Diagnosis

Are You Considering Shoulder Replacement Surgery?

Circumstances vary, but generally patients are considered for total joint replacement if:

• Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living
• Pain is not relieved by more conservative methods of treatment — such as medications (including, for the shoulder, injections of cortisone, a powerful anti-inflammatory medication) and physical therapy — and/or by restricting activities
• Stiffness in the joint is marked and, in the shoulder, significantly limits range of motion of the arm
• X-rays show advanced arthritis or other problems

Restoration of movement is particularly important in the shoulder, the body mechanism that allows your arm to rotate in every direction. If you’re experiencing severe shoulder pain and reduced shoulder movement, there are probably many daily activities you can no longer do — or do as well or as comfortably — as before your shoulder problems began.

The Results: In a study of 24 patients who had undergone total shoulder replacement*

• Before surgery, 100% of patients had disabling pain
• After surgery, 92% of patients had no pain

Remember, even if your orthopaedic specialist determines that shoulder joint replacement is a good medical option for you, it is still up to you to make the final decision. The ultimate goal is for you to be as comfortable as possible, and that always means making the best decision for you based on your own individual needs.

Patient Testimonial

“I had the operation so I could get back to life, back to making a living. I’m so glad I did it.”

“I felt confident going into surgery, and my rehab was great. Now I can reach up with both hands, get a book off a shelf, write normally on a blackboard, and sleep without constantly waking up in pain — things people said I’d never do again.”

— Steve Fish, 53 Stryker Shoulder Replacement 2004

Bottom line: You don’t have to live with severe shoulder pain and the functional limitations it causes. If you have not experienced adequate results with medication and other conservative treatments, shoulder replacement may provide the pain relief you long for — and help you to return to the lifestyle and activities you enjoy.

Repair

Advancements in Shoulder Replacement

If you’re reading this website, chances are you’re considering or preparing for shoulder surgery. That’s good news — because shoulder replacement has been proven to relieve severe shoulder pain and restore function in the vast majority of patients. Advancements in the design of shoulder prosthesis allow the potential for you to restore your range of motion. Developed with patient comfort in mind, the Solar® Shoulder is designed for a more natural feel throughout range of motion.

The Solar® Shoulder is designed to replicate the natural anatomy of the patient and help provide you with maximum range of motion so you can get back to the activities you enjoy.*

As you read, make a note of anything you don’t understand. Your orthopaedic surgeon will be happy to answer your questions so that you’ll feel comfortable and confident with your chosen treatment plan.

According to the American Academy of Orthopaedic Surgeons, approximately 23,000 people have shoulder replacement surgery each year. Shoulder problems may arise because of injury to the soft tissues of the shoulder, overuse or underuse of the shoulder, or even because of damage to the tissues. Shoulder problems result in pain, which may be localized to the joint or travel to areas around the shoulder or down the arm.

*Individual results vary and not every patient will experience the same post-operative range of motion and results.

About Shoulder Replacements

Replacement of an arthritic or injured shoulder is less common than knee or hip replacement. However, shoulder replacement typically offers all the same benefits as those procedures — including joint pain relief and the restoration of more normal joint movement.

Restoring your movement is particularly important in the shoulder, because it’s the mechanism that allows your arm to rotate in every direction. If you’re experiencing severe shoulder pain and reduced shoulder movement, there are probably many daily activities you can no longer do — or do as comfortably — as before your shoulder problems began. This may mean you’re ready to consider shoulder replacement surgery.

In shoulder replacement surgery, the artificial shoulder joint can have either two or three parts, depending on the type of surgery required.

• The humeral component (metal)
• The humeral head component (metal)
• The glenoid component (plastic) replaces the surface of the socket

There are two types of shoulder replacement procedures:

1. Partial shoulder replacement is performed when the glenoid socket is intact and does not need to be replaced. In this procedure, the humeral component is implanted, and the humeral head is replaced.
2. Total shoulder replacement is performed when the glenoid socket is damaged and needs to be replaced. All three shoulder joint components are used in this procedure.

What’s involved in shoulder surgery?

Certain parts of your shoulder joint are removed and replaced with a plastic or metal device called a prosthesis, or artificial joint. The artificial shoulder joint can have either two or three parts, depending on the type of surgery required.

• The humeral component (metal) is implanted in the humerus, or upper arm bone.
• The humeral head component (metal) replaces the humeral head at the top of the humerus.
• The glenoid component (plastic) replaces the surface of the glenoid socket, or shoulder socket.

There are two types of shoulder joint replacement procedures:

• A Partial Shoulder Joint Replacement is used when the glenoid socket is intact and does not need to be replaced. In this procedure, the humeral component is implanted, and the humeral head is replaced.
• A Total Shoulder Joint Replacement is used when the glenoid socket needs to be replaced. All three shoulder joint components are used in this procedure.

Recovery

How Long Will an Artificial Shoulder Joint Last?

