Joint replacement involves surgery to replace the ends of bones in a damaged point. This surgery creates new joint surfaces.
In shoulder replacement surgery the doctors replace the ends of the damages upper arm bone (humerus) and usually the shoulder bone (scapula) or cap them with artificial surfaces lined with plastic or metal and plastic.
Shoulder joint components may be held in place with cement or they may be made with material that allows a new bone to grow into the joint component over time to hold it in place without cement. In shoulder replacement all or part of the ghenohumeral joint is replaced by a prosthetic implant such shoulder joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage. Severe shoulder arthritis is quite painful and can cause restriction of motion. While this may be tolerated with some medications and lifestyle adjustments there may come a time when surgical treatment is necessary.
- Full shoulder replacement is a major surgical procedure that involves cutting of skin, tendons and bone. Whereas a partial shoulder replacement consists of replacing only the ball of the shoulder joint. This removes the need for a plastic socket, requires the removal of less bone and has a smaller incision than a total shoulder replacement.
- The pain of this surgery is is managed by anaesthetic and by pain medications. Immediately after the surgery strong medications are often given by injection. Within a day or two oral medications are usually sufficient.
- The surgeon begins by separating the deltoid and pectoral muscles, accessing the shoulder in a largely nerve-free area to minimize nerve damage.
- The shoulder is covered by a rotator cuff, which must be opened by cutting one of the anterior rotator cuff muscles. This opens the door allowing the surgeon to view and manipulate the arthritic parts of the shoulder ball and socket
- After the arthritis sections have been removed the surgeon inserts the implant socket, ball and stem components, closes and stitches the rotator cuff muscle and stitches and cleans the incision after which bandage is applied as a temporary covering
- The shoulder rehabilitation program is started on the day of surgery. The patient is encouraged to be up and out of bed soon after the surgery and to progressively reduce their use of pain medications
- There is another type of shoulder surgery called as Reverse shoulder replacement which is done for patients who have developed rotator cuff arthropathy which is arthritis of the shoulder joint which develops because of a massive rotator cuff tear that is no longer repairable. Reverse shoulder replacement surgery allows for restoration of overhead motion alleviates pain and helps restore a functional shoulder
How it Works:
Arthritic shoulders are stiff. Although a major goal of the surgery is to relieve this stiffness by release of scar tissue, it may recur during the recovery process if range of motion exercises is not accomplished immediately.
Total shoulder replacement is generally considered to be as successful in relieving pain as total hip or knee replacement.
- Infection: Infection is a risk with any surgical procedure. When infection occurs after total shoulder replacement it is most commonly caused by bacteria that enter the bloodstream during dental procedures or from urinary tract, skin or fingernail infections. Although uncommon when these complications occur they can delay full recovery.
- Osteolysis: The bone next to the shoulder implant may break down(Osteolysis) because of the body’s reaction to particles that may be caused by contact between metal and plastic components, contact between the shoulder components and the bone cement or contact between the shoulder components and the natural bone particles that exist between the shoulder’s moving parts which can cause more particles or damage to the implant components
- Implant fracture: This is typically caused by patients with extreme performance expectations, heavy or overweight patients or physically active patients
- Removal and/or replacement of the device system or its components may be necessary at some point in the future.
- Dislocation can result from improper positioning of the implant components or falling down and landing on your shoulder or elbow
- Implant components can lose or move due to improper cementing or shock from falls or collisions.
- Cardiovascular disorders associated with the use of bone cement include blood clots, decreased blood pressure, heart attack and in rare instances death.
Shoulder replacement cost varies depending on the type on the implant used. Generally the hospital purchases the implant and includes it as part of the total cost for the surgery.
The ultimate cost for the shoulder replacement surgery is specific to the hospital where the surgery is being performed.
Shoulder replacement India is cheaper compared to other developed countries without a compromise on the service provided by other countries like US and UK. Many patients from other countries are travelling to India for treatment of various diseases and surgeries at a lower cost.
Recovery and After Effects:
Early motion after a complete shoulder replacement is critical for achieving optimal shoulder function.
- After the surgery you will be moved to the recovery room where you will stay for approximately two hours. During this time you will be monitored until you awaken from anaesthesia, at which time you will be taken to the hospital room.
- Your operated arm will be numb from the regional anaesthesia which also can provide good pain relief for next day.
- Typical stay at the hospital would be two to three days but it depends on each individual and how quickly is the progress.
- Your arm will be in a sling for four to six weeks after surgery. If you have regional anaesthesia it will take 12-18 hours to wear off during which the arm will be numb.
- Later once the shoulder is comfortable and flexible strengthening exercises and additional activities are started. Some patients prefer to carry out the rehabilitation program themselves. Others prefer to work with a physical therapist who understands the total shoulder program.
- It is important to understand that proper and extensive post operative rehabilitation is a key factor in achieving the maximum benefit of shoulder replacement surgery.
After one year 95% of TSA patients enjoy pain free function which enables them to exercise the shoulder area sufficiently to promote restoration of strength and motion. Because of this most patients successfully return to the activities they enjoy, making the procedure a highly valued choice for a variety of patients suffering from significant shoulder pain due to cartilage loss.