Shoulder Replacement

WHEN SURGERY is RECOMMENDED: Dr. Sherfey and Dr. Antebi will take the patient’s pain, disability, and age into consideration when recommending shoulder replacement surgery. Patients who experience or having persistent weakness, numbness, loss of motion, or any of the following conditions in the shoulder may consider the procedure:

  • Severe shoulder pain or stiffness that limits your everyday activities
  • Chronic shoulder inflammation and swelling that does not improve with rest or medications
  • Inadequate pain relief from anti-inflammatory medications, injections, or physical therapy
  • Osteoarthritis is an age related arthritis caused by degeneration of cartilage.
  • Rheumatoid Arthritis is the inflammation of the membrane that surrounds the shoulder causing cartilage degradation.
  • Post-traumatic arthritis is a type of arthritis that occurs following a serious injury
  • Rotator cuff tear arthropathy is a chronic rotator cuff tear, leading to arthritis
  • Avascular necrosis is a very painful condition caused by lack of blood supply to the shoulder bone
  • Severe fractures that caused the head of the upper bone arm to break or crack. In some cases, the only treatment available to restore shoulder appearance and function is replacement.

There are two types of shoulder replacement surgery: total shoulder replacement or reverse total shoulder replacement. The decision of which surgery should be performed is based on if you have an attached rotator cuff or not. The damage to your rotator cuff can be determined with an X-ray, physical exam, or an MRI.

  • In a standard Total Shoulder Replacement Surgery the damaged portion of the socket is removed and a
    metal and plastic liner is fitted into the shoulder socket. The head of the humerus bone is removed and a
    metal ball is attached in its place. The rotator cuff muscles and tendons help the shoulder component to
    function like a normal shoulder.
  • In the Reverse Shoulder Replacement Surgery the socket and metal ball are switched. The metal ball is
    fixed to the socket and the plastic cup is fixed to the upper end of the humerus bone. This surgery is also
    recommended if the patient has had a previous shoulder replacement that was unsuccessful.

How is it Performed?

During surgery local anesthetic is injected into the shoulder to reduce the amount of pain you will feel. In many cases the Anesthesiologist will explain to you the options of having a ‘block’ which is an injection in and around the neck which will reduce pain for 12 to 18 hours post operatively. You must remove all rings from your hand prior to surgery.

Dr. Sherfey or Dr. Antebi will make an incision in the front of the shoulder curving along the deltoid muscle to expose the shoulder joint.

  • The damaged bone and cartilage is removed.
  • The damaged humeral head is removed and replaced with a metal stem that is placed into the hollow center of the humerus.
  • A metal ball is placed on the upper part of the stem. This ball replaces the damaged humeral head that was removed.
  • * (Reverse) A metal ball is placed on the socket. This ball replaces the damaged humeral head that was removed
  • The damaged cartilage surface of the socket (glenoid) is removed and replaced with a metal socket and sometimes held in place by screw or cement.
  • * (Reverse) The damaged cartilage surface of the socket (glenoid) is removed and replaced with a metal socket placed on tip of Humerus and sometimes held in place by screws or cement.
  • A plastic spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
  • The muscle & other soft tissues are repaired and the is stitched or stapled back together.

The surgical procedure takes 1 to 3 hours depending on the amount of repair needed.

After surgery, you will be moved to a recovery room monitored by nurses where you will remain for several hour while you recover from the anesthesia. Your arm will be placed in a sling. You will go home within a few hours after surgery.

PREPARING FOR SURGERY

FOLLOW ALL PRE-OPERATIVE INSTRUCTIONS
given to you by Dr. Sherfey or Dr. Antebi.

  • Stop all Aspirin, blood thinners, and anti-inflammatory medications (Motrin, Aleve) 10 days prior to surgery as they can cause bleeding during surgery. DO NOT STOP your blood thinners without consulting your primary care physician first.
  • Stop any naturopathic or herbal medication 10 days prior to surgery as these can also cause bleeding.
  • Continue with all other medications unless otherwise specified.
  • Bring a list of ALL medication with you on the day of surgery to give to the anesthesiologist.
  • You are advised to STOP SMOKING for as long as possible prior to surgery.

REALISTIC EXPECTATIONS: An important factor in deciding whether to have surgery is understanding what the procedure can and cannot do. More than 95% of people who have surgery experience a dramatic reduction of pain and a significant improvement in the ability to perform common activities of daily living. But surgery will not allow you to do more than you could before you developed the injury. Reaching above the level of the shoulder may not improve with shoulder replacement.

MEDICAL EVALUATION: Your surgeon may ask you to schedule a complete physical examination with your primary care physician before the operation. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such as a cardiologist, before the surgery.

TEST: Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help Dr. Antebi & Dr. Sherfey plan your surgery.

MEDICATIONS: Tell your surgeon about the medications you are taking. He will tell you which medications you should stop taking and which you should continue to take before surgery.

DENTAL EVALUATION: Although the incidence of infection after surgery is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your surgery.

URINARY EVALUATION: People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before undertaking surgery.

SOCIAL PLANNING: You will need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry. If you live alone; make advance arrangements to have someone assist you at home.

Total Shoulder Reverse Shoulder

AFTER SURGERY

Patients go home the day of surgery in most cases.

