Total Shoulder Replacement

Anatomy: The Human body consists of four types of joints-
  1. Synovial Joint
  2. Hinge Joint
  3. Pivot Joint
  4. Ball & Socket Joint

The shoulder is a ball and socket joint. It has three bones- Humerus (Upper Arm Bone), Scapula (Shoulder blade), and Clavicle (Collar Bone). The upper arm bone humerus has a rounded head that fits into the Glenoid cavity shoulder blade, Scapula. The area of the two bones surfaces, where they join each is covered with articular cartilage that reduces friction between the two bones and supports movement. All the remaining surfaces of the bones are covered with synovial membranes. The membrane consists of fluid that reduces friction among the bones and cartilage in the shoulder. The entire structure of the shoulder is designed in such a way that this joint has maximum mobility in the entire human body.

Shoulder Replacement Surgery: When one or more bones of the shoulder gets damaged, it is removed and replaced by artificial parts, called the prosthetic shoulder. Either the rounded head of the humerus bone or glenoid cavity or both are removed and replaced. The prosthesis or the artificial counter parts are made of metal when it comes to the rounded head of the humerus and polyethylene is used to make a substitute for glenoid cavity.

Causes of Shoulder Injury: Here are the few causes of Shoulder Injury and pain which can lead to surgery-
  • Fractures: If the patient has suffered from a severe fracture that completely breaks the humerus in pieces the surgeon usually suggests surgery. It is more commonly seen in elderly patients.
  • Rotator Cuff Tear: If the patient suffers from a severe prolonged Rotator Cuff Tear, which is big in size, then this injury, over a period of time, causes Arthritis and breaks the certain Joint Cartilage.
  • Osteonecrosis: This may be caused due to sea diving, sickle cell anaemia, alcohol use, or fracture of the shoulder. In case of any of these conditions, the blood supply to the cell in the shoulder joint is stopped and they die.
  • Rheumatoid Arthritis: It is also referred to as Inflammatory Arthritis. In this case, the synovial membrane is swollen and becomes thick.This in turn damages the cartilage and causes pain and stiffness in the shoulder.
  • Osteoarthritis:It is the most common cause of Shoulder Replacement surgery. It is seen in people above 50 years of age. The cartilage that reduces friction and makes the gliding easy between two bones, wears off after a certain age. As a result, the shoulder becomes stiff and painful.
  • Previous Failed Surgery: This rarely occurs but happens when an implant is loosened, or dislocated or an infection occurs in the joint area. In such cases, the Second joint Replacement surgery is done; which is also called Revision Surgery.
The decision of shoulder replacement surgery is a combined decision of the patient, his doctor, orthopaedic surgeon,and family members. Below are the few reasons why the doctor or orthopaedic surgeon suggests surgery.
  1. Stiffness and no movement due to weakness or some cause.
  2. Chronic pain even while resting and sleeping. The pain is so bad that the patient is not able to sleep.
  3. Inability to perform daily activities dressing, reaching to the wardrobe, washing.
  4. No improvement is seen with lines of treatment like anti-inflammatory medicines, corticosteroids injection for pain relief; physiotherapy.
A detailed physical assessment is done before the decision of the surgery is made. Here are the following steps taken–
  • Medical History: The surgeon will ask detailed questions regarding past injuries, how they took place, the mode of treatment taken up. He will also ask for all the information regarding any other chronic ailment, previous surgery or a other complication that occurred.
  • Physical Examination: The doctor will check the shoulder joint, assess the pain stiffness and swelling that exists. He will also check the range of motion and flexibility motion the patient is able to perform.
  • X-rays:The X-rays play a crucial part in making a decision about Shoulder Replacement surgery. They show a detailed picture of the joint; the small size of joint space between the two bones, bone spur, irregularity in the shape of bones, pieces of cartilage floating in the joint space.
  • Other Tests: The doctor also asks for a CBC and in some cases MRI and CT Scan to understand the damage in the bone and the surrounding Soft Tissues.
Surgery: The patient is admitted to the hospital on the day of surgery. He is first given anaesthesia, that may be a general anaesthesia, regional anaesthesia or a combination of both. tHe Anaesthesia specialist along with the surgeon decides which is the better option for the patient. The surgery takes about two hours. The damaged parts are removed and replaced with prosthetic parts. After the procedure, the patient is shifted to the recovery room and stays there for a couple of hours, where he is closely monitored. He can get up from bed the next day and start with solid food. Later on, he is moved to the hospital room. The patient is usually discharged 2-3 days. In these 2-3 days the patient is given several doses of antibiotics to prevent infection in the joint location.
Post -Operative Care: This is an important part that needs to be taken care of for fast recovery. –
  1. Pain Management: Pain is a natural process after any surgery. The doctors prescribed anti-inflammatory & non-steroidal drugs , steroidal injections, opioids and local anaesthetics to help the patient manage the pain of surgery. It is important to reduce the pain because only after the pain starts subsiding, physical therapy can be started.
  2. Wound Care: The wound is sensitive and needs utmost care. It has suture and staples running all over it. The staples either dissolve over a period of time or are removed after a couple of weeks. Contact with water should be completed prevented to avoid any type of infection and quick healing.
  3. Physical Therapy: Exercises are very important especially in the initial weeks after surgery. A well planned rehabilitation program plays an important part in the recovery. A patient with a well guided home exercise plan, can perform daily activities within two weeks of surgery. The patient can drive in 3- 6 weeks after surgery. Then comes the strength regaining part, where a physiotherapist helps to gradually increase the flexibility, range of motion and strength in muscles. Once the patient recovers, he can start with his sports training program under well equipped guidance.

The team at The Cruciates can help you with any and all aspects of surgery at any point of time, whether you are looking for second opinion, surgery, or post-operative care. We have well renowned specialists from different fields who can guide you wherever the need is. You can get in touch with us by clicking at the link–

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