Your shoulder is an important joint that rotates with a wider range of motion than any other joint in your body. If the pain is so severe that you can’t go open the closet, sleep well, or have other symptoms, your doctor may consider shoulder replacement surgery. This procedure can reduce pain and improve mobility.

Let us see this article to know more about “What happens during shoulder replacement surgery”, as provided by Dr Chandra Shekar. B.

What is a shoulder replacement?

Shoulder replacement is a procedure aimed at relieving pain and dysfunction by replacing the damaged part of the shoulder joint with an artificial component known as a prosthesis. The most common causes of shoulder replacement surgery are osteoarthritis, rotator cuff tear arthropathy, avascular necrosis, or rheumatoid arthritis. This procedure aims to relieve pain, increase strength, increase range of motion, and allow you to use your shoulder.

Shoulder replacement surgery aims to relieve shoulder pain and improve shoulder function by restoring the bones in the glenohumeral joint. The surgeon removes the humeral head at the top of the arm bone (humerus), and reshapes the humeral fossa (glenoid) and then attaches it to the prosthetic components to both bones.

The following is a detailed description of a typical full shoulder replacement surgery. 

The operation usually takes 1 to 3 hours.

Overall description of shoulder replacement

Surgical interventions may vary based on patient needs and surgeon preference. However, usually, the steps are as follows:

• The patient’s blood pressure, heart rate, body temperature and oxygen supply are checked before the operation starts. A mark is placed on the shoulder before entering the operating room to ensure the correct shoulder is operated.
• Anaesthesia is given. The patient is usually given general anaesthesia. Alternatively, some patients receive additional regional anaesthesia to block the feeling in the arm and around the shoulder. The type of anaesthesia the patient will receive is determined long before the operation.
• The surgeon makes a 6-inch incision that starts at the top and front of the shoulder and rotates along with the deltoid muscle. The surgeon then cuts deeper tissue, including one of the rotator cuff tendons, to gain access to the shoulder joint.
• The top of the upper arm bone, called the head of the shoulder, is moved using the scapula or glenoid socket.
• The surgeon will examine the humeral neck of the shoulder, which is just below the round head of the humerus. The surgeon uses a device called an osteotomy to remove bone spores that may develop in the humeral neck of the shoulder as a result of arthritis.
• A surgeon uses the bone saw to remove the humeral head.
• The surgeon prepares the humerus for the shoulder stem prosthesis. The shoulder stem is a narrow, pointed metal rod inserted several inches into the humerus. The top of the rod is designed to accommodate a prosthetic ball that replaces the natural head of the humerus.
• The surgeon uses a particular instrument called a reamer to flatten, shape, and prepare the prosthesis’s shoulder fossa (glenoid).
• The prosthesis, or glenoid prosthesis, is usually made of polyethene and has a smooth, slightly concave design to facilitate movement with the head and shoulders of the prosthesis. New sockets are generally lined with a few short pegs or a flat; straight edge called a keel (which is shaped like a boat keel). The pin or keel matches the natural bone.
• The prosthesis can be bonded to the natural bone with bone cement, or it can be a non-cementitious component (sometimes called a “press fit”). The fast-acting bone cement only takes about 10 minutes.
• After the humerus is repaired, a provisional prosthetic ball is placed in place. Different sizes of the provisional ball are used to test the stability of the new joint before determining the final size.
• The artificial head has a shape and size that conforms to the patient’s existing anatomy and is specially designed to move with the artificial cavity. The exact model is based on the planning of the operation and the observations made during the process.
• The surgeon temporarily inserts the ball into the new socket and moves the shoulder. This checks whether the shoulder joint is easily movable and does not dislocate.
• The surgeon will then move the joint, remove a temporary or experimental component, and attach the final ball to the prosthesis. The surgeon inserts the ball into the new socket and re-checks if the movement and dislocation is easy.
• Muscle and other soft tissue that has been cut are repaired, and the skin incisions are sutured or stapled back.

After surgery, the patient is taken to the recovery room for observation until the surgical anaesthesia disappears. The patient is transferred to the hospital room for the remainder of his or her stay in the hospital.

Many patients spend a night or two in the hospital before being discharged, although it varies depending on circumstances.

Shoulder replacement recovery

Patients can return home after surgery or a very short hospital stay for several days. 

Pain occurs after surgery, which can be controlled with ice, anti-inflammatory drugs, or pain relievers. In addition, antibiotics prevent infection at the surgical incision site and in the prosthesis.

The arm should be held in the sling for up to six weeks. After about two weeks, the patient will drive and perform basic tasks such as shopping and eating. The surgeon or other staff will provide an exercise program for the patient to follow at home. Following this program is essential for strengthening your arms, restoring range of motion, and speeding up the recovery process for your shoulders.

Physiotherapy often helps in recovery after shoulder arthroplasty. The surgeon usually 

decides when to start physical therapy, usually about two to six weeks after surgery, depending on the procedure.

Conclusion:

Most people who undergo shoulder replacement surgery experience significant pain relief, increased mobility, and overall better quality of life.

If you have a problem, questions or concerns, contact your surgeon’s clinic. You will not perform any shoulder movements for the first six weeks after surgery, and you must always wear the sling/immobilizer. Your surgeon will tell you when to remove the sling and what activities to do during your post-operative appointment. The surgeon will also recommend exercises to increase your range of motion and strength.

To find out more about shoulder replacement surgery, make an appointment with a shoulder surgeon Dr Chandra Shekar. B at 9959588386 online or by phone today.