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Total Shoulder Replacement

Total Shoulder Replacement

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  • In conditions where the joint surface in a shoulder is worn out or damaged the joint surfaces can be replaced to address the problem

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Conditions include

  • –Osteoarthritis (wear and tear that causes loss of cartilage and eventually bone on bone contact in the shoulder)

  • –Arthritis after a fracture or an injury (post traumatic arthritis)

  • –Conditions where the bone in the shoulder collapse due to poor blood supply (avascular necrosis)

  • –Where inflammation has destroyed the joint (conditions such as Rheumatoid arthritis)

  • To have a successful anatomic shoulder replacement the ROTATOR CUFF in the shoulder must be in good condition or repairable.

If there is a tear in the rotator cuff it may be better to have  reverse total shoulder replacement – Please see separate information sheet.

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  • The shoulder gradually becomes more painful over time.

  • Sometimes a minor injury or overuse can make a worn out shoulder a lot more painful for a long time

  • The shoulder becomes more and more stiff. It can become hard to reach behind your back or reach the back of your head.

  • There can be cracking and grinding when the shoulder is moved

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  • Lifestyle adjustment

  • –Avoid activities that aggravate the shoulder

  • –Find different ways to do essential activities.

  • Exercises and Physiotherapy

  • –The aim is to maintain the range of motion that is left in the shoulder

  • –And to maintain strength in the shoulder

  • –Exercises need to be done carefully, because done excessively it can make the situation worse

  • Medication such as paracetamol and anti inflammatories

  • –Please check with your normal doctor to make sure that it is safe for you to take these tablets long term.

  • Injections into the shoulder joint

  • –Can sometimes give long lasting relief

  • –Regular injections are not advised.

  • –Should not be done within 3 months of planned shoulder surgery.

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  • Where non operative treatment is unsuccessful and

  • The injury stops you from doing the ‘things that you have to do’  such as getting dressed, making a meal, driving a car, or getting a good night’s sleep

  • and/or the ‘things that you love to do’ in life such as fishing, riding a bicycle, or holding a book to read.

  • You are generally well enough to undergo surgery

  • You are willing to accept the recovery time and long-term limitations of a shoulder replacement

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  • This kind of surgery usually requires a General anaesthetic (being ’completely knocked out’)

  • Often the anaethetist does a nerve block (that numbs and paralyses the arm for about 12 hours) to help with pain relief – it can be very painful surgery.

  • Because it is significant surgery- It is recommended to stay in hospital for a day or two

  • Antibiotics is usually administered at the time of surgery but does normally have to be continued after surgery.

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  • Surgery usually takes about 2 hours

  • But the whole process of going to theatre and waking up from surgery takes longer.

  • There is usually around a 10cm incision on the front of the shoulder

  • The worn-out joint surfaces and any bone spurs are removed and replaced with a special plastic cup and metal or ceramic ball.

  • Tendons and tissue around the shoulder that had to be released to do the surgery are sutured.

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In Hospital

  • The wounds are dressed, and the arm is placed in a sling

  • We often leave a pain catheter in the shoulder to deliver more local anaesthetic at about 10 hours after surgery (when the anaethetist’s nerve block starts to wear off)

  • Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’,  than ‘to catch’ up when it is severe.

  • It is usual to leave hospital the day after surgery, or on the second day after surgery

  • A physiotherapist will usually visit you in hospital to demonstrate gentle exercises.

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At Home

  • Continue to stay on top of your pain with oral pain killers.

  • Do the gentle exercises that physiotherapist demonstrated in hospital. It is usually advised to see a physiotherapist in the community at around 4-6 weeks post surgery.

  • It is OK to remove your sling to do these exercises, but in most cases, it should stay on at all other times for 6 weeks.

  • While the shoulder wounds are covered with waterproof dressings it is safe to have a shower. Please have the dressings replaced if they start to come loose.

  • An appointment is usually made at my rooms to review your progress at about 2 weeks after the surgery

  • Please do not drive before speaking to your physiotherapist or a doctor.

  • If there is any concern about infection, please contact my rooms

  • Please ask you doctor to contact me before starting antibiotics.

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  • A sling is usually worn for about 4-6 weeks.

  • From around 4 weeks on, a physiotherapist will show you how to start to progress your range of motion exercises.

  • From 6-12 weeks sling wear can be weaned shoulder movements increased under physio supervision.

  • Most moderately activities can usually be achieved by 3-4 months, but it will take 6 -9months to become completely comfortable and to return to maximal effort.

  • It often takes up to a year to regain completely maximal range of motion.

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Time frames

  • Self care (washing, dressing, eating) with the operated arm – usually around 4-6 weeks (a sling may still be needed)

  • Driving: when you are able to control a steering wheel with your operated arm and you are not taking strong pain relief anymore (usualy 6-8 weeks post surgery)

  • Golf, fishing, cycling etc.: usually around 3-4 months, but it can be longer (6 months)

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  • Infection occurs rarely(1% of the time), but can be severe. It may need further operations, weeks in hospital.  It can lead to a poor outcome.

  • There may be ongoing pain from other worn out joints in the area, that were not obviously a problem at the time of doing the surgery.

  • It is common to have a bit of numbness next to the scar. Very rarely, severe nerve damage can occur, resulting in paralysis or numbness in the arm.

  • Significant bleeding can occur during surgery. A blood transfusion can occasionally be needed and very rarely it can be life threatening.

  • Although most shoulder replacements last more than 10 years, some can become loose or wear out sooner than expected.

  • The bones around the replacement can break

  • Just like in a normal shoulder, the rotator cuff tendons can tear, which can lead to pain and early loosening of the replacement.

  • A general anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

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  • The large majority of patients experience significant improvement in their shoulder pain and function.

  • Mild discomfort and stiffness persist despite successful surgery.

  • Strength usually recovers, but it can take up to 2 years to reach maximal improvement.

  • Movement in the shoulder usually improves a lot, but may not be normal

  • –The best indication of how a shoulder will move is the pre-operative range (i.e. very stiff shoulders are expected to improve a lot, but usually still have less movement than shoulders that had better movement before surgery)

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How long will the surgery take / How long will I be in hospital? 

  • –about 2 hours, overnight

 

Which hospital?

  • –The Sunshine Coast University Private Hospital

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Anything I should do to prepare for surgery?

  • –You should make sure that she has no pimples or skin breaks around your shoulder. 

  • –if there are any pimples she should wash with benzoil peroxide.

  • –Stop any drugs or supplements that may cause thinning of blood (anti inflammatories, fish oil etc.)

  • –Make sure that you have help at home for after surgery; you will need a sling for 6w and cannot drive for at least 6w

  • –don't smoke

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After care - showering, etc?

  • as long as waterproof dressings are securely in place

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Will I be in a sling?

  • –yes for 6w

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Worst case scenario?

  • –Infection can make the shoudler worse than is now, it may never recover (there is less than 1% risk of this happening)

  • –Very rarely serious complications can occur from the anaesthetic, such as a stroke or heart attack.

  • –Ther is a very small risk of death

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Are there limitations on what I can do after surgery?

  • –Very heavy constant labor is not advised (occasional garden work, home maintenance etc  is ok)

  • –Activties with a high risk of a violent fall or impact is not advised (eg. Motocross, downhill mountainbifing, contact sport)

  • –Regular exercise is OK but heavy or high-volume activity (such as swimming more than 2km a day) is not advised.

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