It is important to realize that shoulder replacement
surgery actually refers to the replacement of the shoulder joint and not the
entire shoulder. It is a common procedure done to repair the damaged shoulder
joint for various reasons.
Why
would someone require shoulder replacement surgery?
The main reason for a shoulder replacement surgery is
the pain, particularly intense pain that negatively affects an individual’s
life. This prevents a person even from performing daily everyday tasks. The
most common reason for the surgery is arthritis, which can either be in the
form of rheumatoid arthritis or osteoarthritis. Rheumatoid arthritis is an
autoimmune disorder that causes the immune system to attack the cartilage
within the shoulder joint.
Osteoarthritis, on the other hand, is caused by an
overuse of the shoulder joint, which usually develops with age. Osteoarthritis
is also common in people who tend to use their shoulder very often as well.
Regardless of the form of arthritis, it presents with pain because moving the
shoulder begins to press against the nerves. There are medications that help to
relieve the pain and inflammation. Shoulder replacement surgery can be done if
the pain is severe.
If the pain can’t be controlled with over the counter
painkillers, prescribed painkillers or other conservative treatment methods.
The other major cause of shoulder
pain that may require the surgery is trauma, such as in cases of a car
accident where the parts of the shoulder joint are damaged. In these cases,
surgery is perhaps the only treatment available for the damage to the shoulder
joint may be extensive.
Shoulder replacement surgery is a fairly common
surgery, and it has been performed since the 1950s. However, it’s still not as
common as knee and hip replacement surgeries.
How
is the surgery done?
To understand how the surgery is performed, it’s
important to know the structure of the shoulder joint. It is a ball and socket
joint – the end of the humerus of the upper arm is ball-shaped and it fits into
the glenoid. This is a socket-shaped and found at the end of the shoulder blade
(scapula). For smooth motion, both the humerus and the scapula are lined with
cartilage which allows the bones to glide and move once the shoulder joint is
moved.
Tying everything together are tendons and muscles. If
any of these parts are damaged, there mild, moderate or severe pain is
experienced, accompanied by difficulties moving the joint, etc. In these cases,
surgical treatment is required, especially when conservative treatment has
failed to relieve the signs and symptoms of shoulder joint problem. For the
surgery, the end of the humerus and the glenoid are replaced with artificial
substances – plastic and metal.
For binding, a kind of cement is used or alternative
materials can be placed that allow the bone to grow naturally. The end of the
humerus is usually drilled with a piece of metal to strengthen the bone,
especially if the damage is severe. In less serious cases, it can just be lined
with plastic. As for the glenoid, it can be smoothed using plastic only or a
combination of plastic and metal.
It is a serious surgery that usually requires general
anesthesia, although sometimes local anesthesia alone can be used. After the
surgery, you will need to rest the joint so that the damaged muscles and
tendons around the joint can heal and fully recover. When this process is done,
physical therapy can then begin to allow you to learn to use your shoulder
again and provide you with the best range of motion possible.
Just like any other surgical procedure, shoulder
replacement surgery has its own risks and possible complications. The possible
risks and complications of this kind of surgery include:
• Infection
at the surgical site – In general, infections at the surgical site are rare if
the procedure is performed correctly by the medical team and if the patient
takes a good care of his shoulder after the surgery. People suffering from
diabetes, chronic liver diseases, rheumatoid arthritis, etc., have an increased
risk of an infection following a shoulder replacement surgery.
Once an infection is diagnosed, antibiotic treatment
is required. In certain cases, when there is a severe infection at the surgical
site, even a complete removal of the artificial shoulder joint is required.
• Blood clots
– Patients tend to develop blood clots following a shoulder replacement surgery
only if they are inactive after the surgery. These are a dangerous
complication, even life – threatening as they can lead to pulmonary embolism.
Blood clots as a complication of shoulder replacement surgery are more common
in overweight and obese patients.
As well as those who have a history of blood clots in
the past, patients suffering from cancer, etc.
• Nerve
injury – is a rare complication of shoulder replacement surgery. If a nerve is
injured during a surgery, a numbness and tingling sensation, as well as,
difficulties moving the muscles can develop. In general, nerve injuries tend to
get better in time, often resolving completely.
• Lack of
motion range – in certain cases even after a surgical replacement of the
shoulder joint, patients are not able to move their shoulder far enough. They
will not even be able to perform regular daily tasks and lead a normal life.
How far you will be able to move your shoulder after the surgery greatly
depends on how far you were able to move your shoulder even before the surgery.
Physical therapy is very important in such cases.
Helping a patient learn how to use the new shoulder joint again gradually and
gaining as much motion range as possible after the surgery.
• Humerus
dislocation – usually occurs in cases when the shoulder is stretched more than
it should and too soon after the surgery. For this reason, a patient should not
move its elbow past the body and toward the back immediately and a couple of
weeks after the surgery. With the help of a physical therapy, a patient is
taught how to use his new shoulder again gradually.
• Humerus
fracture – even though it is a rare complication of a shoulder replacement
surgery, it can occur during and even after the surgery.
• Joint
instability – occurs if the parts of the joints loosen up after the surgery. It
also occurs if the soft tissue of the shoulder joint gets stretched out more
than it should too soon after the surgery.