Shoulder Joint Replacement

Similar to other joint replacement procedures, shoulder replacement surgery is generally done to address persistent pain that is not controlled by non-surgical therapy. Less commonly, poor shoulder motion may also be a reason for replacement surgery.

The shoulder is a ball-and-socket joint, with the top of the arm bone (humeral head) fitting into a socket known as the glenoid. Muscles and tendons, such as the rotator cuff, help hold the joint in place. Surgery involves replacing the humeral head and the glenoid with artificial components. The humeral head replacement is generally made from a metal alloy, while the glenoid component is made from polyethylene plastic. The new components may be anchored by cement or press-fit into place so that the bone grows in around them.

During surgery, a three- to four-inch incision is made along the space between the arm and the collarbone. The procedure lasts about 90 minutes, and the incision is then closed with staples or stitches. Patients typically stay in the hospital for one to two nights, and full recovery usually takes six to 12 weeks.

Rehabilitation

Arthritic shoulders are stiff. One of the major goals of total shoulder replacement surgery is to relieve much of this stiffness. However, after surgery scar tissue will tend to recur and limit movement unless motion is started immediately. This early motion is facilitated by the complete surgical release of the tight tissues so that after surgery the patient has only to maintain the range of motion achieved at the operation. Later on, once the shoulder is comfortable and flexible, strengthening exercises and additional activities are started.

A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. You usually start gentle physical therapy on the first day after the operation. You wear an arm sling during the day for the first several weeks after surgery. You wear the sling at night for 4 to 6 weeks. Most patients are able to perform simple activities such as eating, dressing and grooming within 2 weeks after surgery. Driving a car is not allowed for 6 weeks after surgery.

Here are some "do's" for when you return home after your shoulder joint replacement:

• Do follow the program of home exercises prescribed for you. You may need to do the exercises 4 to 5 times a day for a month or more.
• Do ask for assistance. Your physician may be able to recommend an agency or facility if you do not have home support.
• Do avoid placing your arm in any extreme position, such as straight out to the side or behind your body for the first 6 weeks after surgery.

Many thousands of patients have experienced an improved quality of life after shoulder joint replacement surgery. They experience less pain, improved motion and strength, and better function.

Here are some "don'ts" for when you return home after your shoulder joint replacemen:

• Don't use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.
• Don't overdo it! If your shoulder pain was severe before the surgery, the experience of pain-free motion may lull you into thinking that you can do more than is prescribed. Early overuse of the shoulder may result in severe limitations in motion.
• Don't lift anything heavier than a glass of water for the first 6 weeks after surgery.
• Don't participate in contact sports or do any repetitive heavy lifting after your shoulder replacement.

Frequently Asked Questions about Shoulder Joint Replacement

• What are the symptoms to detect Shoulder Replacement?

Patients with arthritis typically describe a deep ache within the shoulder joint. Initially, the pain feels worse with movement and activity, and eases with rest. As the arthritis progresses, the pain may occur even when you rest. By the time a patient sees a physician for the shoulder pain, he or she often has pain at night. This pain may be severe enough to prevent a good night's sleep. The patient's shoulder may make grinding or grating noises when moved. Or the shoulder may catch, grab, clunk or lock up. Over time, the patient may notice loss of motion and/or weakness in the affected shoulder. Simple daily activities like reaching into a cupboard, dressing, toileting and washing the opposite armpit may become increasingly difficult.
How do I know if I am ready for shoulder replacement surgery?
Patients who have tried the usual treatments for shoulder arthritis, but have not been able to find adequate relief, may be a candidate for shoulder replacement surgery. Patients considering the procedure should understand the potential risks of surgery, and understand that the goal of joint replacement is to alleviate pain. Patients generally find improved motion after surgery, but these improvements are not as consistent as the pain relief following shoulder replacement surgery.

• How long is the recovery following shoulder replacement surgery?

Hospital stays vary from one to three days for most patients. You will be sent home wearing a sling and you should not attempt to use the arm except as specifically instructed by your doctor.

Most physicians will begin some motion immediately following surgery, but this may not be true in every case. Usually within two to three months, patients are able to return to most normal activities and place an emphasis on strengthening the muscles around the shoulder and maintaining range of motion.

• What are the symptoms of severe arthritis of the shoulder?

Common symptoms of shoulder arthritis include:

• Pain with activities
• Limited range of motion
• Stiffness of the shoulder
• Swelling of the joint
• Tenderness around the joint
• A feeling of grinding or catching within the joint

Can rehabilitation be done at home

In general the exercises are best performed by the patient at home. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program.

When can I return to ordinary daily activities?

In general, patients are able to perform gentle activities of daily living using the operated arm from two to six weeks after surgery. Walking is strongly encouraged. Driving should wait until the patient can perform the necessary functions comfortably and confidently. Recovery of driving ability may take six weeks if the surgery has been performed on the right shoulder, because of the increased demands on the right shoulder for shifting gears.

With the consent of their surgeon, patients can often return to activities such as swimming, golf and tennis at six months after their surgery.