Shoulder Arthroplasty

Your shoulder is the most mobile joint in your body. This complex structure of bones, muscles, tendons, ligaments, and cartilage enable you to move your arm and hand easily during daily activities. When pain and loss of motion develop from disease or injury, surgery may be necessary to correct the problem.

Shoulder arthroplasty is a procedure in which damaged portions of the joint are repaired or replaced with artificial parts. These parts together are called a prosthesis. The prosthesis will move more smoothly than the damaged joint and should reduce the pain in your shoulder.

The prosthesis consists of a metal ball attached to a stem and a cup made of plastic material. Your doctor may choose to use only the ball and stem portion of the prosthesis. This is known as a hemiarthroplasty. A total shoulder arthroplasty is needed if the glenoid (curved area where the humerus inserts into the joint) must also be replaced.

Joint replacements are designed to help you continue with your daily occupations. They are not meant to hold up to the stresses of rigorous activities or sports requiring extensive shoulder use.

Before Surgery

• Recovery planning - Talk with your doctor about your recovery time after surgery. You may need to plan for help at home while you are healing.
• Medications - Inform your doctor of all medications you are taking. Some drugs interfere with blood clotting and healing. Your doctor may have you take antibiotic medications before the surgery. This will reduce your risk of infection.
• Tests - In addition to X-rays of the joint, you will need to have blood and urine studies completed.
• Blood donation - You can donate blood for your use during your surgery. Donations can be made up to 5 weeks before the surgery date.
• Diet Restrictions - The day before your surgery, you will probably be instructed to avoid eating or drinking after midnight. You may take medications cleared by your doctor.
• Shoulder preparation - Your shoulder must be free of skin infections. Contact your doctor if a problem arises before your surgery date. On the day of the procedure, wash your shoulder with soap before going to the surgical center.

Day of Surgery
Arrive at the surgical center a few hours before your procedure is scheduled. You will probably be given an intravenous (IV) line. Fluids and medications are transported through the IV to your body. When you are in the operating room, you will be given medications to help you relax and "sleep" during the surgery. Anesthesia may be given to numb the nerves of your shoulder and arm.

During Surgery
An incision, or cut, will be made in the skin over the shoulder. The shoulder muscles and tendons will be examined and repaired if needed. The top of your humerus (upper arm bone) will be exposed, and the damaged areas will be removed. The prosthesis is then inserted and may be cemented to the bone. The shoulder is closed with sutures or staples and a dressing is applied. A sling is placed on the shoulder to keep the joint from moving. The entire procedure usually lasts 1 ½ to 2 ½ hours.

After Surgery
Following the procedure, you will continue to have intravenous (IV) medications. The medications are necessary to prevent infection, blood clots, and reduce your pain. Most patients go home within a day or two.

Your doctor will instruct you in how to passively move the joint using your other arm to mobilize the shoulder. This is important in minimizing joint stiffness. You may also be referred to a physical and/or occupational therapist to guide your rehabilitation.

Your recovery depends on your age, overall health, and how well you follow your rehabilitation program. Full recovery is typically expected in about 3 to 6 months.

Complications
The complication rate following shoulder arthroplasty is relatively low. Talk with your doctor about risks involved with this surgery. The most common problems reported are shoulder dislocation, abnormal bone growth, loosening of the prosthesis, nerve injury, and infection.