SHOULDER REPLACEMENT SURGERY

Shoulder Replacements are generally required in patients with Severe complex fractures of the shoulder where reconstruction and preservation is impossible. Painful shoulders because of arthritis with an inability to pursue normal activities. Painful shoulders with restricted mobility because of severe muscle tears and consequent arthritis.

• As far as possible, attempts are made to preserve the humeral head. Fractures with minimal displacement (where the bones are well aligned) can be treated in a comfortable shoulder sling. Shoulder movements are started early to avoid stiffness.
• The shoulder is a ball and socket joint where the ball is significantly larger than the socket. Thus the configuration of bones itself does not afford as much stability as seen in the hip and knee. Shoulder Replacements, thus, require fine balancing of muscles and soft tissues such that the joint is stable, painless and mobile. Shoulder replacement surgery is now pursued by Specialist Shoulder Surgeons (and not just joint replacement surgeons) around the world. They understand shoulders better and have good experience in this field.
• In a Shoulder Replacement, the ball is replaced with metal. The most commonly used sockets are made of a special polyethylene. Both these components are fixed in bone with a special cement. Some replacement surgeries involve replacing the ball alone. This is a Hemiarthroplasty –half a shoulder replacement, done mostly in the fracture situation or if the muscles are severely torn. In case of intact muscles (but severe arthritis) both the ball and socket are replaced - a Total Shoulder Replacement.
• Patients with severe rotator cuff tears cannot have the regular shoulder replacement. They require a special implant known as the "Reverse Shoulder Replacement".

WHAT TO EXPECT

• For detailed information please see "Guide to a Shoulder Replacement". Patients are generally admitted a day before surgery. Relevant investigations to assess the patient's fitness for surgery and shoulder condition are performed on this day.
• The operation takes approximately 90 minutes. Patients are kept in a sling after surgery. Pain is minimal and patients start walking the very next day. They spend 2-3 days more in the hospital wherein our physical therapists start shoulder and breathing exercises. Medicines are prescribed for approximately a week after surgery, stitches are removed at 2 weeks and range of motion and gradual strengthening exercises started at approximately 3 weeks post surgery. Patients start pursuing normal activities at roughly 6 weeks after the operation.