SHOULDER REPLACEMENT PATIENT S GUIDE

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Megan Webster
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1 SHOULDER REPLACEMENT PATIENT S GUIDE HIGHLIGHTS FOR PATIENTS Remember to get up and MOVE!

3 DISCLAIMER HIGHLIGHTS FOR PATIENTS The following information is provided about shoulder replacement in general. It is not intended to provide recommendations regarding your medical care or if shoulder replacement is appropriate for you. Your orthopaedic surgeon is responsible for all recommendations and decisions about your medical care if you and your surgeon decide that shoulder replacement is appropriate for you. The following information also does not provide a complete or full discussion of the specifics of shoulder replacement surgery; the prosthesis that may be used; your care before, during, and after surgery; or the potential complications associated with shoulder surgery and your particular condition. Depending upon your particular condition, some of the general information provided may not be applicable to you. You will need to discuss the specifics of your case with your surgeon. Lima Corporate does not guarantee any specific results, recovery or rehabilitation. WARNING: Please remember the information on this document is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider. The people appearing in the photographs on this publication are models and used for illustrative purposes only. This publication is intended for distribution in the U.S only.

5 INTRODUCTION HIGHLIGHTS FOR PATIENTS THE SHOULDERS ARE AMONG THE MOST IMPORTANT JOINTS IN THE HUMAN BODY. As a joint pain sufferer, you re undoubtedly used to making decisions dictated by limitations. Unfortunately, the natural shoulder joint can wear out plus they may be subject to debilitating conditions such as arthritis, disease, or other questions, concerns, hopes and expectations. The purpose of this guide is to provide you with more information you need to proceed with confidence as to what to expect along the road to recovery, and what you can do to injuries. Arthritis and other debilitating joint conditions can interfere with just about every aspect of your life - from walking, to exercising, WE BELIEVE KNOWLEDGE AND PREPARATION AS TO WHAT TO EXPECT PRE- AND POST- OPERATIVELY WILL MAKE YOUR RECOVERY EASIER. maximize your outcomes. Make sure to go over pertinent information with your care team as well. The more you know, the working, enjoying time with family and friends, to getting a full night of sleep. Any surgery is a big better prepared you ll be to take charge of your comfort and mobility again. step. Medical professionals expect you to have Luigi Ferrari Chief Executive Officer Lima Corporate

6 Shoulder THE ANATOMY 6 THE ANATOMY HIGHLIGHTS FOR PATIENTS THE SHOULDER IS A BALL AND SOCKET JOINT. HOWEVER, UNLIKE THE HIP IT HAS FAR GREATER MOBILITY AND BECAUSE OF THAT, ALSO LESS STABILITY. The muscles, tendons and ligaments help support and mobilize the joint. The main muscles around the joint are the deltoid and rotator cuff muscles. The bones that make up the shoulder joint are the humerus (arm) and scapula (shoulder blade). In a normal shoulder the humeral head articulates with the glenoid (part of the scapula) in a smooth manner as they have a healthy covering of cartilage.

ROTATOR CUFF DELTOID HUMERAL HEAD GLENOID JOINT

disease causing infl ammation of the joints >

$arthritis following a fracture > ROTATOR CUFF$

7 ROTATOR CUFF DELTOID HUMERAL HEAD GLENOID JOINT PATHOLOGIES > OSTEOARTHRITIS Degeneration of joint cartilage and underlying bone > RHEUMATOID ARTHRITIS A chronic progressive disease causing infl ammation of the joints > TRAUMA Fracture of the proximal humerus or arthritis following a fracture > ROTATOR CUFF ARTHROPATHY Condition involving arthritis and an irreparable rotator cuff

8 Shoulder INTRODUCTION 8 IS SHOULDER REPLACEMENT RIGHT FOR YOU? THE DECISION TO HAVE SHOULDER REPLACEMENT SURGERY SHOULD BE A COOPERATIVE ONE BETWEEN YOU, YOUR FAMILY, YOUR FAMILY PHYSICIAN, AND YOUR ORTHOPAEDIC SURGEON.

