joint. The artificial joint is made of metal, usually a titanium or a cobalt-chrome alloy. For a standard shoulder replacement the stem is placed inside the humerus bone. The glenoid component is made of a special plastic (polyethylene). The glenoid is cemented into place. Not all patients require a glenoid component and the final decision to use a glenoid component is made during the surgery. For reverse shoulder replacements the ball is secured to the socket with a press-fit and supplemented with screws. The humeral stem is then press-fit or cemented into place. A high-strength plastic then is placed to act as a spacer between the stem and the ball.
Most people are able to return to normal everyday activities such as dressing themselves and grooming within the first two weeks after successful shoulder replacement surgery. It is good to have someone who can help with daily activities for the first couple of weeks after surgery. When can I shower? In most cases your surgical incision will be closed with absorbable sutures and skin is stitched with staples. Showering may occur 3 days after surgery and a bandage should cover the incision until the 2 week follow-up.
This is for 4 to 6 weeks depending on the type of shoulder replacement surgery. Standard total shoulder replacements and partial replacements require a sling for 4 weeks after surgery. Reverse total shoulder replacements require a sling for 6 weeks.
Return to work will be dictated by your type of work and your desire to return. In general, I advise taking 2 weeks off of work. Immediately after surgery you can move your elbow and wrist up and down. This allows you to eat, drink, write, use a keyboard and do other minimal activities that do not require the use of your shoulder.
Most people return to all of their normal activities after shoulder replacement. In fact, many patients are able to do more because their motion is improved and their pain is decreased. It is recommended that you do not frequently lift over 25 pounds after a shoulder replacement.
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