Shoulder Arthroplasty

Your shoulder is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the collarbone (collarbone) (clavicle). The shoulder is a ball-and-socket joint, which means it has two parts: a ball and a socket. Your upper arm bone's ball, or head, fits into a shallow socket in your shoulder blade. This socket is known as the glenoid. The bones of a healthy shoulder joint. The surfaces of the bones where they touch are canopied with articular cartilage, a smooth substance that defends the bones and assists them to move well. The synovial membrane is a thin, smooth tissue that covers all remaining surfaces inside the shoulder joint. This membrane produces a little amount of fluid that lubricates the cartilage and reduces friction in your shoulder in a healthy shoulder. The muscles and tendons that encircle the shoulder offer stability and support. All of these structures permit the shoulder to rotate through a wide range of motion than any other joint in the body.

The damaged elements of the shoulder are removed and replaced with artificial components known as prostheses during shoulder replacement surgery. The two treatment options are to replace either the ball or both the ball and the socket of the humerus bone (glenoid).

Shoulder pain and impairment can be caused by a variety of factors, leading to patients considering shoulder joint replacement surgery.

• Osteoarthritis (Degenerative Joint Disease) This is related to the age "wear and tear" type of arthritis. It commonly happens in people 50 years of age and older, but may take place in younger people, too. The cartilage that cushions the shoulder's bones weakens and wears away over time. The bones then rub against one another. Over a span of time, the shoulder joint slowly turns out to be stiff and painful. Unluckily, there is no way to forbid the development of osteoarthritis. It is a popular reason people have shoulder replacement surgery.
• Osteoarthritis of the shoulder:

As the cartilage that canopies the ends of the bones wears away, it can lead to bone rubbing on bone and generate painful bone spurs.

• Rheumatoid Arthritis This is a disease in which the synovial membrane that encircles the joint turns out to be inflamed and thickened. This chronic inflammation can harm the cartilage and sooner or later cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most popular form of a group of disorders termed "inflammatory arthritis."
• Post-traumatic Arthritis This can predate a serious shoulder injury. Fractures of the bones that make up the shoulder, as well as injuries in the shoulder tendons and ligaments, can cause articular cartilage to deteriorate over time. This results in shoulder pain and limits shoulder function.
• Rotator Cuff Tear Arthropathy A patient with a very big, long-standing rotator cuff tear might develop cuff tear arthropathy. In this state, the alteration in the shoulder joint due to the rotator cuff tear may cause arthritis and destruction of the joint cartilage.
• Avascular Necrosis (Osteonecrosis) Avascular necrosis is an agonizing condition that happens when the blood supply to the bone is discontinuous. Because without a blood supply, bone cells die, osteonecrosis can eventually destroy the shoulder joint, resulting in arthritis. Chronic steroid use, deep-sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use are risk constituents for avascular necrosis.
• Severe Fractures A severe fracture of the shoulder is another common ground people have shoulder replacements. When the head of the upper arm bone is destroyed, it may be very hard for a doctor to put the pieces of bone back in place. Additionally, the blood supply to the bone pieces can be discontinued. In this instance, a surgeon may advise a shoulder replacement. Older patients with osteoporosis are most at danger of severe shoulder fractures.
• Failed Previous Shoulder Replacement Surgery Some shoulder replacements fail despite their high quality due to implant loosening, wear, infection, and dislocation. When this takes place, a second joint replacement surgery — called revision surgery — may be essential.

You, your family, your family physician, and your orthopedic surgeon should all make the decision to have shoulder replacement surgery together. There are various reasons why your doctor may suggest shoulder replacement surgery. People who gain from surgery frequently have:

• Intense shoulder pain prevents you from doing things like reaching into a cabinet, dressing, toileting, or cleaning your clothes.
•  Average to hard pain while resting. This pain may be stark enough to prevent a good night's sleep. Loss of motion and/or failing in the shoulder.
• Failure to do considerably better with other treatments such as anti-

Orthopedic Valuation Your family physician may refer you to an orthopedic surgeon for a thorough examination to see if you are required for this procedure or have any benefit from it. An evaluation with an orthopedic surgeon includes several components:

•  A medical history - Your surgeon will ask you questions regarding your general health and the severity of your shoulder pain as well as your capacity to function.
•  A physical examination - This will evaluate your shoulder motion, stability, and strength. X-rays. These images help to judge the extent of damage in your shoulder. They can display loss of the normal joint space between bones, flattening or irregularity in the shape of the bone, bone spurs, and loose pieces of cartilage or bone that may be floating inside the joint
• Other tests - Blood tests, an MRI scan, or a bone scan may be required to establish the state of your shoulder's bone and soft tissues.

  Your orthopedic surgeon will skim through the results of your evaluation with you and talk about whether shoulder joint replacement is the ideal technique to relieve your pain and enhance your function. Various treatment options will be explored and evaluated, such as drugs, injections, physical therapy, or other forms of surgery.