9 There are several reasons why your doctor may recommend shoulder replacement surgery. People who benefit from surgery often have: Severe shoulder pain that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing. Moderate to severe pain while resting. This pain may be severe enough to prevent a good night s sleep. Loss of motion and/or weakness in the shoulder. Failure to substantially improve with other treatments such as anti-inflammatory medications, injections, or physical therapy.

10 Shoulder THE PROCEDURE 10 THE PROCEDURE HIGHLIGHTS FOR PATIENTS IN A NORMAL SHOULDER THE HUMERAL HEAD ARTICULATES WITH THE GLENOID (PART OF THE SCAPULA) IN A SMOOTH MANNER AS THEY HAVE A HEALTHY COVERING OF CARTILAGE. 1 WHAT IS SHOULDER REPLACEMENT? The shoulder joint is the third most common joint replaced in the body. The shoulder is a ball-and-socket joint: the ball (humeral head) of your upper arm bone (humerus) fits into a shallow socket (glenoid). When this joint becomes worn or painful, your surgeon may recommend a shoulder replacement. Sometimes, only the ball is replaced, this is called a hemiarthroplasty. When the ball and socket are both replaced, this is called a total shoulder arthroplasty. The ball is made of metal and the socket is made of metal or plastic.

2 IS SHOULDER REPLACEMENT RIGHT FOR ME? Your surgeon will perform a physical; take X-Rays or other electronic pictures to see if shoulder replacement surgery is right for you.

11 2 IS SHOULDER REPLACEMENT RIGHT FOR ME? Your surgeon will perform a physical; take X-Rays or other electronic pictures to see if shoulder replacement surgery is right for you. Age is usually not a factor. If you have pain, limited movement, cannot sleep well at night or cannot perform everyday tasks, your surgeon may recommend shoulder replacement surgery for you.

12 Shoulder THE PROCEDURE 12 3 TELL ME MORE ABOUT THE ACTUAL SURGICAL PROCESS. Shoulder replacement surgery is performed in the hospital by a trained orthopaedic surgeon. Commonly, the procedure takes between 1-3 hours. An incision is made that is between 3-8 inches in length and is made in the front or side of the shoulder in order to gain access to the joint. The humeral head (ball) is removed and a metal stem is placed in the humerus (arm bone). The stem serves as a base for the new humeral head (ball) to sit on. If you are having a total shoulder replacement, the glenoid (socket) is smoothed and prepared and a metal or plastic component is attached so that it articulates with your new humeral head (ball). 4 HOW LONG WILL I BE IN THE HOSPITAL? You should expect to stay in the hospital between 1-3 days; however it could depend on many factors and your surgeon will determine this. 5 WILL MY INSURANCE COVER MY SURGERY? Most private insurance companies do cover shoulder replacement surgery as well as Medicare and Medicaid. You should contact your insurance provider to determine if you are covered under your specific plan. 6 WILL MY SHOULDER APPEAR NORMAL AFTER SURGERY? Most patients will have no abnormalities. You will have a visible scar on the front or side of the shoulder from the incision.

ANATOMICAL SHOULDER PROSTHESIS REVERSE SHOULDER PROSTHESIS RESURFACING SHOULDER PROSTHESIS 7 WHAT IS A REVERSE

When a patient has a torn or severely weak rotator cuff muscle, your surgeon may recommend a procedure called a

The reverse shoulder replacement is similar to a total shoulder replacement except in a reverse shoulder

13 ANATOMICAL SHOULDER PROSTHESIS REVERSE SHOULDER PROSTHESIS RESURFACING SHOULDER PROSTHESIS 7 WHAT IS A REVERSE SHOULDER REPLACEMENT? When a patient has a torn or severely weak rotator cuff muscle, your surgeon may recommend a procedure called a reverse shoulder replacement. The reverse shoulder replacement is similar to a total shoulder replacement except in a reverse shoulder replacement, the socket and metal ball are switched. The ball is fixed to the socket and the cup is fixed to the upper end of the humerus. The reverse shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. Your surgeon will determine which procedure is best for you.

