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Shoulder Replacement

For patients who have persistent shoulder pain and poor shoulder motion that cannot be treated by non-surgical therapy, shoulder replacement surgery may be a good option.
The Anatomy of a Healthy Shoulder
The shoulder is a ball and socket joint and allows for the rotation of the arm in all directions. The ball portion of the joint consists of the rounded head of the upper arm bone, and the socket portion is made up of a depression (glenoid) in the shoulder blade. The joint is surrounded and lined by cartilage, muscles, and tendons that provide support, stability, and ease of movement.    

What is Shoulder Replacement?
In shoulder replacement surgery, the painful surfaces of the damaged shoulder are resurfaced with artificial shoulder parts. The part that replaces the ball consists of a stem with a rounded metal head. The part that replaces the socket consists of a smooth plastic concave shell that matches the round head of the ball.

When both sides of the joint are resurfaced, it is called a total shoulder replacement. However, your doctor may determine that only the humeral side of the joint (ball) should be resurfaced. This is called a partial shoulder replacement.

During surgery, a three- to four-inch incision is made along the space between the arm and the collarbone. The procedure lasts about 90 minutes, and the incision is then closed with staples or stitches. Patients typically stay in the hospital for one to two nights, and full recovery usually takes six to 12 weeks.

Frequently Asked Questions

What happens during shoulder replacement surgery?
One the day of surgery, an intravenous tube will be inserted into your arm to administer necessary medications and fluid during surgery. You will then be taken to the operating room and given anesthesia. After the anesthesia takes effect, your shoulder will be scrubbed and sterilized with a special solution that removes bacteria from your skin.

The procedure is performed through an incision over the shoulder that will expose the joint. Special, precision guides and instruments will be used to cut the humeral head (ball) and prepare the bone to accept the implant. The new metal ball and stem are then inserted. If the socket is to be resurfaced, its damaged surface is smoothed and the new plastic surface is inserted. The ball and socket are then joined. When the surgeon is satisfied with the fit and function, the incision will be closed and covered with dressings. A special drain may be inserted into the wound to drain the fluids that naturally develop at the surgical site. The surgery usually takes one to three hours, although this depends on the severity of the damage in your shoulder.

A sterile bandage will be placed over the wound, and you will be sent to the recovery room where you will be carefully monitored. As the anesthesia wears off you will slowly regain consciousness. A nurse will be with you and may encourage you to cough or breathe deeply to help clear our lungs. Your arm will be in a sling or brace, and it may be wrapped in an ice pack to help control pain and swelling. You will also be given pain medication. When you are fully conscious, you will be taken back to your hospital room.

What can I expect after surgery?
When you are back in your hospital room, you will begin a gentle rehabilitation program to help relax the muscles around your new shoulder. On the day of surgery you may be encouraged to get out of bed and take a few steps. You will continue to receive pain medication as needed, and your bandage will be removed about two days after surgery.

Depending on your specific situation, you will probably remain in the hospital from one to three days. Your shoulder area may be warm and tender for several weeks. Before you are dismissed from the hospital, your physical therapist will show you how to perform the rehabilitation exercises that are important for your recovery.

How soon can I return to normal activities after surgery?
Successful joint replacement surgery may relieve your pain and stiffness and may allow you to resume some of your normal daily activities as instructed by your doctor. But even after you have fully recovered from your surgery, you may still have some restrictions. Normal daily activities for shoulder replacement patients do not include contact sports "jamming" activities such as hammering, repetitive heavy lifting, or activities that put excessive strain on your shoulder. Although your artificial joint can be replaced, a second implant is seldom as successful as the first.

How long will a shoulder replacement last?
Longevity of the prosthetic shoulder varies from patient to patient. It depends on many factors, such as your physical condition and activity level, as well as the accuracy of implant placement during surgery. Please remember that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of your life.

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