Patients that are experiencing chronic shoulder pain that affects quality of life and daily function may be suffering from shoulder arthritis. Generally speaking, arthritis is a condition in which the cartilage surface that protects and cushions the ends of the bone in the knee joint is damaged and worn thin. This can be from wear and tear (osteoarthritis), trauma, or diseases that cause severe inflammation in the joint (e.g. rheumatoid and psoriatic arthritis). If your pain has not decreased with medication, injections, and/or acceptable activity changes, you may be a candidate for shoulder replacement.
What is shoulder replacement surgery?
Anatomic total shoulder replacement
An anatomic total shoulder replacement entails resurfacing the damaged parts of the joint with metal and polyethylene (a hard plastic) generally removing only a few millimeters of bone. If the surrounding rotator cuff is healthy and the bone loss is not too severe then replacing the shoulder surface anatomically is the best option
Reverse total shoulder replacement
In a reverse total shoulder replacement the ball and socket of the shoulder joint are still resurfaced, but in reverse. Specifically, the socket is covered with a metal ball and the ball that is removed is replaced with a plastic socket. A reverse shoulder replacement is indicated in a patient with arthritis and no functioning rotator cuff or arthritis with severe bone loss on the socket side of the joint. Rehabilitation and recovery are similar to an anatomic total shoulder replacement, but functional outcomes may be different depending on the severity of your rotator cuff damage.
What happens during shouldr replacement surgery?
Your treatment begins with a pre-surgical evaluation to plan for the best size and position of your artificial joint utilizing computer templated digital x-rays and CT scans.
During your shoulder replacement surgery, Dr. Morrison uses instruments, guides, and computer navigation. These tools allow for precise removal of damaged bone and resurfacing with implants in the optimal position.
What is the recovery time?
Everyone heals from his or her surgery at a different pace. In most cases, however, you will be restricted in some of your shoulder movements for 6 weeks. You will wear a sling for 4-6 weeks when not engaged in exercises. Your physical therapist will guide you through this progression. You will gradually return to normal function without any sling. Most patients have functional range of motion by week six and can begin lifting heavier weight at week twelve. Your new joint and surrounding tissues will continue to heal even up to a year after your procedure.
Can I sleep on my side?
You may sleep on your non-operative side whenever you feel comfortable and your operative side at 6 weeks.
How long do I need to keep a bandage on my incision?
Waterproof bandage should be worn for 7 days after your surgical procedure. Remove the waterproof bandage after 7 days post-op. Continue to shower as normally after that without a bandage. If desired, you may continue to wear a bandage to protect the incision from irritation.
When can I shower (get the incision wet)?
You may shower as soon as returning home as long as the waterproof bandage is in place for the first 7 days. After waterproof bandage is removed, continue to shower as normal.
When can I immerse my shoulder in water (e.g., bath, swimming pool, ocean, hot tub)?
Typically, you should not swim or get in a hot tub or bath tub for six weeks. However, in some circumstances we will allow patients to do so after four weeks if there is no drainage. Check with your therapist and surgeon.
How long will I be on pain medication?
You will likely require some form of pain medication including Tylenol and an anti-inflammatory medication (e.g. Meloxicam or Celebres) for 6 weeks. Some patients also require a stronger pain medication (narcotic or opioid) for a shorter time period after surgery. Ice, rest, and elevation also play an important part in managing pain and swelling.
Do I need a physical therapist?
Yes! The physical therapist plays a very important role in recovery. You will see a physical therapist the day of your surgery. If you are unable to go home the day of surgery, the physical therapist will see you during your hospital stay. Over 95% of patients start outpatient physical therapy within 2-3 days of going home. Therapy is typically 2-3 times weekly for 6 weeks. The therapist should follow the protocol that has been issued to you on your pre-op visit and/or discharge from the hospital. Your therapist will keep your surgeon informed of your progress.
When can I drive?
Once you are out of your sling during the day, have the ability to raise your arm to the top of the steering wheel, and are completely off narcotic medication you can drive. This is typically 3-4 weeks after surgery.
When can I return to work?
This depends on your profession. Typically, if your work is primarily sedentary, you may return as soon as you feel ready. If your work is more rigorous and requires heavy lifting, squatting, or climbing you may require up to two to three months before you can return to full duty.
I am constipated. What should I do?
It is very common to have constipation postoperatively. This may be due to a variety of factors, but is especially common when taking narcotic pain medication. A simple over-the-counter stool softener (such as Colace) is the best prevention for this problem. In rare instances, you may require a suppository or enema.
What should I expect for my range of motion at six weeks? At one year?
Everyone's range of motion varies and depends on individual factors (especially your range of motion before surgery). Your potential will be discussed with your surgeon prior to surgery. In most cases, you will be able to place your hand on top of your head and reach your opposite arm pit by 6 weeks. At 12 weeks you should be able to reach your back packet easily. The final range of motion improves from there slowly up to one year after surgery.
Do I need antibiotics before dental work or an invasive procedure?
Yes. You will be given instructions explaining this in detail at your surgical discussion and first follow-up visit. This is also located your joint replacement booklet. Avoid any dental cleaning or non-urgent procedures for six weeks postoperatively.
I feel depressed and/or have a loss of appetite. Is this normal?
It is not uncommon to have feelings of depression and/or have a loss of appetite after your hip replacement. This may be due to a variety of factors, such as limited mobility, discomfort, increased dependency on others and medication side effects. Feelings of depression and/or loss of appetite will typically fade as you begin to return to your regular activities. If your feelings of depression and/or loss of appetite persist, consult your primary care physician.
How long will my total shoulder replacement last?
This varies from patient to patient. For each year following your shoulder replacement, you have a 1 percent chance of requiring additional surgery. For example, at 10 years postoperatively, there is a 90 percent success rate. Newer implants and technologies may have even better success rates.
When do I need to follow up with the office for x-rays?
Follow-up appointments should be made postoperatively at six weeks, six months, year one, year two, year five, and every five years after that. More frequent follow up may be requested if needed.
Normal things about your new knee:
- Clicking noise with motion
- Swelling around shoulder or lower arm
- Bruising all the way from your upper arm down to your elbow and armpit
- Warmth around shoulder
- "Pins and needles" feeling at or near your incision
- Dark or red incision line
- Bumps under the skin along the incision. Occasionally, the sutures used to close the wound can be felt.
Abnormal things about your new shoulder (call the surgeon if you experience any of these):
- Increasing bright redness, particularly spreading from incision
- Increasing pain and swelling that is not controlled by pain medicine
- Fevers (above 101 degrees)
- Persistent drainage from your wound
