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About Joint Replacement

Joint replacement is one of the most consistently successful therapeutic measures in all of medicine and surgery today. In general, patient satisfaction with pain relief and enhanced mobility is extremely high.

However, as in all major surgical procedures, there are significant risks that patients will want to discuss carefully and thoughtfully with their surgeons. Patients should ask their surgeons to explain any risks or benefits, which will help patients make informed decisions.

This page explains the key points about knee replacement surgery and hospital stay. If you need additional materials about knee replacement, videotapes and other brochures are available.
Just ask.

Please keep in mind that procedures and protocols vary, sometimes widely, from surgeon to surgeon, hospital to hospital and even patient to patient. Nevertheless, the goals of the process—to reduce pain and enhance mobility—are essentially the same.

We will be more than happy to answer your specific questions and explain how these procedures will be tailored to fit your personal condition and needs.

 
 

Procedures

Knee Replacement | Hip Replacement | Shoulder Replacement | Joint Health

Shoulder replacement

Reproduced with permission from Your Orthopaedic Connection. ©American
Academy of Orthopaedic Surgeons.

Shoulder replacement is a procedure that is done for the severely arthritic joint, and only after other forms of treatment, such as medication and physical therapy, no longer have any benefit.

The shoulder is a ball and socket joint. The head of the humerus (arm bone) is the ball and the glenoid (part of the shoulder blade or scapula) is the socket. The shoulder bones are held together by muscles and ligaments, and cushioned by cartilage.

Shoulder with arthritis

Wear and tear, injury, inflammation and/or previous surgery all contribute to the arthritic process. As the arthritic process develops, the cartilage wears out, and the nerve endings that lie beneath the surface become irritated and produce the symptoms of pain. This joint destruction makes the shoulder stiff, painful and unable to carry out its normal functions.

Because there are many conditions that can lead to a painful joint, the shoulder surgeon must find out whether arthritis is the cause of the problem. The surgeon must also consider other possibilities such as rotator cuff damage, frozen shoulder, and shoulder pain from neck arthritis.

If your orthopedic surgeon determines that arthritis is the cause of the problem in your shoulder, he/she will let you know if shoulder replacement surgery is likely to be helpful.

The surgical procedure

Shoulder replacement involves removing the diseased portions of the joint and replacing them with new parts. Shoulder replacement surgery provides a new metal ball for the humerus, and a new plastic liner for the glenoid (socket). Many times, arthritis affects the ball much more severely than the socket. In these instances, the ball may be replaced and the socket left alone. This is known as a hemiarthroplasty, that is, half a joint replacement.

The metal ball replacing the humeral head is anchored to the humerus by a stem that fits into the canal of the humerus. The stem is either held by cement (polymethylmethacrylate) or coated with a surface that allows new bone to grow into the stem. When the glenoid (socket) is replaced, a plastic (ultra-high molecular-weight polyethylene) socket is cemented in place.

The surgery takes about 2 hours to complete. Patients are usually in the hospital for 2-3 days after the surgery.

Therapy starts immediately after the procedure. Strengthening the weakened muscles and soft tissue surrounding and supporting the joint requires a longer-term program of exercise and physical therapy. Although many patients see and feel immediate benefits, they must continue to rehabilitate themselves for several months to get the total benefit. Recovery of strength in the shoulder can take up to a year.

Anesthesia

Anesthesiology has come a long way in the last twenty-five years. There are newer, more stable drugs, and there is more accurate and more complete monitoring.

There are, however, some risks involved that are largely related to the severity and amount of underlying diseases, such as heart disease, atherosclerosis (hardening of the arteries) or lung problems. With an increase in the severity of these conditions, there is, naturally, an increase in the risk. Nevertheless, the safety record of anesthesia today is very high.

It is essential that patients tell their surgeon and anesthesiologist about all of the medical conditions they have, as well as all the medicines that they are taking.

Hospital stay

Before surgery

Most patients are admitted to the hospital the day of surgery. Prior to surgery the shoulder that is being replaced will be thoroughly cleaned with an antibacterial surgical sponge.

After surgery

During the first few days after surgery there is naturally some pain. However, pain can be adequately controlled by medication.

In spite of any mild discomfort, it is important that patients make the effort to do the deep breathing and physical therapy exercises as instructed. Patients who breathe well and work at strengthening their muscles, improve their lung capacity and circulation, and tend to get well faster.

There are also certain restrictions that may be placed on patients early in the postoperative period in order to avoid unusual strains on the joint that could result in dislocation of the joint or disruption of the sutures. The nurses and therapists are very familiar with the procedures and will give instructions that can be easily implemented.

Exercise and physical therapy

Most people who have shoulder replacement surgery are able to sit up and get out of bed with some help later on the day of surgery.

A physical therapist may begin gentle exercises of your shoulder on the day of surgery or the day after. These exercises are just passive motion, which means you relax and let the therapist move your arm for you.

Your therapist may also begin some simple exercises to keep the muscles of your other arm and your legs strong.

Rehabilitation is not too demanding early on, but it is very important that you do the exercises. The main goal of rehab is to allow you to move your shoulder as far as possible so it's easier for you to do daily activities, such as dressing, cooking, and driving. Most people eventually regain about two-thirds of normal shoulder motion after surgery. But other things that affect how much movement you get after surgery are how much movement you had before surgery and whether the soft tissues around your shoulder were also damaged. It is very important that you take part in physical therapy both while you are in the hospital and after you are released from the hospital to get the most benefit from your surgery.

Social services

Many patients, especially those who live alone, are concerned about whether or not they will be able to manage for themselves in the first few weeks after they leave the hospital. In addition, if they should need assistance, they are concerned about who will pay for it.

Insurance coverage for home care is generally limited, but there are agencies available that can provide some help. Someone can visit the home and show patients how to adapt everyday activities to accommodate joint limitations during the healing process. A home health care agency can assist with needs like bathing and dressing. The hospital Social Services Department can direct patients to these agencies.

Mid Coast Hospital's care coordinators will work with the patient to ensure that the transition from the hospital to home is as seamless as possible.

Patients sometimes benefit from going to a rehabilitation facility after they are discharged from the hospital. The decision about whether to go to a rehab facility or directly home is made by the patient, but the orthopedic care team will make their recommendation based on the progress that a patient makes in the first several days after surgery.

Patient involvement and commitment

With shoulder replacement, the surgeon replaces the diseased shoulder joint and, along with the physical therapist, occupational therapist and nursing staff, guides the patient through the recovery process. However, rehabilitation is up to the patient. The patient must participate fully in the rebuilding and strengthening of weakened muscles. To get the total benefit of shoulder replacement, the patient must make a serious commitment to doing the prescribed exercises and developing and maintaining an active life-style.

 
 
The Mid Coast Center for Joint Replacement
123 Medical Center Drive, Brunswick, Maine 04011
Phone: (207) 386-0418
Mid Coast Medical Group-Orthopedics
430 Bath Road, Brunswick, Maine 04011
Phone: (207) 442-0350