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Orthopaedic & Joint Replacement Surgeries


Shoulder Replacement Surgery

Shoulder Arthroscopy is a surgery that relieves the patient from shoulder pain and restores the functionality of the shoulder. 

In this type of surgery, the surgeon evaluates the shoulder region and fixes the tears by using special instruments and making small incisions. 

The Arthroscope is a device that consists of a camera and light to inspect and repair problems of the joint. It is a minimally invasive procedure and guarantees less pain. It deals with diseases involving the bones, tissues, ligaments, tendons, cartilage and muscles of the shoulder joint.  

Indications of Shoulder Arthroscopy 

This surgery is meant for people who didn't get benefit from physical therapy, injections or medications. Cases include: 

  • A torn rotator cuff
  • Shoulder stiffness
  • A torn or damaged biceps tendon or cartilage ring
  • Bone spurs
  • Removal of inflamed tissue
  • Shoulder instability
  • Shoulder impingement
  • Clavicle arthritis/ arthritis of the collarbone
  • Debridement/drainage of shoulder joint shoulder  

Causes 

  • Traumatic injury
  • Dislocation of shoulder joints
  • A disease of the bones
  • Overuse of joint 

Diagnosis and tests 

  • Physical examination
  • MRI
  • Ultrasound
  • CT Scan
  • EMG (electromyogram) 

Shoulder Arthroscopy Procedure 

Before Procedure 

  • A complete physical examination of the affected area is done by the physician.
  • The medical history should be provided to the doctor including medications being taken.
  • The doctor may ask to stop for certain medications before the surgery such as blood thinners.
  • The patient is advised to stop smoking as it will adversely affect the wound and recovery.
  • The patient will be asked to fast for 8 -12 hours before surgery.
  • If the patient is asked to take any drugs, then he/ she should do it with a small sip of water. 

During Procedure 

  • Generally, the shoulder arthroscopy is an outpatient surgery. However, it may depend on the health of the patient.
  • Most surgeries take less than one hour but the time may vary from person to person.
  • The surgery is performed under general anesthesia.
  • The patient may be lying down with arm propped up or in a semi-seated position.
  • Sterile fluid is injected into the area which expands the surgical site for a good view.
  • A small cut is made and the arthroscope is inserted.
  • Images that are captured by the arthroscope can be viewed on the monitor.
  • Then, the surgical instruments are inserted into the joint to remove and repair the damaged area.
  • After taking the instruments out, the incisions are closed either with small sterile bandages or stitches. 

After Procedure 

  • The patient will be monitored for about 1 to 2 hours after surgery before being discharged from the hospital.
  • The shoulder may swell after the surgery, a pack of ice can be placed on the swollen area 3-4 times a day to minimize the swelling.
  • The patient may experience discomfort and pain for at least a week but medications will be provided to control the pain.
  • The patient may be asked to wear an immobilizer to protect the shoulder.
  • The surgeon may request a physical therapist depending on the complexity of the repair.
  • Recovery of the patient will depend on the type of repair and procedure performed.

 

 

Shoulder joint replacement surgery can either replace the entire AC joint, in which case it is referred to as total shoulder joint replacement or total shoulder arthroplasty ; or replace only the head of the humerus, in which case the procedure is called a hemiarthroplasty.

Implants

The two artificial components that can be implanted in the shoulder during shoulder joint replacment surgery are:

  • The humeral component. This part replaces the head of the humerus. It is usually made of cobalt or chromium-based alloys and has a rounded ball attached to a stem that can be inserted into the bone. It comes in various sizes and may consist of a single piece or a modular unit.
  • The glenoid component. This component replaces the glenoid cavity. It is made of very high-density polyethelene. Some models feature a metal tray, but the 100% polyethylene type is more common.

Shoulder joint replacement surgery is performed under either regional or general anesthesia, depending on the specifics of the case. The surgeon makes a 3–4 in (7.6–10.2 cm) incision on the front of the shoulder from the collarbone to the point where the shoulder muscle (deltoid) attaches to the humerus. The surgeon also inspects the muscles to see if any are damaged. He or she then proceeds to dislocate the humerus from the socket-like glenoid cavity to expose the head of the humerus. Only the portion of the head covered with articular cartilage is removed. The center cavity of the humerus (humeral shaft) is then cleaned and enlarged with reamers of gradually increasing size to create a cavity matching the shape of the implant stem. The top end of the bone is smoothed so that the stem can be inserted flush with the bone surface.

If the glenoid cavity of the AC joint is not damaged and the surrounding muscles are intact, the surgeon does not replace it, thus performing a simple hemiarthroplasty. However, if the glenoid cavity is damaged or diseased, the surgeon moves the humerus to the back and implants the artificial glenoid component as well. The surgeon prepares the surface by removing the cartilage and equalizes the glenoid bone to match the implant. Protrusions on the polyethylene glenoid implant are then fitted into holes drilled in the bone surface. Once a precise fit is achieved, the implant is cemented into position. The humerus, with its new implanted artificial head, is replaced in the glenoid socket. The surgeon reattaches the supporting tendons and closes the incision.


Shoulder Replacement

Diagnosis/Preparation

Damage to the AC joint is usually assessed using x rays of the joint and humerus. They provide information on the state of the joint space, the position of the humeral head in relation to the glenoid, the presence of bony defects or deformity, and the quality of the bone. If glenoid wear is observed, a computed tomography (CT) scan is usually performed to evaluate the degree of bone loss.

The treating physician usually performs a general medical evaluation several weeks before shoulder joint replacement surgery to assess the patient's general health condition and risk for anesthesia. The results of this examination are forwarded to the orthopedic surgeon, along with a surgical clearance. Patients are advised to eat properly and take a daily iron supplement some weeks before surgery. Several types of tests are usually required, including blood tests, a cardiogram, a urine sample, and a chest x ray. Patients may be required to stop taking certain medications until surgery is over.

Following surgery, the operated arm is placed in a sling, and a support pillow is placed under the elbow to protect the repair. A drainage tube is used to remove excess fluid and is usually removed on the day after surgery.

A careful and well-planned rehabilitation program is very important for the successful outcome of a shoulder joint replacement. It should start no later than the first postoperative day. A physical therapist usually starts the patient with gentle, passive-assisted range of motion exercises. Before the patient leaves the hospital (usually two or three days after surgery), the therapist provides instruction on the use of a pulley device to help bend and extend the operated arm.

Complications after shoulder replacement surgery occur less frequently than with other joint replacement surgeries. However, there are risks associated with the surgery such as infection; intra-operative fracture of the humerus or postoperative fractures; biceps tendon rupture; and postoperative instability and loosening of the glenoid implant. Advances in surgical techniques and prosthetic innovations are helping to significantly lower the occurrence of complications.



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