Shoulder Replacement
This treatment is also known as anatomical shoulder replacement or total shoulder replacement arthroplasty.
In a total shoulder replacement, the damaged components of the shoulder joint are removed and replaced with artificial parts, including a plastic prosthesis (in the shoulder socket) and a metal ball (at the upper arm bone's top).
These artificial parts have the correct anatomic structure, meaning the shoulder can function properly. The risk of pain is decreased as rubbing and inflammation are largely prevented.
Who might need shoulder replacement surgery?
This surgery aims to relieve pain, but it also enhances the function, motion and strength of the shoulder, which allows patients to return to pre-surgery activity levels quickly. Many individuals who have received this surgical treatment have returned to their previously loved fitness activities, such as pilates, yoga, swimming, tennis and golf.
You may benefit from total shoulder replacement if you have one or more of the following conditions:
Is a total shoulder replacement right for me?
If non-surgical measures have been ineffective and you have shoulder pain that inhibits your everyday activities, you may benefit from a total shoulder replacement. This surgery is effective, safe and evidence-based, being performed successfully for many years and in many countries.
Dr Brumby-Rendell may advise a total shoulder replacement due to several considerations. Individuals that would benefit from this procedure generally experience the following:
- Intense pain in the shoulder which affects daily tasks, such as driving, dressing, reaching and washing
- Varying levels of pain when resting, specifically during the night
- A weak shoulder with limited movement capacities
- Other treatment options (such as physical therapy, cortisone injections and anti-inflammatory medication) have not relieved pain.
Preparing for total shoulder replacement surgery
Before your surgery, you may need to be assessed by an anaesthetist or physician. This practice makes sure your health is strong enough for surgery.
Approximately one week before your procedure, you will be advised to stop consuming various medications, including blood thinners, arthritis therapies and anti-inflammatories, to prevent excessive bleeding.
Information will also be given regarding your recovery process. Generally, you will stay at the hospital for 2 to 3 days after surgery. For around 6 weeks post-procedure, you may require help performing everyday domestic activities, such as bathing, dressing and cooking.
Dr Brumby Rendell's supportive team can assist you in organising to stay at a rehabilitation facility for a short duration if you cannot access extra support at home.
It is important that you DO NOT drive post-surgery for around 6 weeks. Therefore, you must organise for someone to pick you up from the hospital when you are ready to return home.
The conventional shoulder replacement surgery procedure
To perform total shoulder replacement (an open surgery), an incision must be made from the upper arm to the shoulder's front. The surgery takes around 2 hours, and you will be under anaesthetic for this duration. To reduce nerve function during and slightly after your surgery, an inter-scalene nerve block will generally be used. The effect of this block will cease after 12 to 18 hours.
An anterior approach to the shoulder is used by going in between the pectoral and deltoid muscles. Once down onto the shoulder, the subscapularis muscle (front rotator cuff muscle) is released off the humerus and tagged for later repair.
Arthritic sections of the shoulder are then removed, and the humeral head is replaced with an artificial metal ball. A plastic prosthesis is then secured to the glenoid.
After performing these surgical replacements, Dr Brumby-Rendell stitches the rotator cuff muscle together, stitches the incision, cleans the wound, and applies a bandage. Following this, you will be shifted to a recovery room, where you will come out of anaesthesia (which usually takes a few hours). Then, you will be moved to your hospital room.
Recovery
Throughout your recovery, you will likely feel some pain, as this is a major surgery. This is normal as your body heals and recovers. To ease your pain, you will be given pain medication post-surgery.
You should wear a sling for 2 weeks when you leave the hospital. You may have to immobilise your arm for longer if your shoulder condition was severe.
For approximately 4 weeks, you will likely have restricted arm function, and must not partake in pulling, pushing or heavy lifting motions. Instead, you should follow the rehabilitation exercises assigned to you, as they are designed to increase shoulder strength and healing.
DO NOT drive after shoulder surgery until you have been permitted to do so by Dr Brumby-Rendell and can drive safely. For more information regarding driving after surgery, click here.
To monitor your recovery, you will be required to attend check-ups with Dr Brumby-Rendell.
After Surgery
Shoulder replacement surgery has excellent success rates, with numerous sources indicating a satisfaction rate of up to 95% post-procedure. Modern shoulder replacements are estimated to last 15 to 20 years, and revision surgery is rarely required.
First two weeks following surgery
You will be required to wear a sling and will have restricted arm function and mobility. As the priority is promoting soft tissue and skin healing, shoulder exercises are largely restrained from during this timeframe.
Two weeks later
Dr Brumby-Rendell's practice nurse will assess your wound. Here, it will be decided if you can stop wearing a sling, and you may be able to increase shoulder movement. Shoulder exercises will be recommended to promote healing and shoulder movement range.
Six weeks later
At this stage, you will have recommenced most of your everyday activities, but must not partake in pulling, pushing or heavy lifting motions. Your shoulder will have started to regain strength, and rehabilitation exercises should continue.
Three months later
Here, you will have regained almost half of your standard range of motion. Although you will feel relatively comfortable, your shoulder may still feel weak. During this period, precautions to reduce the risk of shoulder dislocation can be removed.
Six months later
You will have improved shoulder strength and motion and will likely experience little to no pain.
One year later
One year after surgery, you will either be pain-free or experience very occasional aches due to intense activity or cold weather. Your shoulder function, range and strength will have improved significantly. The outcomes after one year are very close to the expected maximal recovery.
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