Shoulder Replacement Surgery

Although shoulder replacement surgery, are performed less frequently, they are similar to knee and hip prostheses. The main idea is based on the logic of replacing the damaged articular surfaces with artificial surfaces. In modern prostheses, the main structures are titanium, the surfaces that rub against each other are composed of cobalt-chromium-molybdenum alloy and polyethylene.

Shoulder prosthesis, which is generally needed as a result of various traumas and painful shoulder disorders, is becoming increasingly common, such as knee and hip prosthesis. The development of prosthesis designs and the increasing success in treatment increases the number of shoulder prosthesis surgery applications.

A prosthesis can be a solution for many painful shoulder ailments that were thought to be insoluble in the past. Shoulder prosthesis surgery is the removal of the round-shaped upper part of the arm bone (humeral head) that forms the shoulder joint and the extension (glenoid) of the shoulder blade that articulates with the arm bone and supports these damaged structures with prosthetic materials.

In which cases is shoulder replacement surgery performed?

Shoulder prosthesis surgery comes to the fore in cases where the person’s complaints are not relieved by medication and lifestyle changes in diseases with pain and limitation of movement in the shoulder. Diseases in which shoulder prosthesis treatment is frequently preferred can be listed as follows:

• Shoulder joint calcification

• Rheumatic diseases with progressive destruction of the shoulder joint

• Avascular necrosis in which the nutrition and structure of the humeral head is impaired

• ‘Cuff tear arthropathy‘ caused by long-term rotator cuff muscle tears.

• Multicomponent humeral fractures with a low probability of functional union.

When the patient require the prosthesis due to fracture and tumour, we classify the case as emergency surgery. Especially since fractures requiring prosthesis are at advanced ages it will usally require, preoperative consultations, examinations, and transfer of the patient. In such cases, waiting for 10 days is not a problem. When it is waited longer, the risk of limitation in shoulder movements increases. In shoulder calcifications and avascular necrosis, the patient should decide the time of surgery, not the doctor.

The only reason for the operation is pain and limitation of movement, which impairs the standard of living. If the patient wants to manage the problem in his shoulder without losing much of his life comfort, insistence is completely unnecessary. Especially since avascular necrosis is seen in young patients, it would be reasonable to wait as long as possible. It is very important to evaluate the treatment options by calculating that the life of the shoulder prosthesis is around 20 years. But the patient does not need to suffer because his age is young. Prostheses that loosen over time can be successfully revised in good hands.

Follow-up after shoulder replacement surgery

In general, the hospital stay after surgery is 2-4 days. On the first postoperative day, the person is encouraged to eat his/her food with the elbows on the table. Your consultant will suggest you to use an arm sling for 4-6 weeks. It is not appropriate to lift more than 2 kilograms in this process. Control examinations are usually performed in the 2nd week and 6th week. According to the examination findings, your physichan will create a unique exercise program for each person.

The life of the shoulder prosthesis 

It is possible to use place the shoulder prostheses with the appropriate technique for at least 20 years without any problems. At the end of this period, wear may develop on the components of the prosthesis. Worn-out components can be replaced with new ones with a second operation called revision surgery.

Shoulder Prosthesis Results

In prostheses made in good hands, 95-98% of patients can use their arms at elbow level without pain.  Writing, most of the kitchen work, toilet and hygienic maintenance are trouble-free.

80-90% of patients can lift their arms to shoulder level and use them painlessly. This level of use is sufficient for hair care. Patients can button their underwear and wear their jackets comfortably.

5% of patients have painless but insufficient shoulder movements. In this case, patients can eat their meals and use the computer. However, they often need the help of the other arm for other tasks.

There are 2% of unsuccessful results. In that case, the patient would be in pain.

Post-Shoulder Replacement Surgery Process 

Until the wound heals, patients use an arm sling for 10 days a day. A night arm sling is recommended for 4 weeks. In fractures, the arm sling period can be extended up to 6 weeks. However, all patients immediately start arm swinging exercises, wash their face, and use a computer. From the 10th day, passive arm movements are started. Active movements are started in the 3rd week.

While passive movements are allowed in fractures, active movements are allowed once the fracture is healed. Performing this process by experienced physiotherapists ensures both less pain and better functional outcome. You should be patient until the end of the 6th month to fully evaluate the result.

What are the Risks of Shoulder Prosthesis?

Infection is the most important risk as in all prostheses. In case of infection, an oral antibiotic may be sufficient, while many treatment options may be required. From intensive intravenous antibiotic use, washing and cleaning (debridement) of the wound, removal of dentures and re-prosthesis.

Shoulder prosthesis dislocation is rare in prostheses made in good hands. It is usually due to technical errors during surgery. It is common if the surgeon does not have enough inexperienced. In cases where this situation occurs more than once or the prosthesis remains dislocated, the prosthesis needs to be reconstructed.

Limitation in shoulder movements may be due to technical errors in the surgery. Or it may be due to the patient’s non-compliance with the postoperative process. Especially in prostheses made in advanced ages after fracture, both the reluctance of the patients and the painful rehabilitation of the patients adversely affect the compliance of the patients. In the constraints not allowed by technical errors, the prosthesis can require change. If there is no technical error, a satisfactory result can be obtained by persistent physical therapy, if it is not enough, by force under anesthesia or by loosening the joint capsule with arthroscopy.

If the painful shoulder is not due to infection, it may be due to technical problems or the psychological structure of the patient. The cause could not be found in 20% of the patients with pain. In the case where the cause is known, appropriate treatment, if not known, pain treatment, if not sufficient, shoulder arthroscopy may be necessary to investigate the cause and finally, prosthesis revision may be required.

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