Total Shoulder Replacement

Surgery is to replace the ends of the bones in a damaged joint. This surgery creates new joint surfaces. In Total Shoulder Replacement Surgery, doctors replace the ends of the damaged 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.

 Preparation for Total Shoulder Replacement Surgery

Depending on your age and overall health, your surgeon may have you get a thorough physical examination done by your general physician or if you have heart disease you will need to get checked by your cardiologist. Your surgeon may also order pre-surgery tests such as:

• Urinalysis
• Chest X-ray
• EKG
• ECG
• Blood tests (depending on your medical history)

You should discontinue use of any anti-inflammatory medication, including aspirin, one week before surgery. Check with your doctor before discontinuing use of any medication.

Before Your Operation

Wear loose-fitting clothes and a button-front shirt when you go to the hospital for your surgery. After surgery, you will be wearing a sling and will have limited use of your arm.

Total Shoulder Replacement Surgery 

The procedure starts with a 4-6 inch incision on the front of the shoulder from the middle of your collarbone to the middle of your arm. This allows access to the shoulder joint without harming the deltoid or pectorals muscles that are used for the shoulder’s power. The procedure involves the removal of the damaged shoulder joint and replacing it with metal and plastic implants. If the socket is unaffected or can be repaired a hemiarthroplasty may be performed—replacing only the ball of the humerus. In a Total Shoulder Replacement the socket of the scapula is also replaced. The ball is replaced by a half-moon shaped metal implant that may or may not be cemented into place; the socket is replaced with a plastic socket that is fixed into the scapula with bone cement.

When the procedure is complete tendons and ligaments are secured or repaired. Then the incision is closed with either stitches or staples, covered with a bandage, and your arm immobilized with a sling. The repair requires protection from active use for at least 6 weeks. Procedures usually take about 2 hours, however, due to preoperative preparation and postoperative recovery time you can expect about 6 hours for the entire process. Patients can spend 2 to 4 days in the hospital depending on their progress and type of surgery.

What to Expect After Total Shoulder Replacement Surgery

Right after surgery

• You will have intravenous (IV) antibiotics for about a day after surgery. You will also receive medicines to control pain and perhaps medicines to prevent blood It is not unusual to have an upset stomach or feel constipated after surgery.
• When you wake up from surgery, you will have a bandage on your shoulder and probably a drain to collect fluid and keep it from building up around your joint. You may have a catheter, which is a small tube connected to your bladder, so you don’t have to get out of bed to urinate. You may also have a compression sleeve on your arm. This sleeve squeezes your arm to keep the blood circulating and to help prevent blood clots.
• 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.
• 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.
• Your doctor may teach you to do simple breathing exercises to help prevent congestion in your lungs while your activity level is reduced

The risks of Total Shoulder Replacement Surgery include:

As with any surgery there are risks of having complications. The risks vary from person to person. That’s because each person’s health status is different as well as the type of shoulder replacement they will need. The most common problems after shoulder replacement include:

• Infection (most susceptible within the first two years)
• Stiffness in the shoulder – following your physical therapy routine can help prevent stiffness
• Instability in the glenohumeral joint
• Component failure or loosening requiring more surgery
• You may not get complete pain relief
• Rotator cuff tears
• Fractures in the joint
• Deep vein thrombosis
• Pneumonia
• Dislocation – most likely to occur during the healing process, which is why it’s important to wear the shoulder immobilizer
• Nerve injury
• Detachment of the deltoid muscle