Shoulder Surgery

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The shoulder is a ball-and-socket joint. The ball portion of the joint is called the humeral head, and is part of the humerus (upper arm bone). The socket portion is called the glenoid, and is part of the scapula (shoulder blade). The humeral head fits into the glenoid and the two bones rub together as the shoulder moves.

Ball and socket of healthy shoulder joint surfaces In a healthy shoulder joint, the surfaces of these bones where the ball and socket rub together are very smooth and covered with a tough protective tissue called cartilage. Arthritis causes damage to the bone surfaces and cartilage. The damaged surfaces eventually become painful as they rub together.

Arthritic shoulder joint surfaces There are many ways to treat pain caused by arthritis. One way is total shoulder-replacement surgery. The decision to have total shoulder-replacement surgery should be made very carefully after talking to your physician and learning as much as you can about the shoulder joint, arthritis and the surgery.

In total shoulder replacement surgery, the ball and socket that have been damaged by arthritis are removed and replaced with artificial parts made of metal and a very durable plastic material. The artificial parts are called “implants.” These implants are shaped so that the shoulder joint will move very similar to the way the joint moved when it was healthy. The patient is taken into the operating room and positioned on a special operating table as though lounging in a beach chair. The arm is placed on a board that will allow the surgeon to move it up or down as necessary during the surgery. Anesthesia is given. When it has taken effect, the skin around the shoulder and upper arm is thoroughly scrubbed and sterilized with an antiseptic liquid.A 6-inch incision is made over the shoulder joint. The incision is gradually made deeper through muscle and other tissue until the bones of the shoulder joint are exposed.

What to Bring to the Hospital

Below is a list of things you may want to bring with you to the hospital in preparation for your surgery. Talk with your physician as he/she may have additional information about preparing for your hospital stay.

• Your personal belongings should be left in the car until after surgery. Tell your family that your room will be assigned when you are in surgery or in recovery, at which point they can bring your personal items to your room.
• Personal grooming items that you may want to pack include a toothbrush, toothpaste, hairbrush, eyeglasses/contacts, comb, deodorant, shaving cream/electric razor, shampoo, lotion, undergarments, and a robe.
• Bring slippers or flat rubber-soled shoes for walking in the hallways.
• Bring loose-fitting clothing for your trip home.
• Bring any medications you are currently taking. You should also write down your medication information to be given to the hospital staff. Be sure to include the name, strength, and how often you take the medications. Please communicate any allergies you might have to your doctors and the nursing staff.
• If you use a breathing exerciser (IBE), be sure to bring it with you from home, as you will probably need this right after surgery.
• Leave jewelry, credit cards, car and house keys, checkbooks, and items of personal value at home. Bring only enough pocket money for items such as newspapers, magazines, etc.

Getting to the Joint

The patient is taken into the operating room and positioned on a special operating table as though lounging in a beach chair. The arm is placed on a board that will allow the surgeon to move it up or down as necessary during the surgery. Anesthesia is given. When it has taken effect, the skin around the shoulder and upper arm is thoroughly scrubbed and sterilized with an antiseptic liquid.

An incision about six inches long is made over the shoulder joint. The incision is gradually made deeper through muscle and other tissue until the bones of the shoulder joint are exposed.

Socket implant The implant that replaces the socket consists of a durable plastic insert with a very smooth, cupped surface.

Removing the surface of the socket The arm is maneuvered until the humeral head is dislocated from the socket. Special precision instruments are used to remove the damaged cartilage and bone surface from the glenoid, and to shape the socket so it will match the shape of the implant that will be inserted. Holes are drilled into the socket to accommodate the fixation pegs on the implant. The pegs help stabilize the implant. The socket implant is attached by using a special kind of cement for bones.

Socket Prepared for Implant

Inserting the implant The socket implant is attached by using a special kind of cement for bones. The cement is pressed into the holes. The implant is then inserted.

