Shoulder Joint Replacement

What is Shoulder Joint Replacement

Shoulder joint replacement is surgery to replace damaged parts of the shoulder joint with artificial parts (prostheses). Two parts may be used to replace this joint:

  • The humeral component replaces the head of the upper arm bone (humerus). This is a rounded ball that is attached to a stem that fits into the humerus.
  • The glenoid component replaces the socket (glenoid depression).

The prostheses are usually made of metal and plastic. Depending on the damage to your shoulder, the surgeon may replace just the humeral head (hemiarthroplasty) or replace both the humeral head and the glenoid (total shoulder replacement). The surrounding muscles and tendons hold the prosthetic parts in place.

This procedure may be done to relieve joint pain or to treat severe shoulder fractures or arthritis. This surgery may be done if other non-surgical treatments have not worked.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures, organs, or nerves.
  • Fracture of the upper arm bone during or after surgery.
  • Instability of the shoulder after surgery.
  • Loosening of the glenoid component over time.
  • Unusual bone growth.
  • Failure of bone healing after surgery.

What happens before the procedure?

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
  • You may be given antibiotic medicine to help prevent infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

General instructions

  • Plan to have someone take you home from the hospital or clinic.
  • Plan to have someone with you for 24 hours after the procedure. It is also recommended that you have someone to assist you at home for the first few weeks after the procedure.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your healthcare provider.
  • Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to make you fall asleep (general anesthetic).
    • A medicine that is injected into your shoulder area to numb everything around the injection site (regional anesthetic).
  • An incision will be made on the front of the shoulder from the collarbone (clavicle) to the point where the shoulder muscle (deltoid) attaches to the upper arm bone.
  • The upper arm bone will be removed from the socket to expose the ball-like end of the upper arm.
  • The center cavity of the humerus bone will be cleaned and enlarged to create a hollow area that matches the shape of the implant stem. The top end of the bone will be smoothed so the stem will be level with the bone surface when it is inserted.
  • If the ball of the prosthesis is a separate piece, the proper size will be selected and attached.
  • If the socket portion of the joint is healthy and the surrounding muscles are in good condition, the surgeon may decide not to replace it. However, if the socket needs to be replaced:
    • The surgeon will prepare the socket surface by removing the remaining damaged cartilage.
    • The socket bone will be gently reshaped to fit the implant.
    • The glenoid component will be implanted and cemented into position.
  • The arm bone, with its new artificial head, will be replaced in the socket. The surgeon will reattach the supporting tendons and close the incision with sutures or stitches.
  • A bandage (dressing) will be placed over your incision.
  • Your arm will be placed in a sling or immobilizer, and a support pillow will be placed under your elbow.
  • Tubes will be placed to remove excess drainage. These are usually removed after a couple of days.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • Your arm will be numb if you were given a regional anesthetic. This may last until the next day.
  • You will be given pain medicine as needed.
  • Your arm and shoulder will be stiff and bruised. This will improve over time.
  • An icing device will be placed around your shoulder. This helps to control pain and swelling.
  • Your arm will be in a sling or immobilizer. You will need to wear this for 2–4 weeks after surgery or as told by your health care provider.
  • Your health care team may begin to show you exercises for your shoulder.
  • Do not use your arm to push yourself up in bed or from a chair.
  • Do not lift anything that is heavier than a cup of coffee.
  • Do not drive for 24 hours if you were given a sedative. Ask your health care provider when it is safe for you to drive.

Summary

  • Shoulder joint replacement is surgery to replace damaged parts of the shoulder joint with artificial parts (prostheses).
  • The surgeon may replace just the humeral head (hemiarthroplasty) or replace both the humeral head and the glenoid (total shoulder replacement), based on the damage to your shoulder.
  • Taking medicine, icing the painful area, and doing exercises as told by your health care provider will help control your shoulder pain, swelling, and stiffness after surgery.
  • After the procedure, do not lift anything that is heavier than a cup of coffee and do not use your arm to push yourself up in bed or from a chair.

Shoulder Joint Replacement, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After your procedure, it is common to have:

  • A bruised and stiff shoulder.
  • A bruised and stiff arm.
  • Some pain.

Follow these instructions at home:

If you have a sling:

  • Wear the sling as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
  • Keep the sling clean.
  • If the sling is not waterproof:
    • Do not let it get wet.
    • Cover it with a watertight covering when you take a bath or a shower.

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If your sling is not waterproof, cover it with a watertight covering when you take a bath or a shower.
  • Keep the bandage (dressing) dry until your health care provider says it can be removed.

Managing pain, stiffness, and swelling

  • If directed, put ice on the affected area.
    • If you have a removable sling, remove it as told by your health care provider.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your fingers often to avoid stiffness and to lessen swelling.

Driving

  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not drive for 2–4 weeks after surgery or as told by your health care provider.

Medicine

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, use it as told by your health care provider. Do not stop using the antibiotic even if you start to feel better.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision area. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave staples, stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
  • If you have a tube to remove drainage, follow instructions from your health care provider about caring for it. Do not remove the drain tube or any dressings around the tube opening unless your health care provider approves.
  • Check your incision area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Activity

  • Do not use your arm to push yourself up in bed or from a chair. This requires too much muscle.
  • Follow lifting restrictions as told:
    • Do not lift anything that is heavier than a cup of coffee for the first 6 weeks after surgery, or as told by your health care provider.
    • Do not lift anything that is heavier than 10 lb (4.5 kg) for 6 months, or as told by your health care provider.
  • Do exercises, including physical therapy, as told by your health care provider.
  • Try not to overuse your shoulder. This includes repetitive pushing or pulling. Early overuse of the shoulder may result in later problems. (Overusing the shoulder is easy to do when your pain goes away for the first time.)
  • Avoid overstretching your arm for 6 weeks after surgery, or as told by your health care provider.
  • Avoid sitting for a long time without moving. Get up and move around one or more times every few hours.
  • Ask for help with some activities. Your health care provider may be able to suggest a clinic or agency for this if you do not have home support.
  • Do not participate in contact sports.

General instructions

  • Keep all follow-up visits as told by your health care provider. This is important.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing. If you need help quitting, ask your health care provider.

Contact a health care provider if:

  • You develop a rash.
  • You have a fever.
  • You have more redness, swelling, or pain in the incision area.
  • You have more fluid or blood coming from your incision area.
  • You have more pain when moving your shoulder.

Get help right away if:

  • Your incision area feels warm to the touch.
  • You have pus or a bad smell coming from your incision area.
  • The edges of the incision site break open after sutures have been removed.
  • You have chest pain or shortness of breath.

Summary

  • It is common to have pain and stiffness in your shoulder and arm after the procedure. Put ice on the affected area and take pain medicine as told by your health care provider.
  • Do not use your arm to push yourself up in bed or from a chair.
  • Do exercises, including physical therapy, as told by your health care provider.
  • Check your incision area daily. Call your health care provider if you see signs of infection.
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