Shoulder replacement surgery is extremely technical. It should be carried out by a surgical team with experience in this process. There are various types of shoulder replacements. Your surgeon will assess your situation cautiously before making any decisions. He or she will discuss which form of replacement might be most beneficial to your health. Do not be afraid to inquire about the sort of implant that will be utilized in your case and why that choice is the best option for you. Total Shoulder Replacement The arthritic joint surfaces are replaced with a highly polished metal ball linked to a stem and a plastic socket in a conventional total shoulder replacement. A total shoulder joint replacement. These constituents come in different sizes. They can be bonded into the bone or "pressed-fit" into it. If the bone is of good quality, your surgeon may opt to use a non-cemented (press-fit) humeral component. The humeral component may be implanted with bone cement if the bone is soft. An all-plastic glenoid (socket) component is implanted with bone cement in the majority of instances. Implantation of a glenoid component is not well-advised if:

• The glenoid has fair cartilage
• The glenoid bone is terrible deficient
• The rotator cuff tendons are irreparably torn

Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are mostly good candidates for conventional total shoulder replacement. These x-rays were taken prior to and post total shoulder replacement surgery for osteoarthritis. Stemmed Hemiarthroplasty Based upon the state of your shoulder, your surgeon may substitute only the ball. This process is known as hemiarthroplasty. In a conventional hemiarthroplasty, the head of the humerus is substituted with a metal ball and stem, akin to the component used in a total shoulder replacement. This is called a stemmed hemiarthroplasty. Some surgeons propose hemiarthroplasty when the humeral head is highly fractured but the socket is normal. Other signals for a hemiarthroplasty include:

• Only the head of the humerus is affected by arthritis, whereas the glenoid has a healthy and undamaged cartilage surface.
•  Shoulders with a significantly week glenoid bone
• Some shoulders with severely torn rotator cuff tendons and arthritis

In some cases, the surgeon will choose between complete shoulder replacement and Hemi hip replacement while the patient is still in the operating room. Research shows that compared with half joint replacement, total shoulder replacement can better alleviate the pain of patients with osteoarthritis. Rejuvenation Hemi Arthroplasty Rejuvenation Hemi Arthroplasty includes using a stemless cap prosthesis to replace only the articular surface of the humeral head. With its bone protection advantages, it provides an alternative to standard shoulder arthroplasty for patients with shoulder arthritis. Hemiarthroplasty may be an option for you in the following situations: • The glenoid still has a complete cartilage surface • There has been no recent neck or humeral head fracture • Hope to keep the humerus Active hemi-hip arthroplasty avoids the risk of component wear that may occur in traditional total shoulder arthroplasty in this patient population. Rejuvenating half joint replacement may be easier to convert to complete shoulder replacement in the future due to its more conservative character. This X-ray shows a cloak-shaped prosthesis used for rejuvenation hemiarthroplasty. Reverse Total Shoulder Replacement Reverse complete shoulder replacement is a different form of shoulder replacement. Reverse total shoulder replacement is suitable for people with the following conditions: • Complete rotator cuff tear with severe arm weakness • Severe arthritis and the effects of rotator cuff tear (arthropathy caused by rotator cuff tear) • Front shoulder replacement failed An x-ray reverse total shoulder replacement. For these people, traditional total shoulder replacement can cause pain. They may also be unable to raise their arms beyond 90 degrees. The inability to lift the arm from one side can be very weak. The socket and metal ball are switched in all-reverse shoulder replacements. This means that a metal ball is connected to the shoulder bone and a plastic socket is connected to the upper arm bone. This allows the patient to use the deltoid muscle instead of a torn rotator cuff to raise the arm. (left) Rotator cuff arthropathy. (Right) Reverse total shoulder replacement allows other muscles, such as the deltoid, to complete the work of the damaged rotator cuff tendon.

Your plastic surgeon will go over the risks and complications of shoulder replacement surgery with you, including the risks and complications of the operation itself as well as the risks and difficulties that can emerge afterward.When complications occur, most are successfully treatable. Possible complications include the following. Infectious diseases Infection is a complication of surgery. In terms of shoulder joints, infection can occur in the wound or in depths around the prostheses. It happens after the hospital or home. It can happen after many years. Mild infections in the wound region are generally treated with antibiotics. Main infections or deep infections may require more surgery and elimination of prostheses. The infection by your body can be extended to its joint replacement. Problem of Protuna Design, materials and surgical technology of the Prosase continues to advance, but the prosthesis is used and the pieces can loosen. The composition of the shoulder exchange can also be dislocated. Excessive, loose wear or dislocations may require additional surgery (revised procedure). Nervous injury The nerve nerves near the substitution of the joints can be damaged during surgery, but this type of injury is rare. Over time, these neuronal injuries often improve and recover completely.

