Procedures
|
Reproduced with permission
from Your Orthopaedic Connection. ©American
Academy of Orthopaedic Surgeons. |
Shoulder replacement
is a procedure that is done for the severely arthritic
joint, and
only after
other forms of treatment, such as
medication and physical therapy, no longer have
any benefit.
The shoulder is a ball and socket joint.
The head of the humerus (arm bone)
is the ball
and the glenoid
(part of the shoulder blade or scapula)
is the socket. The shoulder bones
are held together
by muscles and
ligaments, and cushioned by cartilage.
Wear and tear, injury,
inflammation and/or previous surgery all contribute
to the
arthritic process.
As the arthritic process develops,
the cartilage wears out, and the
nerve endings
that lie
beneath the surface become irritated
and produce the
symptoms of pain. This joint destruction
makes the shoulder
stiff, painful and unable to carry
out its normal functions.
Because there are many conditions
that can lead to a painful joint,
the shoulder
surgeon
must
find out
whether arthritis is the cause
of the problem. The surgeon must
also
consider
other possibilities
such
as rotator cuff damage, frozen
shoulder, and shoulder pain from
neck arthritis.
If your orthopedic surgeon determines
that arthritis is the cause
of the problem in
your shoulder,
he/she will let you know if
shoulder replacement surgery is likely to be helpful.
Shoulder replacement involves
removing the diseased portions
of the joint
and replacing them with
new parts. Shoulder replacement
surgery provides a new
metal ball for
the humerus, and
a
new plastic liner for the glenoid
(socket). Many
times, arthritis
affects the ball
much more severely
than the socket. In these
instances, the ball may
be replaced and
the socket left
alone.
This is
known as a hemiarthroplasty,
that is, half a joint replacement.
The metal ball replacing
the humeral head is anchored
to
the humerus
by a stem that
fits
into the canal
of the humerus. The stem
is either held by cement
(polymethylmethacrylate)
or
coated with a surface
that allows new bone
to grow into the stem. When
the glenoid
(socket)
is
replaced, a
plastic (ultra-high
molecular-weight polyethylene)
socket is
cemented in place.
The surgery takes about
2 hours to complete.
Patients are usually
in
the hospital
for 2-3 days after
the surgery.
Therapy starts immediately
after the procedure.
Strengthening the
weakened muscles and
soft tissue surrounding
and supporting the
joint requires a
longer-term program of exercise
and
physical therapy.
Although many patients
see and feel immediate
benefits, they must
continue
to rehabilitate
themselves
for
several months
to get the total
benefit. Recovery of strength
in
the shoulder can
take up to a
year.
Anesthesiology has
come a long way
in the last
twenty-five
years. There
are
newer,
more stable
drugs, and there
is more accurate
and more complete
monitoring.
There are, however,
some risks
involved that are
largely related
to the severity
and amount
of underlying
diseases, such
as heart disease,
atherosclerosis
(hardening
of the arteries)
or
lung problems.
With
an increase
in the severity
of these conditions,
there is,
naturally,
an increase in the
risk.
Nevertheless,
the safety
record of anesthesia
today is
very high.
It is essential
that patients
tell their
surgeon and
anesthesiologist
about all
of the medical
conditions
they have,
as well
as all the
medicines
that they are
taking.
Most
patients
are
admitted to the
hospital
the
day of surgery.
Prior
to
surgery the shoulder
that
is
being replaced
will
be
thoroughly cleaned
with
an
antibacterial
surgical
sponge.
During the first few days after surgery
there is
naturally some
pain. However,
pain can
be adequately
controlled by
medication.
In
spite of
any mild
discomfort, it
is important
that patients
make the
effort to
do the
deep breathing
and physical
therapy exercises
as instructed.
Patients who
breathe well
and work
at strengthening
their muscles,
improve their
lung capacity
and circulation,
and tend
to get
well faster.
There
are also
certain restrictions
that may
be placed
on patients
early in
the postoperative
period in
order to
avoid unusual
strains on
the joint
that could
result in
dislocation of
the joint
or disruption
of the
sutures. The
nurses and
therapists are
very familiar
with the
procedures and
will give
instructions that
can be
easily implemented.
Most people who have shoulder replacement surgery
are able to sit up and get out of bed with some
help later on the day of surgery.
A physical therapist may begin gentle exercises
of your shoulder on the day of surgery or the
day after. These exercises are just passive motion,
which means you relax and let the therapist move
your arm for you.
Your therapist may also begin some simple exercises
to keep the muscles of your other arm and your
legs strong.
Rehabilitation is not too demanding early on,
but it is very important that you do the
exercises. The main goal of rehab is to allow you
to move
your shoulder as far as possible so it's
easier for you to do daily activities, such as
dressing,
cooking, and driving. Most people eventually
regain
about two-thirds of normal shoulder motion
after surgery. But other things that affect
how much
movement you get after surgery are how much
movement you had before surgery and whether
the soft tissues
around your shoulder were also damaged. It
is very important that you take part in physical
therapy
both while you are in the hospital and after
you are released from the hospital to get
the most
benefit from your surgery.
Many
patients, especially
those who
live alone,
are concerned
about whether
or not
they will
be able
to manage
for themselves
in the
first few
weeks after
they leave
the hospital.
In addition,
if they
should need
assistance, they
are concerned
about who
will pay
for it.
Insurance
coverage for
home care
is generally
limited, but
there are
agencies available
that can
provide some
help. Someone
can visit
the home
and show
patients how
to adapt
everyday activities
to accommodate
joint limitations
during the
healing process.
A
home health care agency can
assist with needs
like bathing and
dressing.
The hospital
Social Services
Department can
direct patients
to these
agencies.
Mid
Coast Hospital's
care coordinators
will work
with the
patient to
ensure that
the transition
from the
hospital to
home is
as seamless
as possible.
Patients
sometimes benefit
from going
to a
rehabilitation
facility
after they
are discharged
from the
hospital. The
decision about
whether to
go to
a rehab
facility or
directly home
is made
by the
patient, but
the orthopedic
care team
will make
their recommendation
based on
the progress
that a
patient makes
in the
first several
days after
surgery.
With
shoulder
replacement,
the surgeon
replaces the
diseased
shoulder
joint and,
along with
the physical
therapist,
occupational
therapist
and
nursing staff,
guides
the
patient through
the recovery
process.
However,
rehabilitation
is
up to
the patient.
The patient
must participate
fully in
the rebuilding
and strengthening
of weakened
muscles. To
get the
total benefit
of shoulder
replacement,
the
patient
must
make a
serious commitment
to doing
the prescribed
exercises
and
developing
and
maintaining
an active life-style. |
