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SHOULDER & ELBOW REPLACEMENT

Your shoulder is an important joint that rotates with a greater range of motion than any other joint in your body. If it’s causing you pain to the point that you can’t reach into a cabinet, can’t sleep well, or experience other symptoms, your healthcare provider might consider replacement surgery. This procedure can relieve your pain and increase mobility.

What is a shoulder replacement?

A shoulder replacement is a procedure that tries to eliminate the source of pain and dysfunction by replacing damaged parts of the shoulder joint with artificial components called prostheses. The most common reasons for a shoulder replacement surgery are osteoarthritis, rotator cuff tear arthropathy, avascular necrosis or rheumatoid arthritis. The procedure is meant to relieve your pain, improve your strength, increase your range of motion and enable you to use your shoulder and arm.

Why is a shoulder replacement done?

Shoulder replacement surgery is an option given to patients who suffer from joint dysfunction. This is usually the result of osteoarthritis, rotator cuff tear arthropathy, avascular necrosis, or rheumatoid arthritis, or (rarely) for those who have sustained a severe fracture from a trauma or fall. Generally, all other modes of treatment are considered first, such as physical therapy and medications.

You may be a candidate for shoulder replacement surgery if you have the following symptoms:

• Your shoulder pain is so severe that you struggle with everyday activities such as washing, getting dressed and reaching into a cabinet.
• You have loss of motion in your shoulder.
• You have weakness in your shoulder.
• You have pain that’s so bad that it prevents you from getting a good night’s sleep.
• You’ve tried anti-inflammatory medications, cortisone injections and physical therapy with no relief.
• You have prior arthroscopic surgery, rotator cuff or fracture repair that failed to relieve your symptoms.

What are the types of shoulder replacements?

Your surgeon will have a conversation with you regarding what type of shoulder replacement you may need. There are four options:

• Hemiarthroplasty: In this procedure only the ball and stem are replaced. The stem is connected to the ball and articulated with your natural socket.
• Resurfacing Hemiarthroplasty: This involves replacing the joint surface of the humeral head with a cap-like prosthesis, without a stem.
• Anatomic Total Shoulder Replacement: The arthritic joint is replaced with a highly polished metal ball attached to a stem on the humeral side, and a plastic cup on the glenoid socket.
• Stemless Total Shoulder Arthroplasty: This is a bone-preserving version of the total shoulder arthroplasty where the metallic ball is attached to the upper arm without a stem.
• Reverse Total Shoulder Replacement: In the reverse total shoulder replacement, the joint is literally reversed meaning the metal ball is placed where the glenoid socket was and a plastic cup is attached to the stem and is moved to the upper arm bone (humerus).

Home going instructions

• Check the incision daily for increased swelling or drainage.
• Keep the dressing intact. Your dressing is sealed and will allow you to bathe and shower. Let the water trickle over it and pad it dry afterward. Your dressing will be removed at your first follow up appointment.
• At discharge, you will be given a return appointment, 10 to 14 days later for removing your dressing as well as a prescription for pain medication.
• Your healthcare provider will advise you of specific precautions and the limitations of activity.

General instructions include the following:

• Drive as instructed by your healthcare provider. You will, however, need a driver available to take you home at the time of discharge.
• Limit lifting anything heavier than a glass of water for the first two to four weeks.
• Limit lifting heavy objects for two months.
• Resume active movement of arm within limits of pain.
• Continue exercises at home as instructed by your physical therapist and other healthcare providers. Be careful – don’t overdo it!
• Don’t use your operative arm to push yourself up from a bed or chair.
• Don’t do any repetitive heavy lifting. Don’t play contact sports.
• Avoid placing your arm in any “extreme position” for the first six weeks after surgery. An example is to not stretch your arm straight out to the side or behind your back.

After discharge

Your rehabilitation will be ongoing and progressive. It may take six months to one year to achieve the optimal benefit. It is important to realize that progress is sometimes slow and not always steady. You must persevere through your therapy program, performing your exercises several times a day for five to 10 minutes each. Don’t lift anything heavier than five pounds during the first month following surgery. Also, refrain from using your arm to lift, reach, push or pull above waist level (for six weeks). After about six weeks you’ll begin physical therapy where you’ll use gym-type equipment to strengthen your muscles. The healthcare provider will monitor your progress during visits at intervals of six weeks for the first four to five months, and then less frequently for one year.

Please note that any healthcare provider or dentist contemplating a future operative or invasive procedure, including dental work, must give you antibiotics preoperatively and postoperatively to prevent infection. This includes all surgeries, minimally invasive (or "oscopy") procedures, tooth extractions and root canals. Any infection, such as a urinary tract infection, must be treated promptly with antibiotics, as bacteria can spread to the replaced joint. When receiving any medical treatment, notify the person in charge that you have had a total shoulder replacement.

Return to work depends on your progress with therapy and your job demands. People who do not have a physically demanding job can usually go back to work after two months. If your job involved heavy lifting or doing repetitive overhead activity, you may have to make changes to your work environment. If you have a highly demanding job, you should maximize your therapy exercises including strengthening and discuss the best time to return to work with your surgeon. People who have undergone a shoulder replacement are able to participate in sports such as golf, swimming and tennis. Discuss your goals with your surgeon and therapist before so you can plan your rehabilitation and sport activities accordingly.

How long does it take to recover from shoulder replacement surgery?

The recovery period varies from person to person and also depend on the type of surgery you had. Typically, you should use your arm for waist-level activities on day one following surgery. You should dress and feed yourself within the first week. Be careful with driving. Only resume driving when you’re certain that you can do so safely.