Shoulder Replacement

Shoulder Replacement:

A shoulder replacement involves replacing a shoulder joint that has been damaged or worn away, usually as a result of arthritis or injury.

About Shoulder Replacement:

The shoulder joint is a ball and socket joint. The “ball” is formed by the top of your upper arm bone (humerus) and the “socket” is the end of your shoulder blade (scapular).

During your shoulder replacement, a metal ball on a stem is inserted into your upper arm bone and a plastic surface is fitted onto the socket. You may have a shoulder replacement if you have osteoarthritis in your shoulder and the rotator cuff is intact.  The rotator cuff is made up of a group of four muscles and their tendons. It plays a crucial role in keeping your shoulder joint stable.

If you have severe arthritis, a torn rotator cuff or have had a shoulder replacement that was unsuccessful your surgeon may decide to do a reverse shoulder replacement. During this procedure, the metal ball is attached to your shoulder blade and the plastic socket fitted to the top of your upper arm bone.

An artificial joint usually lasts at least 10 years, after which it may need to be changed.

About the Operation:

On the day of your admission to hospital, the nurse looking after you will re-check your blood pressure pulse and temperature and your pre-operation details to ensure we have the correct and up-to-date information. Your surgeon will ask you to sign a consent form if not already done at your previous clinic appointment, this confirms that you understand the risks, benefits and have given permission for the operation to go ahead.

The operation is USUALLY carried out under a general anaesthetic, which means that you will be asleep during the procedure. Whilst in theatre, AND BEFORE YOU GO TO SLEEP the anaesthetist MAY administer a regional anaesthetic, which will block the feeling in your shoulder which can last up to 24 hours after your operation. 

A single cut, usually around 10-20cm long, is made along your upper arm and shoulder. Your surgeon will remove the top of the upper arm bone and fix the metal ball on a stem with special cement. He will smooth the surface of the socket and fix the new plastic socket in place.

When the joint has been replaced, the surgeon will close the wound with stitches and the wound will be covered with a dressing.AND YOU WILL HAVE A SLING FOR COMFORT

The operation can take up to approximately three hours.

What to Expect Afterwards:

Usually, you will be in hospital overnight after your operation.  The nursing staff will regularly check your vital signs and wound after the operation. If bleeding occurs further dressings will be applied. You will need to rest until the effects of the anaesthetic have passed. When you feel ready, you can begin to drink and eat, starting with water only.

Painkillers (Analgesia) will be given as requested. You may, or may not come back from theatre with a Patient Controlled Analgesia Pump (PCA).

A physiotherapist will visit you after your operation to guide you through exercises to help you recover.

You may or may not need an x-ray before you go home.

Once the surgeon has said you can be discharged, you will need to arrange somebody to drive you home. You should have a relative or friend stay with you for the first 24hrs if you live alone.

On your discharge from hospital, the nurse will return any medications you had brought in with you, and new medications including pain killers started by the hospital – highlighting when to take them.  You will also be provided with an information sheet on when to take your medications.

An appointment with the GP practice nurse to remove your stitches will be made for 10-14 days after your operation

An appointment will be made for you to see your surgeon in the follow-up clinic this could range from two to six weeks after your surgery, dependant on your surgeons instructions. Information will also be given to you by the nursing staff on how to care for your dressing to your shoulder, spare dressings will be provided so you can change the dressing as required.

Recovering from a Shoulder Replacement:

You will may need to keep your arm in a sling on and off for 6 weeks. The sling is worn to support your shoulder by stopping the weight of the arm from pulling down on it, and to protect the repair of your muscle. The sling may be removed for exercising, eating, washing and dressing and may be left off after 10 days if comfortable. 

At this stage:

  • Avoid putting your arm behind your back to scratch, fasten clasps or buttons.
  • Avoid putting your arm out to the front or the side above shoulder level.

You will only be allowed by your surgeon to do specific exercises for the first 3 weeks; these exercises will be shown to you by the physiotherapists on the ward.  These exercises are essential as the first stage of your recovery.

After 3-6 weeks you will be allowed to progress to the second stage of exercises which will be given to you by the out-patient physiotherapy team. You will continue your out-patient physiotherapy rehabilitation until you have restored your function, work and hobbies. This generally takes between six to twelve weeks. 

At this stage:

  • Avoid doing any heavy lifting for 3-4 months after your operation
  • Avoid driving for 2 months or longer until you are confident that you could perform an emergency stop without discomfort.

It is important to continue with the exercises, and be guided by the advice recommended by your physiotherapist.

Complications:

  • COMMON (2-5%)

-          Pain: the procedure will hurt afterwards. It is important to discuss this with the staff and ask for pain killers if needed.  Keeping the arm up (elevated) in a sling will reduce the pain.                            

-          Scar:  the operation will leave a thin scar.  You can discuss thelength of this with the surgeon.

  • RARE (<1%)

-          Infection: This may present as redness, discharge or temperature around the wound. A course of antibiotics may be necessary once the source has been isolated.  

 -    Hypertrophic/ keloid scar: These are scars which grow excessively (within the wound margin and beyond respectively). They occur in some people. They can not be predicted although if you have a previous keloid scar you are at greater risk. Scars may be treated with steroid injection or surgically if necessary. 

-          Delayed wound healing:  may occur if the wound is under tension, infected or short of blood supply.                       

-          Fat necrosis (death of soft tissue):  this is also a cause of delayed wound healing.            

-          Bleeding: there will inevitably be some bleeding, but this is Usually controlled at the time of the operation.

-  Neurovascular damage: there are many important nerves and blood vessels that run through the arm. These can be damaged during the operation. This may leave numbness or weakness in the muscles below the elbow. Rarely, this will lead to a further operation.          

-   Delayed/ non-union:  this may happen because the bone is damaged, the bone is poor quality or the blood supply to the bone is inadequate.

-    Failure of fixation   this may happen because the bone is damaged, the bone is poor quality or the blood supply to the bone is inadequate.

 After surgery, your shoulder and arm may be sore and/or uncomfortable for several weeks. You may also have some swelling in the upper part of your arm.  It may take some months to get the strength and movement back in your arm. A full recovery can take up to six months, but this varies from person to person, so it is important to follow your surgeon and physiotherapist’s advice.


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