Shoulder Joint Replacement Surgery
Shoulder joint replacement is a surgical procedure performed to remove damaged parts of the shoulder joint and replace them with an artificial prosthesis. The replacement of the joint involves treating either the humerus head called the ball, or the glenoid known as ball and socket.
A smooth surface covering the bone, known as the cartilage, and a smooth tissue membrane covering the remaining of the shoulder surface ensure that the normal function of the shoulder.
Factors that Lead to Shoulder Joint Replacement
There are various conditions that damage the hip joint resulting in the need for a hip replacement surgery. These include:
Rheumatoid arthritis (Inflammatory arthritis): This is the inflammation and thickening of the synovial membrane which surrounds the joint. The inflammation causes injury and loss of cartilage, stiffness and pain.
Osteoarthritis: This is a disorder which breaks down the cartilage in the joint, and as a result wearing off the bones due to friction against each other. This friction causes pain, inflammation, swelling and immobility. Osteoarthritis mostly affects middle-aged and older individuals and is a major cause of shoulder replacement surgery.
Post-traumatic arthritis: This is a form of arthritis caused by injury that occurred and fractured the bones and tore the ligament or tendons, which eventually leads to gradual damage of the cartilage resulting in pain and immobility of the shoulder.
An acute fracture: This occurs when the head of the humerus (arm bone) wears out and breaks, which as a result disrupts blood supply to the bone.
Rotator cuff tear arthropathy (RCTA): Also known as shoulder arthritis with a large rotator cuff tear, this occurs when the shoulder loses cartilage on the joint surface and tears tendons of the rotator cuff leading to arthritis.
Osteonecrosis (Avascular Necrosis): This is a condition where the blood supply to the bone is disrupted causing the blood cells to die, which damages the shoulder joint.
Pre-op Guidelines
Before the shoulder replacement procedure, an appointment is scheduled whereby he/she undergoes a physical examination to evaluate their fitness. If the patient is taking certain blood thinning medications such as aspirin or ibuprofen, he/she is advised to stop at least 2 weeks prior to the surgery to avoid excessive bleeding. The orthopaedic surgeon will give the patient a list of what to do and what not to do in order to have a successful surgery with faster healing.
Techniques Involved in Shoulder Replacement Surgery
Shoulder replacement surgery lasts approximately 2 hours, and there are various techniques used in the procedure. These include:
Total Shoulder Replacement
During this procedure, a metal ball attached to a stem and socket and covered with plastic is used to replace the damaged joint surface. The elements used in the upper arm bone (humeral head) can either be cemented or non-cemented (press-fit). Non-cemented element is used on a bone that is still in good condition while cemented is used when the bone has become soft.
Reverse Total Shoulder Replacement
This procedure is used on individuals who have had a severe arthritis and rotator cuff tearing that weakens the arm or have had a shoulder replacement which has since malfunctioned. This reverse method enables the arm to be lifted by use of deltoid muscle rather than the torn rotator cuff.
Partial Shoulder Replacement (stemmed hemiarthroplasty)
During this procedure, the injured arm’s humeral head is removed and replaced with a prosthetic ball. The natural socket, glenoid bone and cartilage remain if they are not damaged.
Resurfacing Hemiarthroplasty
This procedure entails replacing only the joint surface of the humeral head with a prosthesis that is shaped like a cap but does not have a stem and is essential in preserving the bone. Resurfacing hemiarthroplasty is recommended for individuals who have had a fresh fracture on the humeral head or neck, their glenoid has an unharmed cartilage surface or the humeral head needs to be preserved.
Risks Involved in Shoulder Replacement Surgery
Just like any other surgical procedure, there may be risks involved in shoulder replacement surgery, although they can be managed. These include:
- Infection occurring around the prosthesis or wound itself
- Damage to the nerves
- Dislocation of the prosthesis
- Loosening or wearing out of the prosthesis
Post-op Care After Shoulder Replacement Surgery
Immediately after the surgery, the patient remains under observation as he/she recovers from the effects of the anaesthesia. Antibiotics will be administered to avoid any risk of infection. Nonsteroidal anti-inflammatory drugs or local anaesthesia will be prescribed to alleviate any pain.
The patient will be shown different ways on how to ensure a successful rehabilitation by exercising to enhance flexibility and reinforce the shoulder. A sling will be given to support the shoulder for up to 4 weeks, and to prevent accidental straightening of the arm.
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