Overview
In the United States, the first shoulder replacement surgery was performed in the 1950s to treat severe shoulder fractures. Now, shoulder replacement surgeries are performed to treat arthritis and other painful conditions of the shoulder. According to the Agency for Healthcare Research and Quality, in the U.S., about 53,000 people annually have shoulder replacement surgery. It has proven to be a safe and effective procedure to relieve pain and help patients resume everyday activities.
In shoulder replacement surgery, a prosthesis, an artificial component, replaces the damaged part of the shoulder. Treatment options are either replacing just the head of the humerus bone or both the ball and socket. Shoulder pain and disability is caused by a variety of conditions. Shoulder joint replacement surgery may be recommended by Dr. Stowell if a patient suffers from any one of the following shoulder conditions:
- Osteoarthritis – is a degenerative joint disease caused by age-related wear-and-tear. It usually occurs in people 50 years of age and older in which cartilage that cushions the shoulder bones softens and wears away, causing the bones to rub against each other. The shoulder joint gradually becomes stiff and painful. Osteoarthritis is a very common reason for shoulder replacement surgery.
- Rheumatoid Arthritis – is a chronic type of inflammatory arthritis in which the synovial membrane surrounding the joint becomes inflamed and thickened. This disease can gradually cause cartilage loss, pain, and stiffness.
- Post-traumatic Arthritis – is caused by a serious shoulder injury. The articular cartilage is gradually damaged due to fractures of the bones that comprise the shoulder or tears of the shoulder ligaments or tendons. It limits shoulder function and causes shoulder pain.
- Rotator Cuff Tear Arthropathy – develops from a large, long-standing rotator cuff tear that leads to arthritis and destruction of the joint cartilage.
- Avascular Necrosis (Osteonecrosis) – is a painful condition caused by a disruption in blood supply to the bone. Bone cells die without proper blood supply. Osteonecrosis can gradually destroy the shoulder joint and lead to arthritis.
- Severe Fractures – is a common reason for patients to seek shoulder replacement surgery. When the head of the upper arm bone is shattered, it is challenging for any orthopedic surgeon to put the pieces of bone back in place; moreover, the blood supply to the bone can be greatly interrupted. In this case, Dr. Stowell may recommend shoulder replacement.
- Failed Previous Shoulder Replacement Surgery – A second joint replacement surgery or revision surgery may be necessary, although uncommon. Implants from previous shoulder replacement surgeries can loosen, dislocate, wear, or become infected.
Shoulder Bones
Bones of a healthy shoulder
Treatment
Shoulder replacement surgery may be recommended by Dr. Stowell if you often have:
- Severe shoulder pain that interferes with daily activities or household chores.
- While resting, moderate or severe pain preventing you from getting a good night’s sleep.
- Loss of motion or severe weakness in the shoulder.
- Failure to show substantial improvement with conservative treatment options such as anti-inflammatory medications, cortisone injections, and/or physical therapy.
Dr. Stowell will thoroughly examine whether you will benefit from shoulder replacement. He will gather your medical history, perform a physical examination, order X-rays and other tests. He will evaluate and discuss with you whether shoulder joint replacement is the best method to relieve your pain and improve your function.
Once Dr. Stowell determines that shoulder replacement is the best treatment option for you, your specific case will determine which type of shoulder replacement is most suitable for you:
- Total Shoulder Replacement – replaces your arthritic joint surfaces with a polished metal ball with or without stem and a plastic socket. It may be either press fit or cemented into your bone depending on the quality of your bone. If your bone is soft, the humeral component may be implanted with bone cement. In most cases, Dr. Stowell implants an all-plastic glenoid (socket) component with bone cement. He will decide whether implanting a glenoid component is necessary depending on the state of your cartilage or bone or if your rotator cuff tendon is irreparably torn. Patients with intact rotator cuff tendons and bone-on-bone osteoarthritis are generally good candidates for conventional total shoulder replacement. Studies show that patients with osteoarthritis get better pain relief with total shoulder replacement than from hemiarthroplasty.
- Hemiarthroplasty – replaces only the head of the humerus with a metal ball. Dr. Stowell may recommend this procedure if the humeral head is severely fractured but the socket is normal or if severely weakened bone in the glenoid is present. Dr. Stowell may need to make the decision between a total shoulder replacement and a hemiarthroplasty at the time of surgery in the operating room.
- Resurfacing Hemiarthroplasty – replaces just the joint surface of the humeral head with a cap-like prosthesis that does not have a stem. This is an alternative to the stemmed hemiarthroplasty for those with shoulder arthritis to preserve the humeral bone. Patients may qualify for this procedure if the glenoid still has an intact cartilage surface and the humeral neck or head has not suffered a fresh fracture. It is a more conservative approach and can be easier to convert to total shoulder replacement, if necessary, in the future.
