PATIENT INFORMATION – Ward Oakley, MD Shoulder Patients

 

A Total Shoulder Replacement (TSR) is indicated for relieving the pain associated with osteoarthritis of the shoulder joint.  Shoulder arthritis is usually the result of the wear and tear of age related osteoarthritis.  This is a degenerative and progressive process.  The protective cartilage is worn away resulting in the exposure of bare bone in the shoulder socket (glenohumeral joint).  Arthritis is more common as the patient ages, but clearly some patients seem to have a genetic predisposition to the condition with severe involvement at an early age.  Arthritis causes limited range of motion, pain, stiffness, swelling, tenderness and a feeling of popping or grinding in the shoulder. 

 

There are two main types of Total Shoulder Replacements (TSR). The standard TSR is for patients who have only joint arthritis and have maintained good functioning of all their shoulder muscles.

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Some patients develop the need for a Shoulder Replacement because they have no Rotator Cuff, the deep muscles of the shoulder that are important for giving the shoulder strength in functioning.  When a patient either wears out their Rotator Cuff muscles or has suffered an injury to them in the past that cannot now be repaired this leads to a painful dysfunctional shoulder that can also develop disabling arthritis.  Such a condition is called Rotator Cuff Arthropathy.  The other type Total Shoulder Replacement that these patients require to achieve pain relief and regain function is called a Reverse Total Shoulder.

 

There are other conditions that can also lead to arthritic destruction of the shoulder joint:  fractures of the shoulder joint, Rheumatoid arthritis, psoriasis, Paget’s disease, osteonecrosis, etc.  Total Shoulder Replacement is indicated for these conditions as well.

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WHEN ARE YOU READY FOR TOTAL SHOULDER REPLACEMENT (TSR)?

The patient makes the decision to have shoulder replacement.  The patient makes that commitment when he/she has the appropriate radiographic evidence (x-ray and/or MRI pictures) that the shoulder joint is destroyed (severity of arthritis) and the pain and limitation of function is affecting their functions of daily living. The patient needs to be mindful of the fact that there is no cure for arthritis short of surgical replacement.  All the medicines, physical therapy, various types of injections, and so forth will not cure the arthritis but they may help a patient remain comfortable and functional.  And that is good.  But when that goal of having a comfortable and functioning shoulder cannot be meet with these non-surgical approaches then that is when you should consider a Total Shoulder Replacement.

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COMPLICATIONS OF TOTAL SHOULDER REPLACEMENT

The results from a Total Shoulder Replacement are very good; however no surgery is without its risks and complications.  These complications include infection, blood clot formation (Thrombophlebitis), damage to blood vessels, nerves, or bones, stiffness or loss of motion in the shoulder, loosening or failure of the implant, and those risks commonly associated with any surgery requiring anesthesia.

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Potential Complications

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• As with all surgeries there is the risk of infection at the operative site. This is a rare occurrence of less than 1%.  Antibiotics are administered prior to surgery as a preventative action.

• The development of a blood clot in the venous system of your leg or arm, also known as Deep Vein Thrombosis (DVT) is a potential complication. This is a rare occurrence of about 1% in shoulder surgery.  Specific precautions are taken to minimize this uncommon risk.

• Nerve injury from either the anesthetic scalene block or stretch injury during surgery is a rare possibility at about 1% as reported in the medical literature. Such injuries usually are temporary and resolve in the first few weeks to months after the surgery.

• Loosening or Failure of the Implant is very uncommon but does increase over time. The majority of Total Shoulder Replacements last the life time of the patient.  However the younger the patient and the more aggressively active they are with that shoulder the more likely the plastic liner will wear out or the implant may become loose.  Revision shoulder can reasonably be performed but with each surgery the risks and complications increase.

• General complications with any surgery that requires general anesthesia such as heart attack, heart failure, stroke, pneumonia, gastrointestinal problems such as nausea, vomiting, diarrhea, constipation and urinary tract infection, and even death.

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SURGERY AND HOSPITALIZATION

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PRE-OPERATIVE EVALUATION:

Prior to surgery you will need a complete medical evaluation which is usually completed by Dr. Ward Oakley and Ms. Connie Tighe, NP.  If there are any major medical issues that need clarification or treatment before surgery then you will be asked to have your family physician/internist to do so.  Some patients have cardiac/heart problems that require a cardiologist to evaluate before surgery.

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SURGERY:

The Total Shoulder Replacement surgery takes approximately 2 hours to perform.  The necessary anesthesia is usually a combination of a nerve block for just the shoulder (scalene shoulder block) and general anesthesia.  This provides maximum comfort for you during and after the surgery.  The scalene shoulder nerve block keeps your shoulder numb for 8-14 hours after the surgery.

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HOSPITALIZATION:

You will usually be hospitalized overnight after the surgery.  Prior to being discharged home the day after surgery your shoulder wound dressing will be changed to a simple large bandage, the shoulder sling and brace will be adjusted, and you will be instructed in some simple exercises by the physical therapist.

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MEDICATIONS:

You will be given prescriptions for several medicines to help with your pain and discomfort after leaving the hospital.  Some patients are very sensitive to strong pain medicines/narcotics and if so they can minimize those side effects of nausea, itching, flushing, etc. by taking a “Benadryl” tablet about 10-15 minutes before taking those type narcotic pain medicines.

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HOME AFTER SURGERY

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BRACE/SLING:

The brace/sling is for your comfort.  Feel free to have someone help adjust it as needed.  Many patients like to place a small pillow or folded towel under the sling between the body and the sling, especially when reclining or sleeping propped up in bed.

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CLOTHES:

Keep your clothes loose and as comfortable as possible.  You may want to take a simple t-shirt and split it down the side on which you had surgery so that you can slip it over your head and other arm and simply tie it or Velcro it under the operated side.  Otherwise it is very easy to wear a 2X or 3X men’s shirt that you simply drape over the operated shoulder and arm and button up in the front.

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WOUND:

The surgical wound is a simple 4-6” incision that you will keep covered with a simple dressing.  No special care is otherwise needed.  This dressing bandage may be changed every few days as needed because of drainage from the wound or after showering.  Showering is allowed after 5 days for those patients that feel comfortable doing so.  It is recommended that someone be closely available to help you the first few times you shower.

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SLEEPING:

Patients are usually more comfortable sleeping with their head elevated slightly, such as in a recliner.  A comfortable recliner is strongly recommended.  Although sleeping in a recliner may not be appealing it has invariably been the most comfortable place that patients go to when they have failed to get comfortable in their bed, sofa, or other places.  Patients that have difficulty getting out of a chair in general will find in necessary to have an electric lift chair.  Such patients usually have significant hip arthritis, knee arthritis, or very weak muscles of various causes.

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Self Care/Loss of use of Dominant Arm:

If you are Right Handed (Dominant Arm) and your right shoulder needs surgery then the temporary loss of use of that arm should be a concern.  This is particularly a concern for Personal Hygiene:  hair, brushing teeth, make-up, etc.  You will not be able to perform these tasks for a few weeks!  It is strongly recommended that you practice using your other arm (non-Dominant Arm) for performing these tasks, prior to your surgery.

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AFTER-SURGERY PROBLEMS to notify Dr. Oakley or Ms. Connie Tighe, NP:

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• Fever > 102.0 F

• Incision with increased redness

• Incision with increased drainage after 48 hrs.

• Pain not relieved with prescribed medications

• Calf pain with swelling and warmth

• Sudden onset of shortness of breath