Medical rating If you decide to receive surgery, your orthopedic doctor may request schedule a complete physical examination with your family's doctor a few weeks before surgery, I'm sorry. This is necessary to make sure you have surgery and be totally healthy to complete the recovery process. Many patients with chronic medical conditions, such as heart disease, should be evaluated by experts before surgery and professionals. Drugs Try to discuss your orthopedic surgeon about your medication. It is possible that some medications have to stop before surgery. For example, the following medications that are above the next cause cause excessive bleeding and two weeks must be detected before surgery. It is recommended to load doctors and cardiologists to stop these medications before surgery. Home planning You can make your recovery period easier before you can make easy changes in your home before surgery. During the first weeks of his surgery, it would be difficult to reach the high shelf and the tableware shelf. Be sure to go through your home before surgery and place the necessary elements on the low shelf. When you go home from the hospital, you will need a few weeks of help in a daily work, such as dressing, bathing, cooking and laundry. If you do not admit at home immediately after surgery, you may need a short stay at rehabilitation facilities until it is more independent. Surgery for your surgery for your surgery, surgery in front of your surgery Wear the clothes and loose buttons shirt when you go to the hospital for your surgery. After surgery, you will use sling, and you will limit the arms. You will be the most likely hospitalized in the hospital on your surgery day. After admission, it will be taken to the preoperative preparation area and will comply with the doctor of the Anesthesia Department. You, your anesthesiologist, and your surgeon discuss the type of anesthesia used. You are a general anesthetic (you are sleepy), local anesthetics (you wow, but you can not feel around the surgical area) or a combination of both types can provide it.

The risk of osteoporosis is high in masses who have definite medical problems, including:

• Celiac disease
• Inflammatory bowel disease
• Kidney or liver disease
• Cancer
• Lupus
• Multiple myeloma
• Rheumatoid arthritis

The procedure to replace the shoulder joint with an artificial device generally takes approximately 2 hours. After surgery, you'll be taken to the recovery room, where you'll be observed for many hours while your anesthetic recovery progresses. You will be shifted to your hospital room once you have awoken.

Antibiotics will be given to you in multiple doses to avoid infection. The day after surgery, most patients are able to consume solid foods and get out of bed. On the first, second, or third day after surgery, you will most likely be able to go home. Pain Management After surgery, you will feel some pain. It is a natural part of the healing process. Your doctor and nurses will work to cut down your pain, which can help you better from surgery faster. Medications are often ordained for short-term pain relief post-surgery. Opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics are just a few of the medications available to help with the pain. Your doctor may use an assemblage of these medications to better pain relief, as well as decrease the need for opioids. Be alert that although opioids assist in relieving pain after surgery, they are a narcotic and can be habit-forming. Opioid habituation and overdose have become a captious public health issue in the U.S. It is crucial to use opioids only as directed by your doctor. As soon as your pain begins to better, stop taking opioids. Discuss with your doctor if your pain has not begun to better within a couple of days of your surgery. Pain management is an essential part of your recovery. Physical therapy will start soon after surgery, and when you feel little pain, you can begin moving sooner and get your strength back more promptly. Talk with your doctor if postoperative pain becomes difficult. The success of a shoulder replacement depends on a cautious and well-planned rehabilitation regimen. You commonly start gentle physical therapy shortly after the operation. Your surgeon or physical therapist will supply you with a home exercise program to fortify your shoulder and better flexibility. Your Recovery At Home When you part from the hospital, your arm will be in a sling. You will need the sling to support and assist your shoulder for the first 2 to 4 weeks after surgery.

• Wearing a sling after surgery will safeguard your shoulder.
• You will have staples passing along your wound or a suture below your skin. The staples will be abstracted many weeks after surgery. A suture below your skin will not necessitate removal. Avoid drenching the wound in water until it has soundly sealed and dried. You may proceed to dress the wound to preclude annoyance from clothing.
•  Exercise is a crucial element of home care, especially during the first few weeks after surgery. To help you restore strength, follow your surgeon's home exercise prescription. Within two weeks of surgery, most patients are able to conduct basic tasks such as eating, dressing, and grooming. For several weeks after surgery, some pain with exercise and at night is normal.
• Driving a car is not permitted for 2 to 4 weeks after surgery.

The success of your surgery will be based highly upon how well you follow your orthopedic surgeon's operating instructions at home at the time of the first few weeks after surgery. Here are some popular do's and don'ts for when you return home: • When getting out of bed or from a chair, don't use your arm to push yourself up because this creates muscle contractions. • Do follow the program of home exercises advised for you. You may be required to do the exercises 2 to 3 times a day for a month or more. • Don't overdo it! If your shoulder pain was intense before the surgery, the feeling of pain-less motion may allure you into thinking that you can do more than is suggested. Early overuse of the shoulder may result in strong restrictions in motion. • Don't lift anything bulkier than a glass of water for the initial 2 to 4 weeks post-surgery. • Do ask for assistance. Your physician may be able to suggest an agency or facility if you do not have support at home. • After your shoulder replacement, avoid contact sports and any repetitive heavy lifting. • Do avoid placing your arm in an unusual position, such as straight out to the side or behind your body for the initial 6 weeks after surgery. Many thousands of patients have felt a better quality of life after shoulder joint replacement surgery. They sense reduced pain, enhanced motion and strength, and better function.

Research is being carried out to design and develop innovative and better shoulder replacements that can be done with diminished invasive surgical methods. Researchers are gathering data to find out which patients are the ideal candidates for which type of shoulder replacement surgery. This information will permit your surgeon to provide you the best advice for the treatment of your arthritic shoulder.