How long a joint replacement will last is impossible to predict. Individual results vary. As successful as most of these procedures are, over the years the artificial joints can become loose and unstable or wear out, requiring a revision (repeat) surgery. Many factors determine the outcome including:

• Age
• Activity level
• Bone strength
• Bone quality
• Disease progression

Loosening is a common cause of joint replacement surgery failure. A small amount of loosening and bone loss will occur. If it reaches a certain degree, a revision surgery may be indicated. Possible Complications of Surgery

As with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications; however, the vast majority can be successfully avoided and/or treated. In fact, the complication rate following joint replacement surgery is very low: serious complications, such as joint infection, occur in less than 2% of patients.1

Besides infection, possible complications include blood clots (the most common complication) and lung congestion, or pneumonia. Some shoulder-specific complications that may occur are nerve injury — since many major nerves and blood vessels travel through the armpit (axilla) — and dislocation, particularly just after the replacement surgery.

Complications may require medical intervention including additional surgery and, in rare instances, may lead to death. Your doctor should discuss these potential complications with you.

After the Surgery

During your hospital stay, your orthopaedic specialist works closely with nurses, physical therapists, and other healthcare professionals to ensure the success of your surgery and rehabilitation. Usually a case manager is assigned to work with you as you move through your rehabilitation routines. As the days progress, expect to become more independent in your movements.

If you need to work with a physical therapist after your joint replacement, the therapist will begin an exercise program to be performed in bed and in the therapy department. The physical therapist will work with you to help you regain muscle strength and increase range of motion.

When fully recovered, most patients with shoulder replacements can return to work and normal daily activities. However, individual results vary. If you are considering doing any of the following activities — which could potentially affect how long your artificial shoulder will last and how well it will perform — discuss it first with your doctor or orthopaedic specialist:

Any activity that places excessive stress on your shoulder joint such as:

• Lifting or pushing heavy objects
• Hammering and other forceful arm/shoulder movements
• Boxing and other arm/shoulder impact sports

The success of your joint replacement will strongly depend on how well you follow your orthopaedic specialist’s instructions. As time passes, you have the potential to experience a dramatic reduction in joint pain and a significant improvement in your ability to participate in daily activities.

References

1. Hanssen, A.D., et al., “Evaluation and Treatment of Infection at the Site of Total Hip or Knee Arthroplasty,” JBJS, Volume 80-A, No. 6, June 1998, pp. 910-922.

Recovery Protocol

Recovering from Shoulder Replacement Surgery

The vast majority of individuals who have joint replacement surgery experience a dramatic reduction in joint pain and a significant improvement in their ability to participate in the activities of daily living.

Keep in mind, however, that joint replacement surgery will not allow you to do more than you could before joint problems developed.

Please contact the office immediately if you develop any of the following symptoms after discharge from the hospital:

• a significant increase in pain
• new numbness, tingling or weakness the arm
• fever over 100°F
• severe swelling
• redness or discharge from the incision site
• excessive bleeding from the wound

Post Op Visits

1st Post-Op visit

Your first post-operative visit will be scheduled by the surgical coordinator. You must be seen in the office between the 10th and 14th post-operative day for suture/staple removal and a wound check. If you are unable to come to the office for this visit, please contact our office as soon as possible.

2nd Post-Op visit

Your second post-op visit will be scheduled by the surgical coordinator. This will be approximately 6 weeks from the date of surgery. You will see your surgeon on this date and x-rays will be taken.

Immediately After Surgery Pain

Post-operative pain is normal and to be expected. Be sure to take your medications as prescribed. Contact the office with any significant increase in your pain.

Incision Care

Dressing: A dressing will be applied to your incision following surgery. This dressing should be left on until your first office visit unless otherwise specified by your physician or physician assistant. Your visiting nurse may receive instructions to remove or change this bandage before your first post-operative visit.

Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area continues to bleed, you should call the office immediately.

Wound Care: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower unless otherwise specified by your physician.

Incision Care: Initially the incision appears pink. Over time, with proper care, it will heal into afine white line. This may take up to one year. For best results, put vitamin E directly onto the incision once it has healed. Keep the incision out of the sun or cover with sunscreen.

Physical Therapy: Most total shoulder replacement patients receive home therapy for the first few weeks following their surgery. When appropriate, you will then be referred to an outpatient facility.

The First Six Weeks After Surgery

Exercise: You will be prohibited from exercising your surgical shoulder for the first 6 weeks after surgery.

Precautions & Limitations Avoid any lifting with the surgical limb for six weeks following surgery unless advised otherwise by your physician. You are restricted from household chores such as laundry, vacuuming, cleaning, raking, shoveling, etc. If you have a question regarding a certain activity, contact the office.

Work: Your ability to work will be largely dependent on your occupation. You are expected to be out of work for a minimum of 6 weeks. Return to work is dependent upon the rate of healing, symptoms, work demands, etc. If you need disability paperwork completed, please contact the office at the earliest possible date.

Driving: You should not drive for 6 weeks unless told otherwise by your surgeon.

Living with an Implant

Security Issues: Because your implant is made of metal, it may trigger security alarms in high security buildings or airports. Upon request, you will provided with an implant card for you to carry that states you have an implant.

Antibiotics: You will be required to take antibiotics before all dental procedures (including cleanings), colonoscopies, endoscopies and gynecologic procedures. This prevents bacteria from attacking and infecting you implant. This is recommended for the life of the implant.

Activity: If you are considering doing any of the following activities, which could affect how long your artificial shoulder will last and how well it will perform, discuss it first with your doctor or orthopaedic surgeon:

• Any activity involving lifting or pushing heavy objects
• Any activity that places excessive stress on your shoulder joint
• Hammering and other forceful arm/shoulder movements
• Boxing and other arm/shoulder impact sports