- Reverse Total Shoulder Replacement – is used when patients have completely torn rotator cuffs and suffer from severe arm weakness or had a previously failed shoulder replacement still leaving them with pain or severely debilitating mobility. In reverse total shoulder replacement, the socket and metal ball are switched: A metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. In doing so, the deltoid muscle is leveraged to lift the arm, not the torn rotator cuff.
Dr. Stowell will explain the potential risk and complications of shoulder replacement surgery as well as those that can occur over time after surgery. Possible, highly treatable complications might include the following:
- Infection – is a complication of any surgery. In shoulder replacement surgery, infection may occur at the site of prosthesis or in the wound. Infection may occur after you go home and can occur even years later. Minor infections can be treated with antibiotics; however, major infections may require additional surgery or even removal of the prosthesis. Any infection in your body can spread to the replaced joint.
- Problems with Prosthesis – may include wearing down, loosening, or dislocating of the components, which may require revision surgery.
- Nerve Damage – Although infrequent, nerves surrounding the replaced joint may be damaged during surgery; however, with time, the injured nerves may regenerate and completely recover.
Preparing For Surgery
Dr. Stowell may request a complete physical examination several weeks before surgery to ensure that you are healthy enough to have the surgery and recover optimally. Those patients with chronic medical conditions such as heart disease, may be asked to be evaluated by a specialist like a cardiologist before surgery.
You must inform Dr. Stowell about your current list of medications because some may need to be stopped before surgery. Dr. Stowell may advise you to stop taking blood thinners, non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, naproxen, most arthritis medications, about two weeks prior to surgery.
Home planning after surgery is important for an easier recovery. Making simple changes for the first several weeks after surgery will allow you to perform daily activities with much more ease like placing any items you regularly access on low shelves. You may need some help dressing, bathing, cooking, and laundry for the first few weeks after surgery.
Surgery
Wear loose-fitting clothes and a button-front shirt when you arrive at the hospital for your surgery. You will go home with a sling and have limited use of your arm. Once admitted to the hospital, you will be taken to the preoperative preparation room and will meet your anesthesiologist who will discuss the type of anesthesia to be used during your surgery. You may be given a general anesthetic, which makes you sleep the entire operation, a regional anesthetic localized to the area of surgery only, or a combination of both types.
Your procedure to replace your shoulder joint with Dr. Stowell usually takes about an hour. After surgery, you will be transferred to the recovery room to recover from the anesthesia for several hours. Once you wake up, you will be taken to your hospital room.
Recovery
To prevent infection, you will be given several doses of antibiotics. Most patients are able to eat solid food and get out of bed the day after surgery and most even go home the same day after surgery.
As with any surgery, you will feel some pain. This is a natural part of the healing process. Dr. Stowell and his medical team will work to reduce your pain, which will help you recover from surgery more quickly. He may prescribe opioids, non-steroidal anti-inflammatory drugs and local anesthetics or a combination of these medications to help you with your pain. Opioids have become a critical public health issue in the U.S. due to its narcotic and addictive qualities. Dr. Stowell may air on the side of minimizing opioid usage and will suggest to stop taking them as soon as your pain begins to improve.
When you leave the hospital, you arm will be in a sling to protect and support your shoulder for the first 2 to 6 weeks after surgery. If Dr. Stowell used sutures beneath your skin, it will be dissolvable and will not need removal. Avoid soaking your wound in water until it has thoroughly healed. You may continue to use bandages to cover the wound from irritating against clothing.
During the first few weeks of surgery, your at-home exercise will be a critical component to regaining strength. Once you have managed your pain, the in-house physical therapy team will help you gain your strength back more quickly and increase your mobility. Your physical therapists will work closely with Dr. Stowell in creating a careful, well-planned rehabilitation program that is critical to the success of your shoulder replacement recovery. Dr. Stowell may provide you with an at-home exercise program to strengthen your shoulder and improve flexibility.
Do’s and Don’ts After Surgery
Your success after surgery will depend largely on how well you follow Dr. Stowell’s instructions at home. Here are some common do’s and don’t upon your return to home after surgery:
- DO follow the home exercises that Dr. Stowell has prescribed for you.
- DO ask for help so you don’t overdo it! If you dealt with extreme pain before surgery, your pain-free motion after surgery may lull you into thinking that you can do more than is prescribed. Early overuse may severely limit your motion and hinder your recovery.
- DON’T drive until Dr. Stowell has confirmed you to do so.
- DON’T use your arm to push yourself up in bed or out of a chair. It will require forceful contraction of muscles that are trying to recover.
- DON’T participate in contact sports or do any repetitive heavy lifting until advised to do so.
- DON’T place your arm in any extreme position such as straight out to the side or behind your body for the first 6 weeks after surgery.
Dr. Stowell loves being on the front-end of technological developments to offer you the best treatment options. He is a part of ongoing efforts to design and develop newer and better shoulder replacements, using less invasive surgical techniques. Thousands of patients continue to benefit from total shoulder replacements, experiencing less pain, improved range of motion and strength, and better overall function.