Virginia Mason's orthopedic surgeons specialize in the following surgical procedures for shoulder replacement:
The goal of a total shoulder replacement is to eliminate pain and restore strength and natural movement in the arm. A shoulder replacement is a major surgical procedure performed in an operating room. You will be instructed on pre-surgical preparations prior to the date of your operation.
A regional anesthetic is given before surgery so your shoulder is numb before surgery and for several days afterwards. After you are asleep from the general anesthetic, your surgeon will make a four- to six-inch incision along the front of your shoulder. The surgeon will then separate the deltoid and pectoral muscles to spare the nerves and muscles. The surgeon will then remove damaged cartilage and bone from the socket and will remove the ball or head of the upper arm bone. At this point a new polyethylene plastic implant will be cemented into the socket.
With the damaged ball or head of the arm bone removed, your surgeon will then create a narrow channel in the middle of the bone to receive the stem implant, which holds the new "ball" in place.
The ball of the implant is attached to the stem or is attached separately at the surgeon's discretion. The stem is kept in place with or without cement. When bone cement is not used, the material of the stem will be made of a porous metal that allows your natural bone to grow into it and secure it in place. The length of a total shoulder replacement surgery takes approximately two hours.
Your surgeon may find the socket in your shoulder blade is in good condition and that only the ball or head of the humerus needs to be replaced. Your surgeon will then remove and replace the ball as would be done during a total shoulder replacement. With a partial shoulder joint replacement, your time in surgery is reduced and your rehabilitation also may be shorter.
Reverse total shoulder replacement surgery is a newer surgical procedure approved by the Food and Drug Administration (FDA) in 2004. With this implant, the ball and socket are reversed so that the ball is attached to the shoulder blade and the socket is attached to the stem that resides within the top of the arm bone (humerus). This type of replacement is used when patients have completely lost their rotator cuff tendons and have arthritis of the ball and socket joint that results in severe pain and poor shoulder function. The procedure is also used in cases where fractures have healed poorly or incorrectly, so that the rotator cuff does not function and there is severe pain and instability. In a normal functioning shoulder, the rotator cuff lifts the arm. With a reverse total shoulder replacement, the deltoid muscles that cover the shoulder will take over this task.
Some patients have severe arthritis in both shoulders and receive bilateral shoulder replacements, usually at separate surgical appointments.
Total joint replacement can be one of the most painful surgeries when traditional methods of pain control are used. At Virginia Mason, however, physicians are using new approaches. The anesthesia delivered to shoulder replacement patients is designed to promote a faster recovery with fewer complications.
The ability of Virginia Mason anesthesiologists to keep joint replacement patients comfortable is evident in patient satisfaction scores for pain control in the 99th percentile on the inpatient unit.
Following surgery, you will be taken to a recovery room where your vital signs will be monitored. Once you have recovered from surgery and are stable, you will be moved to a regular hospital room. Most patients are in the hospital for two to three days.
On the same day as your surgery, a physical therapist will help you sit up in bed and show you how to perform light arm and shoulder exercises. You also may get out of bed and walk a short distance with assistance on this first day. Each day you are in the hospital, and several times a day, the physical therapist will work with you on arm and shoulder exercises. Your road to recovery begins with these simple exercises that will eventually help you regain strength and functional use of your arm.
Prior to joint replacement surgery, many patients attend a physical therapy orientation in Virginia Mason's Section of Physical Medicine and Rehabilitation. The orientation provides patients with helpful information, including safety recommendations (rearranging frequently used items for easier reach), assistive devices (long-handled shoe horn) and joint-specific exercises.
Your surgeon and physical therapist will talk to you in more detail about exercises to do at home after surgery.
When you are out in public, a sling is worn to warn others to be careful around you during the healing period. At home you can go without your sling and use your arm to:
We prefer that you do not lift anything weighing more than three to five pounds until healing is well under way. After one month, you will work with a physical therapist to regain motion and strength. Some patients do it on their own with good results.
Virginia Mason's Peer Partners is a unique program of support for hospitalized patients. Volunteers who have been through similar situations visit with patients and their families to answer questions and assist with non-medical concerns. Peer Partners can also help caregivers understand how to best provide care and support when a patient returns home.
All precautions to ensure patient safety are taken prior to every operation at Virginia Mason. However, as with any surgery, some risks remain such as infection, excessive blood loss and the development of blood clots. The incidence of these risks occurring in patients having joint replacement surgery is very small - less than 1 percent.
There also is the risk of the implant loosening over time or failure of the polyethylene component. When this happens, another surgery is required to fix the problem.
The answer must take into account several factors, including the patient’s age, physical condition and activity level. For most people who have a shoulder replaced, the implant is expected to last the remainder of their lives. We have many options for revision surgery, and implants are lasting longer now due to improved materials and geometry. It is more important to live pain free, enjoy life, exercise and have a higher quality of life than to worry about another surgery.
If you have questions or would like to schedule a consultation with an orthopedic surgeon, call us at (206) 341-3000.