Shoulder Replacement Fundamentals
Shoulder replacement is similar in concept to total knee replacement and total hip replacement. When arthritis has damaged or destroyed the shoulder joint, it may be replaced with a metal ball and plastic socket. The damaged surfaces of the bone are replaced.
Shoulder replacements have been performed since the 1950’s, and fewer are done compared to hips and knees. When the procedure is done well, a motivated patient can often return to such activities as golf, swimming and tennis.
Total shoulder replacement is most frequently considered for patients who have osteoarthritis, rheumatoid arthritis or other conditions. A physician will exhaust all reasonable non-surgical alternatives of management before contemplating a joint replacement. These include rest, modification of activities, medications and sometimes physical therapy.
What are my treatment options?
Your physician will encourage you to explore the following options before recommending a joint replacement:
- Activity modification
- Physical therapy
- Anti-inflammatory medication
- Pain medication
If pain and disability cannot be managed with a non-operative program, total shoulder replacement can relieve pain and allow much improvement in activity. Some patients may sustain severe trauma with fracture of their shoulder. In those situations, replacement of the shoulder with an artificial joint may be a reasonable option.
Under regional or general anesthesia, the shoulder area is surgically approached through an incision on the front of the shoulder. The arthritic joint is entered. The arthritic surface is removed from the humerus (upper arm bone). The socket of the shoulder is prepared and a plastic liner is cemented in place, much like placing a filling on a tooth. A metal ball with a stem is placed down into the arm bone. The surface of the prosthesis has a special coating that allows human bone to grow into it thereby providing fixation, frequently without the need for cement. The rotator cuff muscles are repaired and the wound is closed. The entire procedure takes about 2 1/2 hours. Some of the details may vary according to the specifics of your condition.
Following the placement of the implant, the muscle and skin layers are closed. Some patients require the placement of a drain overnight.
What are the risks of surgery?
Surgery is frequently performed at Cleveland Clinic and is safe. As with any surgery, risks of infection, nerve and vessel injury, bleeding and wound healing problems do exist, but they occur infrequently. Nursing and medical staff will check your arm frequently to ensure that any problems are identified and treated properly, should they arise.
How do I prepare for surgery?
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your appointment time.
- Refrain from eating or drinking anything after midnight the night before surgery.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens after surgery?
The arm may be placed in a sling for the first 24 hours for comfort. The morning following the procedure, the sling is removed and patients are encouraged to use their arm immediately for simple tasks such as eating, brushing teeth, etc., which are performed at waist height.
The first six to eight weeks are devoted to home exercises that improve motion of the arm above the head, to the side and behind the back. Subsequently, home therapy is advanced to strengthen muscles. Most patients perform their own therapy several times a day for no more than five minutes at a time. Some patients may require the additional assistance of outpatient therapy interaction. Activities such as golf may resume in as little as six weeks.
Be sure to ask your surgeon for complete post-operative instructions.
How long is the recovery period after surgery?
You will become increasingly comfortable with use of the arm as the weeks progress. We will ensure that you have adequate pain medication to be comfortable and to be able to perform therapy. You should be able to dress and feed yourself within the first week. We encourage you to use a computer immediately. Sports activities may resume after about six to eight weeks. You should exercise care in driving and only resume driving when you can handle the vehicle safely.
How can I manage at home during recovery from the procedure?
Most patients become independent in personal tasks within days of the procedure. It is often helpful if a family member assists you, especially with stretching exercises.
How frequently should I schedule follow up appointments with my doctor following surgery?
Your physician will instruct you regarding the timing of your follow-up appointments.
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