Glenoid Implant

Replacing the ball portion of the joint The implant that replaces the ball consists of a long metal stem that fits into the humerus. A metal head in the shape of a partial sphere is mounted on top of the stem. The head meets the socket implant in the shoulder blade.

Metal Implant to Replace Ball Portion of Shoulder Joint

Preparing the humeral canal The upper arm bone has relatively soft, porous bone tissue in the center. This part of the bone is called the “canal.” Special instruments are used to clear some of soft bone from the canal. Using a precision guide and saw, the damaged rounded portion of the humerus is removed.

Humeral Head (Ball) Is Removed

Inserting the implant The metal stem implant is inserted into the canal. It can be held in place by either using the special bone cement or by making it fit very tightly in the canal. The surgeon will choose the best method, depending on the patient’s age and expected activity level.

On some implants, the stem and partial sphere are one piece. On others, they may be two separate pieces. If the partial sphere is a separate piece, it usually is secured to the top of the stem after the stem has been inserted.

Stem Implant with Partial Sphere

Closing the Wound

When all the implants are in place, the surgeon places the new ball that is now part of the upper arm bone into the new socket that is part of the shoulder blade. If necessary, the surgeon may adjust the ligaments that surround the shoulder to achieve the best possible shoulder function.

When the ligaments are properly adjusted, the surgeon sews the layers of tissue back into their proper position. A plastic tube may be inserted into the wound to allow fluids to drain from the site for a few hours after surgery. After the tube is inserted, the edges of the skin are sewn together, and a sterile bandage is applied to the shoulder. Then the patient is taken to the recovery room.

After Shoulder Surgery

Here are some ways to promote healing and begin movement after you have had shoulder-replacement surgery. Discuss these techniques with your physician before attempting them. Your physical therapist may modify some of the techniques for you. Do only the techniques that are recommended by your physician or therapist. If you have questions, discuss them with your surgeon before you are discharged from the hospital.

• Avoid many household chores that require the use of your surgery arm. Examples are mopping, using a vacuum and sweeping. Use long-handled feather dusters for dusting high and low items. Your physician will tell you when it is OK to do these activities.
• Be careful to avoid falls.
• Be certain not to exceed the range-of-motion restrictions given by your physician.
• Constipation is a common problem for patients following surgery. This usually is due to your limited activity and pain medicines. Discuss your diet with your physician. It should include fresh fruits and vegetables and eight full glasses of liquid each day unless your physician tells you otherwise.
• Do not use your affected arm to get out of bed or from a chair position. Use the opposite arm.
• Remember that you probably will tire more easily than usual. You may want to plan a rest period of 30 to 60 minutes midmorning and midafternoon.
• Sling use will vary, depending on the situation. Your physician may tell you to wear the sling every night for at least the first month.
• Some swelling around the incision is normal. You will find it more comfortable to wear loose clothing to avoid pressure on the incision. Ask your physician or other qualified health professional about appropriate wound care.
• The amount of weight you can lift using your affected arm will be limited. Your physician may recommend that you do not lift anything heavier than a cup of coffee for the first four to six weeks.
• You may be advised against pulling anything, such as pulling up pants and opening doors, for six weeks after surgery.
• You may experience less pain after surgery, which may make you believe you can do more. Be certain to follow your physician’s instructions so you don’t overdo it.
• You may want to place a pillow behind your elbow when seated or lying down to keep the surgery area forward to help decrease pain.
• You likely will need to avoid contact sports after surgery. Your physician will discuss restrictions with you.
• Your physician may recommend applying ice to your shoulder to help decrease pain. A 2-pound bag of frozen peas or other small vegetables works as well as an ice pack.
• Your physician likely will give you a list of exercises to do when you get home. Typically, you will be asked to do these four or five times a day for a month or more. Follow the instructions you receive.
• Your physician probably will give you a prescription for pain medicine. Please follow your physician’s instructions.