14 Shoulder THE PROCEDURE 14 METAL HEAD WITH STEM METAL HEAD POLYETHYLENE POLIMER SOCKET POLYETHYLENE SOCKET CONVENTIONAL SHOULDER REPLACEMENT REVERSE TOTAL SHOULDER REPLACEMENT

15 8 WHAT ARE THE COMPLICATIONS AND RISKS OF SHOULDER REPLACEMENT SURGERY? Shoulder replacement surgery is a major operation and while uncommon, there are always risks during and after any major surgical procedure. Some complications can include, but are not limited to, blood clots, infection, implant breakage, malalignment, dislocation, stiffness, nerve damage and implant wear. To help avoid complications, your surgeon may prescribe antibiotics or blood thinners prior to and after surgery. Some patients could experience stiffness or pain after surgery. Age and activity level effect longevity of the implant. You should discuss these and other risks with your surgeon. 9 WHAT IS SHOULDER RESURFACING? Resurfacing is a procedure where the patient s humeral head is not removed; it is instead reamed down to fit a metal cap on the top of the bone. This cap functions as a humeral head and can be less invasive than a total joint replacement procedure. Your surgeon will determine if you are good candidate for shoulder resurfacing. 10 WHAT ABOUT THE MEDICATIONS I AM CURRENTLY TAKING? You should discuss all medications you are currently taking with your surgeon prior to surgery. Your surgeon will advise you if you need to make any adjustments with your medication. Certain steroids can cause a delay in healing after surgery and your surgeon may recommend you not take them. Make sure your surgeon is aware of any steroids you may be taking. Generally, your surgeon will also advise you to stop taking any anti-inflammatory medications such as aspirin, or ibuprofen five days prior to your surgery. These medications cause the blood to thin and can lead to excessive bleeding during surgery. Your surgeon will discuss these and all medications you are taking prior to surgery.

16 Shoulder AFTER SURGERY 16 RECOVERY AFTER SURGERY HIGHLIGHTS FOR PATIENTS 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. 1 WHEN WILL I BE ABLE TO RETURN TO WORK? Returning to work can be as soon as 2 weeks or as long as 3 months, but your specific timetable will depend on your job and your surgeon s recommendation. Your surgeon will determine when you will be able to return to work based on your job responsibilities. Returning to work will also depend on your commitment to rehabilitation.

17 Today, about 53,000 people in the U.S. have shoulder replacement surgery each year Agency for Healthcare Research and Quality

18 Shoulder AFTER SURGERY 18 2 WHAT WILL MY RECOVERY BE LIKE AFTER SURGERY? Therapy is crucial to proper rehabilitation of your shoulder. Your surgeon along with a team of therapists will work to design a rehabilitation program specific to you. Therapy may begin as soon as the day of surgery and, subject to your surgeon s recommendation, can last several months post-surgery. Your commitment to following your therapy program will determine how well you recover. 3 WILL I BE ABLE TO CARE FOR MYSELF AFTER SURGERY? It is good to have someone help you with daily activities the first few days or weeks after surgery. You should be able to return to normal activities such as dressing and grooming within a few weeks. 4 WHEN WILL I BE ABLE TO SHOWER? In most cases your surgical incision will be closed with absorbable sutures and covered with surgical glue or staples. Most of the time, you will be able to shower in about 2-3 days after surgery, but you will not be allowed to submerge your incision in water. A bandage should cover the incision until the 2 week follow-up appointment with your surgeon. Your surgeon will advise you of exactly when you will be able to shower based on the type of closure performed. 5 WHEN WILL I BE ABLE TO DRIVE AGAIN? While on any type of narcotic pain medication, you will not be able to drive. You will also be required to wear a sling and there are different state laws that allow you to drive or not with a sling. Your surgeon will advise you when you will be able to drive again, most likely in 4-6 weeks approximately.

