Shoulder replacement is a little-known joint replacement procedure. The surgery began in the 1950s with ball joint replacement for those who had been in an accident and sustained a severe fracture.
In the early '70s the replacement cup was introduced, opening the surgery to an entirely different group of people -those with chronic pain and stiffness due to arthritis or joint wear.
Today, about 17,000 shoulder replacements are done in this country annually. It is a life-altering surgery for those who need it.
Because the surgery is not being done on a weight-bearing joint, recovery is much faster. For those with heart or other conditions that make surgery risky, the operation may be done with local anesthesia, allowing for fewer complications. Patients are up and walking the same day, and sent home two days later with instructions for independent physical therapy which usually lasts about three months. Usually, no further therapy is needed.
Who is at risk?
The majority of those who have shoulder replacement surgery suffer from osteoarthritis. Read more about osteoarthritis. . A second group at risk is those who have done heavy manual labor for years leading to early degeneration of the joint. A third group is those who have had a traumatic shoulder injury that resulted in injury to the joint surface. The common denominator is pain and stiffness that make daily life difficult.
R. Sean Churchill, M.D. - Orthopaedics, Fellowship trained in shoulder and elbow surgery, is with Advanced Healthcare and is one of two surgeons in Wisconsin who specialize in shoulder replacement surgery. He said the majority of his patients have tried anti-inflammatory medications, physical therapy and lifestyle modifications such as lowering shelves so less reaching is required, but the pain persists.
"Most of my patients complain of a constant aching pain throughout the day that becomes worse at night. Many of them can't sleep at night or do such simple tasks as scratch their head or comb their hair, some for a number of years," the doctor said.
Risks of surgery
The risks for shoulder replacement are the same as for any surgery. The potential for post-operative infection or implant loosening are the two most common, though these are rare.
It is also rare that a transfusion is needed with shoulder replacement surgery, something that is often routine when knees and hips are replaced. Patients are up and walking the same day as the surgery. And, for those with heart disease, emphysema or other health concerns, the surgery can be done while the patient is awake, alleviating much of the risk.
"It's rare that anyone would be too sick to undergo the procedure," Dr. Churchill said. Since the artificial shoulder joint does not have the same wear and tear as artificial knees or hips, candidates for a shoulder replacement are advised not to wait until they are incapacitated to have the procedure done.
"My patients are up the same day walking to the bathroom or around the hospital. They go back to their regular home, not to a nursing home. Most find they are off pain medication and have more function within seven to ten days after surgery."
Dr. Churchill stressed the procedure can be done on patients of any age and that he has operated on people in their 90s with excellent results. His older patients have likely had a hip or knee replacement or know of someone who has, he said. "I ask them 'how was their experience with that' and they say, 'oh, it changed their lives.' That puts them at ease about having their shoulder replaced."
Surgical risks are also reduced by the speed with which a patient is up and walking following surgery. A few hours after the replacement, a patient will be walking to the bathroom or around the hospital, alleviating muscle atrophy and the risk of developing blood clots in their legs. When they are released, usually two days following surgery, they will go directly home - not to a nursing home or assisted living center.
Post-operation physical therapy
Physical therapy begins in the recovery room with passive stretching and moving exercises done with the aid of trained staff. A patient will be given a sling to wear the first day while the local anesthesia wears off. Beginning the second day, the sling is discarded and the patient begins actively using their arm.
Following shoulder replacement, the physical therapy Dr. Churchill prescribes is all done by the patient independently at home.
The patient is instructed on a gentle stretching program to follow for the first two weeks. When they return to the clinic, they will be instructed on two more stretching exercises to do at home. At six weeks when they come back for a visit with the doctor and their therapist, strengthening exercises are begun. The final visit is at three months and usually no additional therapy is required.
"I tell them the one thing they must not do for the first six weeks is a pulling-in maneuver, such as with a car door," he said. And while the replacement joint may feel a bit uncomfortable for the first week, patients can immediately sleep on their side without fear of injuring their shoulder.
Better than new
Dr. Churchill said that most of his patients find that their new shoulders are more functional than the old ones within two to three weeks after surgery though that time can vary.
"I had one patient who had been a milkman for forty years who had beaten his shoulders badly. I fixed his one side and in two weeks that was already his dominant side. He asked when he could get the other side replaced. I told him in three months. Three months and one day later, he was getting the other shoulder replaced. A few weeks after his surgery, his wife came in a hugged me. He'd slept in bed with her for the first time in over five years."
Why a specialist is important
Dr. Churchill is one of two shoulder and elbow trained surgeons in Wisconsin. As a result, he does a number of these procedures every month, while other orthopedic surgeons many see only a few a year.
"You wouldn't think of having a hip replaced by someone who does just three a year. You want someone who does three a week," the doctor said. "It should be the same with shoulders, too. But the most important thing for people to understand is that you don't have to live with that shoulder pain ... there are treatment options available."
