Shoulder joint replacement is surgery on the joint to replace the damaged parts to relieve the patient's pain and improve his ability to move.
Overview of the shoulder joint
The scapula humeral joint consists of a concave cavity in the scapula bone called the glenoid cavity, offset by a rounded surface called the head of the humerus. Hence, the joint takes the shape of a ball and a socket and enables the person to move his arm within a range of motion at an angle equal to 135 degrees.
The scapula-humeral joint is surrounded by several ligaments, tendons, and muscles that support and enhance its work. Within it, a lubricating capsule facilitates its movement and has arterial supply and nerve nutrition.
Injuries that require a shoulder joint replacement
All of the following joint injuries require shoulder replacement surgery:
- rheumatoid arthritis
- Post-traumatic arthritis
- Rotator cuff arthropathy (a group of muscles surrounding the joint)
- Avascular necrosis
- severe fractures
- Failed previous joint replacement
Symptoms that require a shoulder joint replacement surgery
You can consult a doctor about a shoulder joint replacement operation if you encounter one of the following problems:
- Severe pain in the joint when performing daily tasks such as changing clothes, for example
- Severe pain when resting and may be enough to prevent you from sleeping
- Loss of movement and weakness in the shoulder joint
- Failure to respond to traditional treatments such as anti-inflammatory drugs, cortisone injections, and physical therapies
Procedures to assess your situation before deciding on shoulder joint replacement surgery
First, the doctor takes your clinical and medical history and performs some clinical examinations. If he suspects a specific diagnosis, he orders some radiographs such as X-rays, magnetic resonance imaging, and computerized tomography.
Types of shoulder joint replacement surgery
Total shoulder replacement
The damaged joint is replaced by a polished metal ball and a plastic cavity suitable for the shape of the ball to settle in.
This artificial joint has two types: supported and unsupported, and the surgeon decides which one to choose according to the patient's condition.
It is not recommended to perform a full artificial shoulder joint replacement if:
- The glenoid cartilage was in good condition
- The glenoid bone in the joint is very weak
- The rotator cuff muscles are irreparably torn
A total shoulder joint replacement is recommended in patients with progressive osteoarthritis and if the rotator cuff tendons are intact.
Half shoulder joint replacement with stem (Stemmed hemiarthroplasty)
In it, the head of the humerus is replaced by a metal ball mounted on a leg that connects it to the humerus, while the intact glenoid cavity remains unchanged.
It is recommended to replace the artificial half-shoulder joint with a leg in the following cases:
- Severe fracture of the head of the humerus with the integrity of the glenoid cavity
- Arthritis involving the head of the humerus only with the integrity of the glenoid cavity
- The glenoid bone is very weak
- Severe rupture of the rotator cuff muscles with arthritis
The surgeon may decide to resort to replacing the total or half joint with a shoulder leg in the operating room at the time of surgery, according to the data available to him after the start of the surgery.
Studies show that patients with osteoarthritis have more significant pain relief with a total shoulder joint replacement than Half shoulder joint replacement with the stem.
Here a replacement of the articular surface of the head of the humerus is performed using a cap (concave socket) over the head.
That is, we do not use a leg to replace the joint surface.
We prefer the replacement of the joint surface in some cases to the replacement of a hemi-joint with a stem sometimes because of its balance in maintaining the integrity of the bones because the change in the joint's bones here is slight.
Joint surface replacement surgery is recommended in the following cases:
- Integrity of the surface of the cartilage of the glenoid cavity.
- No new fractures in the head and neck of the humerus.
- Desire to preserve the integrity of the humerus.
Reverse total shoulder replacement
In the reverse complete shoulder joint replacement, the place of the metal ball and the plastic socket is switched, where the ball is fixed to the bone of the scapula (which contains the glenoid socket). The artificial plastic socket is set above the humerus (which includes the spherical head); that is, the pieces are placed in reverse, allowing The deltoid muscle performs the task of raising the arm instead of the rotator muscles of the palm.
Reverse total shoulder joint replacement is performed on patients with:
- Previous Shoulder Replacement Failed
- Complete rupture of the rotator cuff muscles with severe weakness in the arm
- Complications of severe arthritis and rotator cuff rupture (so-called ruptured cuff arthropathy)
Traditional (non-reversible) total joint replacement for people with pre-existing conditions does not relieve pain. It leaves them unable to raise their arm more than 90 degrees, rendering them unable to perform daily tasks.
Complications of shoulder joint replacement surgery
Replacing the shoulder joint with an artificial joint, like other operations, may result in some complications, which include:
Problems with artificial implants (i.e., in the metal ball and the plastic cavity): It includes the damage and wear of the implants, the occurrence of looseness and lack of stability, their separation from each other, and changing their positions, which leads to additional surgeries.
Sepsis: It may be superficial at the site of the wound or deep at the site of the implant. The management of sepsis depends on its severity and ranges from some pharmacological and topical treatments in mild infection to re-operative work and removal of implants in severe disease.
Nerve damage: The nerves surrounding the joint may be damaged during surgery. Although this is rare, if a nerve is damaged, it often improves with time and may reach complete recovery.
Preparing for surgery for a shoulder joint replacement surgery
Before the scheduled surgery date, you must visit your family doctor (or go to a hospital) for a complete physical examination of all devices to ensure a quick recovery after the operation.
