Shoulder Replacement Surgery (Arthroplasty)
What is it?
Joint replacement also known as arthroplasty, involves replacement with an artificial joint made of metal and plastic. Arthritis affects every patient differently and there are several different types of joint replacement. The correct choice of implant is essential for a good outcome and you should discuss this with your surgeon.
What's involved?
Hemi arthroplasty
The surface of the joint is replaced with a smooth metal head and the other side of the joint is left alone. This is the least invasive option and is the most commonly performed arthroplasty.
Total shoulder replacement
If the cartilage and bone on the socket side of the joint is also badly worn, a plastic polyethylene tray is used to resurface it and this articulates with the metal head. It gives a better range of movement than the hemi arthroplasty, but over 10-20 years the plastic wears away and complex revision may become necessary.
Reverse geometry
The above operations require good muscle function around the shoulder to work properly. In some patients the muscles of the rotator cuff are damaged. If this is the case, a reverse geometry shoulder replacement can restore excellent function in what would otherwise be a painful shoulder with very restricted movement.
What should I expect during recovery?
The anaesthetist will have used an anaesthetic block to numb the arm during surgery and the immediate post-operative period. Once the anaesthetic has worn off (4-8 hours), the shoulder will become painful and you will be given regular pain relief as soon as you get back to the ward. You may be pain free at rest but it is important that you take the pain relief regularly, for when you move the shoulder as part of your rehabilitation program.
A combination of paracetamol or codeine should be taken with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless contraindicated. If the pain relief you have been given is not sufficient please contact your consultant’s secretary or your GP.
The procedure is an open operation through a 12-20 cm incision and is closed with a dissolving stitch. This heals well, usually leaving a faint scar. The dressing should remain in place for 10-14 days, kept clean and dry until it is removed at your follow up appointment. If you have any concerns about the wound you should contact your surgeon’s secretary or your GP practice nurse.
You will be given a sling which will protect your shoulder and should be worn for a minimum of 3 weeks. You will need a dedicated physiotherapy program after your surgery. If you have been seeing a physiotherapist prior to your surgery, you should arrange to see them afterwards so you can start your rehabilitation straight away. If you do not have a physiotherapist we can arrange a referral for you.
Are there any associated risks?
Shoulder joint replacements are very successful and most people are delighted with the operation and its results. Like any operation, there is a very small risk of infection, loosening of the replaced parts or fracture of the bone during the operation. Nerves occasionally become bruised and the shoulder can become stiff. These risks account for only 2-3% of all operations but should be taken into consideration and discussed with your surgeon prior to surgical intervention.
When can I return to driving?
You will be able to return to driving after 6 weeks following your surgery.
When can I return to work?
You can return to a sedentary job such as office work after 3 weeks. Most patients return to light manual work after 6 weeks and heavy labour after 8-10 weeks.
When can I return to exercise?
As a guide, you can return to swimming (breast stroke) after 6 weeks, and freestyle swimming after 3 months. You can return to Golf and contact sports after 3 months.
The One Team Specialists
Anthony Hearnden
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Shoulder, Elbow, Hand and Wrist
A Patient Journey - It Is All In The Planning
The information below has been taken from a letter of advice from a patient who underwent shoulder replacement with Mr Andrew Keightley.
I am aged 80 and am a retired Physio. With those two statements I reveal that I have decades of advising patients and friends on their challenges with limitations of movement and pain. I also have Grade 4 osteo-arthritis in both shoulders and live alone.
And now I have to apply my knowledge and experience to myself. It is all in the Planning!
General Preparation – think about what you will be able to do with only one hand/arm. Do you need to rearrange the position and height of things you will need? I made sure the teabags were accessible and had a jug ready for any visitor to dispense milk so I could manage. I resorted to a dishwasher, as one needs two hands to do washing up! Food in the freezer was removed from fiddly boxes and stored in plastic bags. My microwave is at counter level. Friends are lined up in advance and willing to offer meals and transport.
I used a single duvet on a double bed as it easier to manoeuvre. Pillow stacking was practiced for a supported position for the arm.
Check what seating will work for you for access to reading and TV. Side tables at convenient height for drinks and phones etc.
I found kneeling in the bath felt safest for me to wash with un-operated arm. The side is low and good for supporting getting in and out. I used a towel with hood attached, so the weight of the towel was on my head, the was shoulder covered and arm could be used. And a quick dry light weight towel to dry legs and body. Make the room warm.
Clothing – put one handed shoes out ready – can’t tie shoe laces! Knickers – I got some two sizes too big for easy pulling up and down. Elastic waisted trousers – I felt that skirt hems could escape into toilets. I found vest tops with elastic straps worked well – pulling up over feet and hips. And roomy shirts, front buttoning – charity shops are a good source. This enabled me to dress myself within a few days. The hand on the operated side soon became useful, but only in positions across my body – but could do buttons and stabilise a jar for opening. Front buttoning Nightshirts are also good.
Post surgery – I was glad to have two nights in hospital and have nursing care while my body recovered and I learned to manage the heavy arm in its sling. I was blessed to have a nurse as a daughter who stayed from my discharge after two nights in hospital til Day 7. She enabled me to develop independence as energy levels permitted and she kept producing food and drinks and painkillers to help with the rest and return to activity. Do respect the exhaustion of recovering from surgery and anaesthetic.
By Day 7 I was able to dress and undress myself with a lot of care of the operated arm and then collapse for the next 20 minutes! This arm was very swollen and remains so into Week 5, with serious bruising. Discomfort around the elbow and upper arm was the major factor and remained even after reducing the use of the sling after Week 3. After months of Grade 4 arthritis bone on bone pain, post surgery pain is a relief and comes with the belief that things will continue to improve. The wound was found to be very tidy when dressing was removed. Having now stopped any conventional analgesics, I started Arnica tablets and cream and Vitamin E cream on the scar.
Now at Week 5, I am using my arm happily and have a good level of safe movement. Still with lots of exercises and care on activity. I am still with pain on stretches, but my range is increasing. As my un-operated arm is also limited in strength and mobility, I needed to work out with the physio and modified ways to do some of the expected exercises.
And I will keep going, respecting the weakness of the muscles affected by the surgery. So far so good! Five weeks post surgery and glad I have it done.
For those facing a similar path, my advice is to plan well, listen to your body, and take it one step at a time.
