Shoulder Replacement

Shoulder_pain_elderly_need_of_surgery

Shoulder joint is a ball and socket joint with a more complex bio-mechanics as compared to the hip due to higher range of mobility. Shoulder replacement has good to excellent results in correctly choosen patients. The patients usually presenting with a functional disability due to painful restriction of range of motion benefit the most out of this surgery.

The ball and socket is replaced according to the patient profile. There are few basic differences in the type of replacement that can be offered. Theses are:

  • Shoulder Hemi-Replacement,
  • Total Shoulder replacement &
  • Reverse Total shoulder Replacement

The bio-mechanical differences in these designs are crucial to understand for replicating anatomy and decieding the type of replacement as per patient need. The main indications of Shoulder replacement include:

  • Arthritis of shoulder
  • Irrepairable rotator cuff – cuff arthropathy/ massive tear
  • Post-traumatic Stiff/painful shoulder
  • Oncological process involving the Shoulder
  • Rhematoid arthritis
  • AVN of humeral head

The basic workup of a Joint Replacement surgery essentially remains same and includes:

  • Complete medical examination
  • Complete hematological(blood) and urine examination
  • Radiological examination of both knees
  • A pre- anaesthesia checkup for all associated comorbidities
  • Control of metabolic derangements with medical treatment
  • Home and Social planning and councelling

As per the status of clinical examination your docor might councel you for the implant and type of surgery. Grossly, in cases where only the humeral head (ball) is involved, a hemi replacement is done. In cases where the arthritis process involves both the ball and socket, a total shoulder replacement is looked for. The patients who have a longer standing disease with a dynsfunctional rotator cuff or Cuff arthropathy, A reverse total shoulder replacement is councelled for.

The requirement may differ in indivisual cases with pros and cons of surgical procedure and instrumentation may vary. A patient must understand that the variety of implants available makes it difficult to comment on surgical procedure without thrrough clinical evaluation. We advise you to ask your orthopedic regarding the same and understand how your new shoulder works.

There is no surgical procedure free of risk and shoulder replacement is no exception. The complications associated can be:

  • Infection
  • Blood Clotting (thrombosis)
  • Mechanical complications: Loosening & subsidence
  • Delayed wound healing
  • Immunosuppression in cases of Rheumatoid arthritis
  • Chest Infections

There always exists a difference between the expectations and result with most patients meeting the two by end of 8-12 weeks if there is no associated complication. All patients may not have similar results at the same time but eventually reach the same fate by 3-6 months post surgery.

Following shoulder exercises are crucial pre shoulder replacement. It is important to consider power in various muscle groupsbefore planning the intervention. These exercises are targetted to identify and strengthen various active muscle groups..

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