Your surgeon should ask you about the medications you take regularly. Some medicines must be stopped two weeks before the surgery, such as:
- Non-steroidal anti-inflammatory drugs such as ibuprofen, aspirin, and naproxen
- Also, most arthritis medications should be stopped
- If you are taking blood thinners, you should consult a cardiologist before surgery to tell you when to stop them
Planning at home before surgery
After the surgery, you may not be able to raise your arm to fetch cups and equipment in your home from high shelves and cupboards in the kitchen, so it is recommended that you lower your essential tools at home to lower levels before the operation.
Also, you will need someone to help you with some of your daily tasks at home in the days following the operation. If this person is unavailable, staying in rehabilitation centers is recommended until you can do your daily tasks well.
Shoulder joint replacement surgery
Before the operation
You must wear loose-fitting clothes such as a half-sleeved shirt when you go to the hospital. After the surgery, your arm will be fixed by a shoulder strap (hanging cloth) to ensure that the movement of the arm is limited.
When you go to the hospital, you will meet your surgeon and anesthesiologist and be prepared for surgery in the operating room.
General anesthesia is often used for shoulder joint replacement.
Replacing the shoulder joint with an artificial device takes about two hours.
After the shoulder joint replacement is completed, you will be taken to the recovery room, where it is checked that the effect of the anesthetic is gone, and then you will go to your hospital room.
Recovery after shoulder joint replacement surgery
Your doctor will prescribe antibiotics to prevent infection, you will be able to get out of bed after surgery, and you will be able to go home during the first three days after surgery.
Pain management after shoulder joint replacement surgery
Feeling pain after surgery is normal and is part of the recovery process. Your doctor will work to relieve this pain for you by prescribing some short-acting analgesics such as NSAIDs, local anesthetics, or even opioids.
He will often combine these medications to reduce the dose of opioids given because they are narcotic and addictive.
Morphine is only taken with a doctor's prescription and should be stopped when the pain improves.
If the pain does not improve within the next few days after surgery, you should talk to your doctor.
Managing the pain is essential because it speeds up your recovery. You must go through physical therapy sessions to regain your strength as soon as the pain is gone.
Rehabilitation from shoulder joint replacement
A careful and well-thought-out rehabilitation program is critical and essential to the success of a shoulder replacement.
A rehabilitation program usually begins with gentle exercises shortly after your shoulder replacement, and your doctor will provide you with a home exercise program to improve the flexibility of your shoulder joint.
Recovery at home from shoulder joint replacement surgery
When you return home, you will be wearing a shoulder sling, which will continue to be used for 2-6 weeks, and the surgeon will decide this.
the activities: Exercise is essential to home care, especially during the few weeks after surgery.
Within two weeks of surgery, most patients can perform daily tasks such as getting dressed, eating, and applying makeup.
Some soreness at night and after doing some work during the weeks following surgery is normal.
You are not allowed to drive a car for 2-6 weeks.
Wound care: The wound will include sutures along the path of the surgical incision or a suture under the skin. As for the sutures, they will be removed after several weeks of surgery. As for the sutures will be dissolvable, so we will not need to remove them.
Avoid immersing the wound in water until it is completely dry and closed.
We usually continue to dress the wound to prevent it from getting irritated by contact with clothing.
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Prohibitions and permits of the shoulder joint replacement operation
The success of a shoulder joint replacement operation largely depends on how you follow your surgeon's instructions at home during the first few weeks after the surgery.
- Follow the exercise program prescribed to you by your doctor. You may repeat the exercises twice or thrice daily for a month or more.
- Do not overdo these exercises, especially in the case of severe pain in the shoulder before surgery, because doing the movements without feeling pain after surgery makes you think that you can do more exercises, which will lead in the future (if you do this at an early stage after surgery) to determine Severe shoulder movement in the future.
- Do not use your operated arm to raise yourself when getting out of bed or from a bench.
- Do not lift anything heavier than a glass of water within 2 to 4 weeks of surgery.
- After you've had your shoulder joint replacement, don't engage in contact sports, and don't lift heavy objects frequently.
Shoulder replacement surgery and artificial joint placement take about two hours.
Shoulder joint replacement surgery is not considered a dangerous operation, especially in the presence of a specialized medical team. Still, it is regarded as one of the primary operations that you may have to stay in the hospital for several days after performing it.
The success of the shoulder joint replacement operation and the guarantee of good results depends on several factors, the most important of which is the skill of the surgeon and your adherence to his instructions after you leave the surgery in the weeks following the operation, because this is a matter that plays a very important role in restoring the strength of your arm and the flexibility of your joint.
Pain after surgery and shoulder joint replacement is normal, so your doctor will prescribe some painkillers, and your pain will gradually ease over the few days.
After undergoing a shoulder joint replacement surgery with a prosthetic joint, you can get up and walk. Still, you do not have to move your arm, and you will wear a shoulder sling for two to six weeks, according to what your specialist doctor decides for you.
You cannot drive a car after a shoulder joint replacement surgery for 2 to 6 weeks; your specialist determines this period.
Studies have shown that people who undergo shoulder joint replacement surgery to relieve severe chronic pain suffer fewer post-operative consequences, have more occasional hospital stays, and cost less than people who experience knee joint replacement.
Wearing a shoulder sling after a shoulder joint replacement may last up to six weeks, and your doctor will decide when to remove it.
Yes, it is a common operation, more than 70,000 people in the United States perform this surgery annually
Those who undergo shoulder joint replacement surgery are between 60 and 80 years old.