Surgical Treatment of Arthritis of the Shoulder
Surgical treatments for shoulder arthritis have improved greatly over the past ten years. Surgery has helped people of all ages affected by arthritis to improve their quality of life. Stiff and painful joints damaged by arthritis are now potentially successfully replaced, relieving pain and improving joint function.
Arthritis of the shoulder may be caused by:
- Age-related osteoarthritis (wear-and-tear arthritis).
- Injury-related (such as repeated dislocation of the shoulder) osteoarthritis that can appear many years after the injury.
- A shoulder fracture involving the joint surface due to severe trauma.
- Chronic inflammatory disease (rheumatoid arthritis).
Arthroscopy of the shoulder is a common surgical procedure to examine the inside of the joint. In some patients, surgical treatment during arthroscopy can improve the symptoms from a damaged joint. Some symptoms of early arthritis may be relieved by arthroscopic treatment. When joint damage causes severe pain and the shoulder joint becomes stiff, the most common surgical treatment is joint replacement.The shoulder is a complex joint made of three bones: the humerus, the scapula (shoulder blade) and the clavicle (collar-bone). As shown in the figures, the larger of two joints in the shoulder is the shoulder joint, a ball-and-socket joint where the rounded head of the humerus fits into a socket in the scapula. The second, smaller joint in the shoulder is called the acromioclavicular joint.
Shoulder Joint Replacement
Prosthesis: The artificial shoulder joint is called a prosthesis. The prosthesis is designed to function like a normal joint. As shown in the figure, the rounded head of the humerus is replaced with a metal ball or more recently a carbon-fibre ball. This ball may be fixed to a metal stem that is inserted into the bone cavity of the humerus. However it is also common to simply cover the worn ball with a smooth metal eggshell-type implant. The artificial socket for the scapula is made of plastic and may be attached to the bone with special synthetic cement.
Surgical Procedure: An incision about 20 centimetres long is made across the front of the shoulder. Nerves, blood vessels and muscles are carefully moved aside, and the joint capsule is opened. The humerus is taken out of its socket. The head of the humerus is removed or prepared. Tools are used to prepare the bone cavity of the humerus so that a secure fit is achieved if a metal stem is inserted. The head of the humerus is not removed if a resurfacing implant is being used. If the socket needs to be replaced, a small drill is used to remove damaged cartilage from the surface. Small stems on the outside of the artificial socket are plugged into holes drilled in the scapula. The humerus is fitted into the new socket, and the shoulder is tested to make sure that the pieces fit together properly. Sometimes bone cement or screws are used to anchor the prostheses. The joint capsule is closed with stitches that dissolve. The procedure is completed with the stitching of the skin incision. The procedure usually takes one hour.
- An allergy or bad reaction to antibiotics, anaesthetic drugs or other medicines, surgical tapes or dressings
- Prolonged bleeding or excessive bruising when injured
- Previous problems with blood clots in the legs or lungs recent or long-term illness
- Keloid (raised) scars or poor healing of scars after previous surgery.
Recovery After Arthroscopy and Shoulder Joint Replacement
- Exercises to help strengthen muscles around the joint.
- Movements to avoid.
You will be told when you can use the joint normally and return to normal activities.
Joint Replacement Surgery: After shoulder joint replacement, you will have a bulky dressing on your shoulder. Your arm will be in a sling. This is to protect the shoulder and to keep it in the correct position.
A drainage tube may extend from your wound underneath the dressing. If you have such a tube it will be removed after one day.
Most patients have some pain and discomfort while tissues around the new joint heal. A pain reliever can be taken for this. The pain from the operation usually lasts for a few weeks before it starts to improve.
An exercise program is an important part of your recovery. It usually starts with gentle exercises the day after surgery. These exercises are important to help prevent stiffness and regain shoulder movement. As the tissues heal, your physiotherapist tests the strength in your shoulder and surrounding muscles. An exercise program will be designed for you. Strength and flexibility of your shoulder should steadily improve over the next six to 12 months.
Most patients go home two to three days after surgery, with specific instructions on daily activities. You may be allowed to resume driving in about 3 to 6 weeks, depending on your recovery.
Stitches may are usually under the skin and will dissolve in time leaving a faint scar. You may have regular X-ray examinations to detect any changes such as loosening in the artificial joint. It takes time to recover from joint replacement surgery, and you will need help when you return home. Arrange for a responsible adult to stay with you for several weeks after surgery.
Some patients may have difficulty sleeping on their operated shoulder due to pain during the recovery phase. Most shoulder joint replacements are successful in relieving pain and improving flexibility to a lesser extent if at all. Improved materials and advances in surgical techniques have extended the length of time a joint replacement can last in excess of 10-15 years.
Osteoarthritis of shoulder joint
Metal humeral head resurfacing
Post operative shoulder resurfacing
Post operative shoulder resurfacing
Avascular necrosis of humeral head
Pyrocarbon humeral head replacement
Post operative shoulder hemiarthroplasty
Post operative shoulder hemiarthroplasty
Possible Complications Of Surgery
As with all surgical procedures, arthroscopy and joint replacement surgery do have risks, despite the highest standards of practice. Whilst every attempt is made to minimise risks, complications can occur that may have permanent effects.The following possible complications are listed to inform and not to alarm you.
General Risks Of Surgery
Possible complications of any surgery may include:-
- Pain and discomfort around the incisions
- Wound infection and treatment with antibiotics
- Nausea (typically from the anaes¬thetic; this usually settles down quickly)
- Bleeding from the incisions
- Keloid scars (most scars fade and flatten, but some may become “keloid” and remain raised, itchy, thick and red. A keloid can be annoying but is not a threat to health.)
- Slow healing (most likely to occur in smokers and people with diabetes)
- allergies to anaesthetic agents, antiseptic solutions, suture material or dressings.
Specific Risks Of Arthroscopy
- A build-up of fluid in the shoulder joint that requires drainage.
- Cartilage damage.
- Temporary joint stiffness.
- Temporary injury to nerves close to the surgical area.
Specific Risks Of Shoulder Joint Replacement
- The risk of infection is about one patient in every 200. Infection may occur up to several months after the operation. Infection can spread from any part of your body to the area of the new joint. To help prevent this, you may need to take antibiotics before and after other surgery or dental work. Infrequently, the infection may be resistant to treatment, and a second operation is needed to remove the prosthesis, followed by a third operation to replace it.
- The artificial joint may become loose where the metal or cement meets the bone. This causes pain and eventually another operation will be needed.
- The artificial shoulder joint can dislocate, that is, the ball comes out of the socket. This risk is most likely soon after surgery while the tissues around the new joint are still healing. If it happens more than once, another operation may be needed.
- As the surgery is performed close to the nerves to the arm, permanent nerve damage is possible. Minor nerve injuries usually heal well over time, and the nerves may recover completely.
- The main arterial blood supply to the arm is also potentially at risk during surgery but injury of the vessels is uncommon.
Please Report To Me
Please contact me through any of the above numbers or via your General Practitioner at once if you develop any of the following problems:
- Temperature higher than 38C or chills.
- Severe pain or tenderness in the shoulder.
- Heavy bleeding from your wound.
- Redness around an incision that is spreading.
- Worsening flexibility or inability to move the shoulder.