A GUIDE TO TOTAL SHOULDER REPLACEMENT
Making the decision to have a total shoulder replacement should be a topic discussed between the individual considering the surgery as well as the individual s family, general practitioner and orthopaedic surgeon. WHO NEEDS TO HAVE TOTAL SHOULDER REPLACEMENT SURGERY? Initially, the majority of individuals with arthritis in their shoulder will be prescribed conventional treatments, such as mild analgesics and physical therapy. However, if these conventional treatments fail and an individual s quality of life is negatively affected, he or she may want to consider shoulder replacement surgery. Individuals who benefit from shoulder replacement surgery frequently have: Weakness and/or decreased range of motion in the shoulder. Severe pain that affects the individual s ability to perform everyday activities. These activities may include toileting, dressing, reaching and showering/bathing. Moderate/Severe pain when resting (may prevent an individual s ability to sleep). Individuals who have tried other conventional treatments, but are still in pain: These conventional treatments may include physical therapy, anti-inflammatory medications and/or cortisone injections. An individual who has shoulder fractures should also consider total shoulder replacement surgery. 2
WHAT IS A TOTAL SHOULDER REPLACEMENT? Typically, during a total shoulder replacement surgery the patient s arthritic joint surfaces are replaced with a plastic socket and smooth metal ball with an attached stem. These mechanisms are available in a variety of sizes and may be cemented or press fit into the patient s bone. The press fit technique is utilized when the patient s humeral bone is solid; however, if this bone is soft, the humeral component may be implanted using bone cement. In the majority of cases, a plastic socket (glenoid) is implanted using bone cement. Using a glenoid component (plastic socket) is not recommended if the: glenoid bone itself is severely deficient; cartilage of the glenoid bone is in good shape; or tendons of the rotator cuff are torn beyond repair. An individual who has bone-on-bone osteoarthritis with intact rotator cuff tendons is usually a good candidate for a conventional total shoulder replacement surgery. Although there are other shoulder procedures that can be performed (i.e., resurfacing hemiarthroplasty and stemmed hemiarthroplasty) studies indicate that individuals with osteoarthritis receive the most benefits from a total shoulder arthroplasty procedure, as opposed to the other procedures available. 3
A REVERSE TOTAL SHOULDER REPLACEMENT FOR AN INCOMPETENT ROTATOR CUFF Individuals who have an incompetent rotator cuff will need reverse shoulder replacement surgery. During this procedure, the ball and socket are reversed for anatomic position. A reverse shoulder replacement surgery is indicated for individuals who have: severe arm weakness due to torn rotator cuff; already had shoulder replacement surgery, but it failed; or severe arthritis and tearing of the rotator cuff. A total shoulder replacement procedure takes approximately three hours to complete. This includes time for the patient to receive anesthesia. Patients receive general anesthesia to make sure they stay asleep during their total shoulder replacement surgery as well as local anesthesia (scalene block) to numb the entire arm. The local anesthesia is administered into the nerves exiting neck. Most of Dr. O Grady s patients remain in the hospital overnight; however, some patients will go home the day of their procedure. PREPARING FOR A TOTAL SHOULDER REPLACEMENT An Initial Consultation with Dr. Christopher O Grady During an initial consultation, Dr. O Grady will examine the patient s shoulder to determine whether he or she is a candidate for total shoulder replacement or any other type of surgical intervention. Unless the patient has brought previous radiographic imaging results to the initial consultation, Dr. O Grady will most likely want the patient to have X-rays, a magnetic resonance imaging (MRI) test or a computed tomography (CT) test. 4
Radiographic Imaging Results Once Dr. O Grady reviews the patient s radiographic imaging results, he will determine whether or not the patient is a good candidate for total shoulder replacement surgery, or for any other type of surgical intervention. If Dr. O Grady believes that shoulder surgery is a good option, he will discuss specifics about the surgery with the patient. If the patient decides that he or she does want to have shoulder surgery, Dr. O Grady will discuss potential surgery dates with the patient. Medications, Vitamins and Herbal Supplement Usage During their initial consultation, patients need to tell Dr. O Grady which prescription and/or over-the-counter medications they take on a regular basis. He also needs to know the vitamins, and herbal supplements his patients take: This is extremely important because some medications, vitamins and herbal supplements may cause excessive bleeding. Medications that may cause excessive bleeding include: the majority of arthritis medications; blood thinners; and non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen, aspirin and naproxen sodium. Generally, patients should discontinue taking NSAIDs at least two weeks prior to surgery; however, before discontinuing prescription medications, patients need to speak with Dr. O Grady and/or their primary care physician. Clearance for Surgery The majority of patients must visit their primary care physician for a physical several weeks prior to their total shoulder replacement procedure to receive clearance for surgery. Many patients who have chronic medical conditions may also need to visit a specialist to be evaluated. For example, an individual with heart disease may need to see a cardiologist prior to surgery. 5
