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What causes damage to the shoulder?
Following are some of the causes of shoulder damage:
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Osteoarthritis: This is a condition where the cartilage that covers the ends of bones is damaged. It is also called wear and tear arthritis.
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Rotator cuff injuries: Injury to the rotator cuff (group of muscles and tendons surrounding the shoulder joint) can lead to cartilage and bone damage in the shoulder joint.
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Fractures: Fractures in the shoulder joint damages the bones in the region and require replacement surgery.
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Rheumatoid arthritis: It is a self-immune inflammatory disease that occurs when the immune system affects the healthy cells in the body and causes inflammation to the joints.
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Osteonecrosis: In this condition, blood flow to the humerus (the long bone of the upper arm that extends from shoulder to the elbow) is affected and eventually, the bones are damaged due to lack of blood.
When do you need shoulder replacement surgery?
The patient is subjected to this surgery for the following reasons:
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Severe pain due to shoulder arthritis
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Stiffness in the shoulder and hand
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Grinding or grating sensation in the shoulder
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Cartilage tear which results in severe pain while moving the hand
How is this surgery done?
The orthopedic surgeon will go about recommending one of the below shoulder replacement options based on the severity of joint damage with the patient.
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Hemiarthroplasty: In this procedure, the ball (the humeral head) is replaced by connecting the metal stem to the ball with the help of a natural socket (the glenoid).
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Resurfacing Hemiarthroplasty: This procedure doesn’t involve the stem, rather replaces the joint surface of the humeral head with a closure like prosthesis.
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Anatomic Total Shoulder Replacement: This procedure involves replacing the arthritic joint with a metal ball connected to the stem on the humerus and a plastic cup on the glenoid socket.
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Stemless Total Shoulder Arthroplasty: This is an updated bone preserving version of total shoulder replacement, but this doesn’t involve connecting a stem, rather a metallic ball is attached to the upper arm.
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Reverse Total Shoulder replacement: In this procedure, the total shoulder replacement surgery is just reversed, by connecting the plastic cup on the humeral side and the metallic ball on the glenoid socket.
The patient will be sedated with general anesthesia or regional anesthesia for any of the above procedures. The surgery lasts for about 1-2 hours after the patient is moved to the operating room.
The surgeon will first separate the deltoid and pectoral muscles carefully in order to make space to work on the shoulder without damaging the nerves. One of the muscles of the rotator cuff is cut open to reach the arthritic parts of the shoulder ball and socket. The damaged sections of the joint, typically the arthritic sections, are removed and the implant socket, the ball and the stem components are placed. The metallic ball is connected to the stem on the humeral side. Finally, the incision on the rotator cuff is closed followed by cleaning and closing the incision made on the skin. A temporary bandage is applied to cover the operated region.
What are the possible risk factors involved in shoulder replacement surgery?
Like any surgical procedure, though rare, a shoulder replacement surgery also has some risks involved as follows:
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Infection on the operated region, which can be treated with the help of antibiotics. This may sometimes require an additional surgery if the infection is severe.
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Dislocation of implants leading to repetition of surgery with new implants
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Very rarely the prostheses and components may get loosened leading again to additional procedures to fix them
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Damage to nerves during the surgery
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Blood clots in the veins after the surgery
Patients with diabetes are more prone to infections and complications.
What can you expect during the post-op care of a shoulder replacement surgery?
After the surgery, the patient will be moved to the outpatient ward, where the patient will be monitored until the anesthesia wears off. This will normally take 1-2 hours after the surgery. X-rays are done on the operated region to check if the replacement has come out well.
The recovery depends on the individual and normally people will be asked to leave on the same day of the surgery. The doctor also prescribes antibiotics to relieve discomfort in the operated region after the patient is fully awake and to not develop any infection. The patient will be encouraged to get up and walk to get rid of post-surgery stiffness. The physiotherapist will teach the patients some light exercises to be followed at home.
The following post-op care are advised by the Apollo doctors:
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Avoid driving until the shoulder bones are completely healed
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Avoid lifting heavy weights and strenuous exercises as it may lead to complications on the operated spot
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Avoid moving the arm unless advised by the physician
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Follow the prescribed medicines
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Let your doctor immediately known if you have signs of developing fever or any kind of infection.
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