Your sling must remain on 24 hours a day including at night unless instructed otherwise

YOUR RECOVERY at HOME: The success of your surgery will depend largely on how well you follow Dr. Sherfey and Dr. Antebi’s specific instructions at home during the first few weeks after surgery. Some loss of appetite is common for several weeks after surgery. It is important to have a balanced diet (often with an iron supplement) to promote proper tissue healing and restore muscle strength. Drink plenty of Water!

WOUND CARE: You will be given wound care instructions when discharge home. It is normal to have some blood oozing under the dressing, however if the dressing becomes saturated, you can change the dressing with gauze and tape. Remove the dressing 1 week after surgery. You will have stitches, staples, or a glued sterile mesh (most commonly used) on the skin. The stitches, staples, or mesh will be removed at your follow-up appointment usually 2 weeks after surgery. You can shower after you remove the dressing 1 week after surgery. Wash the wound gently with soap and water while showering. Avoid soaking the wound in water such as a bath or jacuzzi. You may continue to bandage the wound to prevent irritation from clothing.

PAIN: Surgery pain is a common concern for most patients. Dr. Antebi & Dr. Sherfey utilize advanced techniques in treating post operative pain. This includes medications given prior, during and after your surgery.After your surgery, you may experience a minimal amount of pain. Your surgeon will provide medication to make you feel as comfortable as possible. Ice packs should be used regularly to reduce swelling and pain.

ACTIVITY & EXERCISE: This is a critical component of healing. You will be instructed about what motion or exercises you can perform and what restrictions you have. The sling must remain on 24 hours a day including at night. The sling only comes off to have a shower and get dressed and on those occasions the arm needs to be kept adjacent to the body. Under no circumstances are you to elevate or rotate the operated arm. You may flex and extend your elbow as much as needed unless instructed by Dr. Sherfey or Dr. Antebi to remove sling earlier. You will then be reviewed 6 weeks post operatively, when the sling will be removed and formal ACTIVE physiotherapy prescribed. This form of therapy, in most cases, will be supervised by a physiotherapist a couple of times a week, You can begin lifting objects after 6 weeks but DO NOT lift more than 2 lbs. The muscle do not fully heal to the bone for 4 months. Physiotherapy will take at least 6 months to achieve a full or near full return of function. If you have a reverse replacement you may be allowed earlier motion. Most people resume driving approximately 6 weeks after surgery when out of sling.

TIME OFF WORK: This depends on your work requirements. Office workers usually require 2 to 4 weeks off and manual laborers 3 to 4 months off. The success rate and return of function is very dependent on the type of replacement.

PREVENTING PNEUMONIA: It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed “atelectasis”) which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths.

HOME PLANNING: Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

A stable chair with multiple pillows or recliner chair for sleeping the first week. Prop your injured arm up with pillows while you are sitting or lying in bed, this will help with swelling and pain. Shirts that button or zip, instead of ones that you pull over your head. Safety bars or a secure handrail in your shower or bath & a stable shower bench or chair for bathing Secure handrails along your stairways & removing all loose carpets and cords.

POSSIBLE COMPLICATIONS OF SURGERY

Your shoulder needs time to heal, so be patient. Do not rush the recovery process.

INFECTION: It is important to follow Dr. Antebi & Dr. Sherfey’s instructions carefully and make sure you are not pushing yourself too fast or too soon. Although the risk of infection is extremely low, it may occur. It may happen while in the hospital or after you go home. Minor superficial wound infections are generally treated with wound cleansing and antibiotics. Major or deep infections may require more surgery and possible removal of the prosthesis.

PREVENTING INFECTION: Keeping your wound clean with antibacterial soap and water is crucial in preventing infection. A common cause of infection following surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. Your surgeon will discuss with you whether taking preventive antibiotics before dental procedures is needed in your
situation.

Warning signs of infection. Notify AVORS immediately if you develop any of the following:

  • Persistent fever (higher than 100°F orally)
  • Shaking chills
  • Increasing redness, tenderness, or swelling of the wound
  • Drainage from the wound
  • Increasing pain with both activity and rest

BLOOD CLOTS: Blood clots in veins are one of the most common complications of surgery. These clots can be life-threatening if they break free and travel to your lungs.

PREVENTING BLOOD CLOTS: Follow Dr. Sherfey’s & Dr. Antebi’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He may recommend that you take a blood thinning medication. Notify your surgeon if you develop any of the following:

Warning signs of blood clots in arm:

  • Increasing pain in your arm.
  • Tenderness or redness above or below your elbow.
  • New or increasing swelling in your shoulder, elbow and hand.

Warning Signs of PULMONARY EMBOLISM: if these occur go to the ER or call 911

Sudden Shortness of Breath or Sudden onset of Chest Pain or Localized Chest Pain & Coughing

IMPLANT PROBLEM: Although implant designs and materials, as well as surgical techniques, continue to advance, implant surfaces may wear down and the components may loosen. Motion may be more limited, particularly in patients with limited motion before surgery.

PAIN: A small number of patients continue to have pain after surgery. However, this complication is rare and the vast majority of patients experience excellent pain relief following surgery.

PAIN MANAGEMENT: After surgery, you will feel some mild pain. This is a natural part of the healing process. Your surgeon and nurses will work to reduce your pain. Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your surgeon may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

NEUROVASCULAR INJURY: Although rare, injury to the nerves or blood vessels can occur during surgery.