PRE-OP CONSULTARTION Benefits of a Total Shoulder Replacement Pain Relief The results achieved with a total shoulder replacement procedure include pain relief and an increased range of motion. The majority of patients are very pleased with the pain relief achieved through total shoulder replacement surgery. That said, it is not uncommon for patients to experience some aching in their shoulder following excessive activity and/or changes in the weather. Improved Range of Motion The shoulder s function and range of motion are typically improved with a total shoulder replacement. However, the amount of improvement in functionality is not as predictable as pain relief is: The amount of functional improvement a patient receives following surgery depends on several factors, including how long the motion of the shoulder has been lost as well as whether the rotator cuff tendons are undamaged and working. Risks and Complications The complication rate following shoulder surgery is less than 5 percent. As with any surgery, infection is of concern; however, to prevent the onset of infection, Dr. O Grady routinely gives his patients antibiotics. The shoulder is a ball-and-socket joint, therefore, a dislocation is possible. In the event of a dislocation, the ball has shifted out of its socket. Artery or nerve damage is extremely rare. As time passes, the components used to replace the shoulder may loosen from the bone. Ten years after a total shoulder replacement procedure approximately 3 percent of the components loosen; however, revision surgery is seldom required. 6
PLANNING AHEAD For the first few weeks following surgery, reaching high cupboards and shelves will be difficult and should be avoided. For this reason, before their total shoulder replacement, patients should go through their home, placing items regularly used on low shelves within easy reach. Patients will need assistance with daily tasks for the first few weeks after their surgery. These tasks will include bathing, dressing, doing laundry and cooking, etc. For this reason, patients need to ask someone that they trust and feel completely comfortable with to assist them during these initial weeks following their total shoulder replacement surgery. Individuals who will not have support at home directly following their surgery may need to reside in a rehabilitation facility until they become more independent. THE DAY OF SURGERY On the day of surgery, patients need to wear loose-fitting clothing and bring a buttonfront shirt to wear home following their procedure. After surgery, the patient s arm will be in a sling and he or she will only have limited use of that arm. Dr. O Grady prescribes pain medications and a polar care unit. Patients will need to wear the sling to protect and support their shoulder for two to four weeks following surgery. 7
RECOVERING FROM A TOTAL SHOULDER REPLACEMENT Rehabilitative exercises consisting of continuous passive motion and stretching exercises are implemented immediately following surgery and are designed to help the patient maintain the range of motion that Dr. O Grady achieved during his or her surgical procedure. To ensure proper healing, these simple exercises need to be performed frequently. The success of a total shoulder replacement surgery is based upon whether a patient can attain and then maintain at least 150 degrees of forward elevation. Patients will begin formal physical therapy exercises two weeks following their surgery. To obtain optimal results, it is imperative that the strict exercise protocol set forth by the physical therapists and Dr. O Grady be followed. These exercises may include: Pendulum exercises (while standing and lying down) Elbow exercises Wrist exercises Forward lean and supine stretch The exercise protocol will continue until the patient s six week, post-op appointment with Dr. O Grady. At this follow-up appointment, X-rays will be taken. Patients return for another follow-up appointment 12 weeks after their total shoulder replacement or reverse total shoulder replacement surgery. 8
5 MYTHS ABOUT TOTAL SHOULDER REPLACEMENT SURGERY 1. Shoulder replacements do not provide good results. False. Shoulder replacements are extremely successful, especially for individuals with osteoarthritis. 2. I am too young to have a shoulder replacement/i am too old to have a joint replacement surgery. No matter what your age, if you have chronic pain in your shoulder, you may benefit from a total shoulder replacement surgery. As long as you are healthy enough to have surgery, there is no reason to continue living with pain. It is never too soon to seek treatment that could provide you freedom from pain. 3. Following surgery, I will have permanent restrictions. False. With proper therapy, the majority of Dr. O Grady s patients achieve a higher level of function than they had before surgery (with less pain). 4. Only patients who have severe arthritis can have their shoulder replaced. False. Although total shoulder replacements are done for individuals who have arthritis, this procedure is also used to address fractures, congenital shoulder defects and rotator cuff tears. 5. Shoulder replacement implants are not reliable or a long-lasting solution. 9
MEET DR. O GRADY Dr. Christopher O Grady, a Board Certified Orthopaedic Surgeon, holds a Certificate of Added Qualifications in Sports Medicine. Dr. O Grady treats conditions of the musculoskeletal system, which result from injury and excessive use, as well as arthritis. 10
If you have pain in your shoulder, seeking assistance from an experienced physician is essential. Individuals who are looking for an Orthopaedic Surgeon in Northwest Florida should click below to schedule an appointment at O Grady Orthopaedics in Gulf Breeze, Fla, today. As an award-winning surgeon, Dr. Christopher O Grady s caring demeanor, expertise and dedication make him one of the top, Board-Certified Orthopaedic Surgeons in Northwest Florida.