19 6 HOW LONG IS THE RECOVERY PERIOD AFTER A SHOULDER REPLACEMENT? You will generally be in the hospital for 1-3 days. When you leave the hospital, you will be in a shoulder sling and your arm will be sore for several weeks. Your surgeon along with the rehabilitation team will work with you to start your rehabilitation. They will work with you on exercises that you will do at home as well as in the clinic that will help you recover. Total recovery is patient specific, but generally ranges from three to six months. 7 WHAT IS THE PHYSICAL THERAPY PROCESS AFTER SHOULDER REPLACEMENT? Working with a physical therapist will be critical in your total recovery from shoulder replacement surgery. Your rehabilitation schedule may start as soon as the day of surgery while you are in the hospital. You will continue to work with a physical therapy team once you leave the hospital. Your surgeon s office will set this up for you. You will be given exercises to perform at home, which are designed to increase your range of motion, mobility and strength. Your surgeon will provide you with a list of do s and don ts after surgery and your rehabilitation team will work with you to design a specific program based on your individual situation.

20 Shoulder THE IMPLANT 20 THE IMPLANT HIGHLIGHTS FOR PATIENTS THERE ARE MANY TYPES OF DIFFERENT SHOULDER REPLACEMENT AND YOUR SURGEON WILL DISCUSS WITH YOU WHICH ONE IS BEST SUITED. 1 WHAT IS THE IMPLANT MADE OF? There are several different parts that make up a shoulder replacement all being of biocompatible materials. Most humeral heads are made of cobalt chrome, stems are generally made up of titanium to promote osteogenisis and the glenoid component is generally made up of titanium and/or polyethylene.

21 It is estimated that about 170 americans per million received a shoulder replacement in 2012 Agency for Healthcare Research and Quality

Shoulder THE IMPLANT 22 95% is the survivorship of the implant at 10 years after surgery 170 53,000 americans per million received a shoulder replacement in 2012

22 Shoulder THE IMPLANT 22 95% is the survivorship of the implant at 10 years after surgery ,000 americans per million received a shoulder replacement in 2012 people in U.S. have shoulder replacement surgery each year 3rd most common joint replacement Talking About Numbers Agency for Healthcare Research and Quality

23 2 WHAT IS THE SURVIVORSHIP OF THE TOTAL SHOULDER IMPLANT? Overall, data shows shoulder replacement implants to have average survivorship of 90 to 95% at 10 years after surgery and approximately 80% 20 years after surgery. 3 HOW COMMON IS A SHOULDER REPLACEMENT? Shoulder replacements are the third most common joint replacement. New advances in joint replacement have made shoulder replacement a very successful surgery. It is estimated that about 170 americans per million received a shoulder replacement in HOW MANY SHOULDER REPLACEMENTS HAVE BEEN PERFORMED? Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain. Shoulder replacement surgery was first performed in the United States in the 1950s to treat severe shoulder fractures. Today, about 53,000 people in the U.S. have shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality (

24 Shoulder YOUR NEW JOINT 24 YOUR NEW JOINT HIGHLIGHTS FOR PATIENTS IN A NORMAL SHOULDER THE HUMERAL HEAD ARTICULATES WITH THE GLENOID (PART OF THE SCAPULA) IN A SMOOTH MANNER AS THEY HAVE A HEALTHY COVERING OF CARTILAGE. Most patients with artificial joints are able to enjoy many activities, though some should be avoided. In general, high impact exercises, such as running, jumping, heavyweight lifting, or contact sports, are not recommended. Participating in these activities, or activities like them, may damage your joint or cause it to wear down much more quickly. Low impact activities such as swimming and walking are encouraged, subject to your surgeon s recommendation.

25 Exercise and maintaining an active lifestyle are important parts of health

26 Shoulder NOTES 26

28 Limacorporate spa Via Nazionale, Villanova di San Daniele - Udine - Italy Tel.: Fax: info@limacorporate.com Lima USA Inc W. Pioneer Parkway, Suite Arlington - TX Tel.: / Fax: / The people appearing in the photographs on this publication are models and used for illustrative purposes only. This publication is intended for distribution in the U.S only. Please remember the information on this document is for educational purposes only and should not be used to make a decision on a condition or a procedure. All decisions should be made in conjunction with your surgeon and your primary care provider. MKT

Shoulder Joint Replacement

Shoulder Joint Replacement Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain. Shoulder replacement surgery was first performed