Shoulder Replacement

Shoulder replacement, or shoulder arthroplasty, is a major surgical procedure that helps in relieving severe cases of shoulder pain, most commonly caused due to arthritis or physical joint damage. Usually performed by an Orthopaedic surgeon, it aims to restore normal functioning of the shoulder joint.

The procedure generally involves removing the damaged joint and replacing it with a specially-designed artificial shoulder implant that allows the same degree of movement as a healthy joint.

Shoulder replacement is often recommended as a last resort for severe shoulder pain that interferes with the day-to-day life of the patient. It may also be prescribed to stop joint damage before it can progress to disability.

The primary cause of shoulder pain severe enough to require shoulder replacement is arthritis, which in turn is usually caused as a result of the cartilage covering the joint wearing out over time. A significant accident causing irreversible damage to the shoulder joint is another cause that warrants shoulder replacement surgery.

Common risk factors in shoulder replacement procedure include risks of any major surgical procedure like blood clotting issues, infections, complications arising due to anaesthesia and nerve injuries. In addition to these, allergy to the metal implants might be a cause for concern in a minority.

However, the potential benefits of the surgery overweigh the tiny risk (<5%) of such complications arising.

Despite being a major surgery, shoulder replacement has overwhelmingly positive outcomes with low risk of surgical complications and high chances of the shoulder implant lasting for at least 15 to 20 years. This procedure is generally regarded as a safe option for helping people affected by shoulder pain in resuming day-to-day activities.

Usually, shoulder replacement is performed on patients in the age group of 60-80 years. However, age is not the only consideration when considering this procedure as the patient’s medical history and current condition are also assessed. Only an orthopaedic surgeon can determine whether a patient is a right candidate for shoulder replacement surgery.

If the pain is manageable and risk of further damage is less, conservative measures such as lifestyle modifications, physiotherapy, and cortisone injections can help provide relief. These measures must always be tried out before the highly invasive shoulder replacement surgery is considered.

Certain pre-operative tests are necessary to rule out conditions that might increase the risk of complications during or after surgery. Some of these tests are:

• Physical examination
• Lab tests
• Complete Blood Count, to rule out Anaemia or Neutropenia
• Coagulation testing, to rule out the absence of any clotting factor
• Urine analysis, to rule out infections or other disorders
• Electrolyte status
• Dental exam, to rule out dental infection or abscess
• Complete X-Ray of shoulder
• ECG, to rule out heart conditions

Shoulder replacement surgery is a surgical procedure performed in the Operation Theatre by an orthopaedic surgeon, usually under general anaesthesia. During this procedure, an incision of about 4-10 inches is made, depending on the condition. The surgeon then cuts out the damaged bone and attached cartilage, resurfaces the shoulder blade socket, and replaces the joint with a plastic or metal device (a prosthesis).

The entire procedure can last for two to three hours, depending on the surgeon, the condition of the patient and whether any complications occur during surgery. Most of the time is spent in preparing the patient for the surgery.

There are different materials that are used for making implants to be used in the surgery. The surgeon will decide on the material to use as an implant depending on your age, the severity of disease and overall condition. Usually, the implant is made of titanium, polyethylene plastic or chrome-cobalt stainless steel.

You will feel no pain during the surgery due to the anaesthesia. However, post-operative pain is common, and it is often the case that you are worse off for the first two weeks after the surgery than before it. With passing time, the pain starts declining, and after about two months, recovery is almost complete, and there is little lingering pain.

Rehabilitation and physiotherapy often begin on the first postoperative day if the surgery goes smoothly. An instant increase in the range of motion prior to surgery is usually observed after the procedure. Full recovery can take anywhere from two months to one year, depending on the pre-operative conditions of the patient and rehabilitation efforts.

You can use the hand and wrist soon after surgery. However, it might take six to eight weeks for unrestricted use of the whole arm to be possible.

The patients are advised to restrict motion in the affected hand for a few weeks after surgery. You can drive approximately four to six weeks after surgery and engage in sports about 12 weeks after surgery.

The cost of shoulder replacement surgery in India may vary between five to seven lakhs at the best hospitals. The type and material of implants have a significant impact on the overall cost. Newer, long-lasting materials cost more as compared to traditional alternatives.

The medical tourism industry in India has seen a remarkable rise in the past few years. People from around the world are coming to India for undergoing various medical procedures due to the availability of experienced doctors and well-equipped hospitals, among other attractions. This translates to the case of joint replacements also, wherein many foreign nationals have undergone surgery under experienced orthopaedic surgeons in India with positive results.

Choosing the right doctor goes a long way in determining the outcome of the surgery. Patients should look for experienced doctors with a previous history of success in such surgeries to minimise the risk of complications. Also, hospitals with a good track record and state-of-the-art rehab facilities should be chosen to shorten the rehabilitation time.

Shoulder replacement surgery, also known as shoulder arthroplasty, is the surgical removal of the damaged portions of the shoulder joint and replacing them with artificial components, known as a prosthesis.

The shoulder joint is a ball-and-socket type of joint. It is made of the humerus (round head of the upper arm bone) that fits into a glenoid socket (shallow socket in the shoulder).

The shoulder joint prosthesis is made up of the following two parts:

• A metal ball (made of stainless steel) is attached to a stem (made of titanium) to keep the ball attached to the arm.
• A polyethylene cup is used to replace the glenoid socket.

The different types of shoulder replacement surgeries include:

• Hemiarthroplasty involves replacing the ball and stem.
• Resurfacing hemiarthroplasty involves replacing the humeral head joint surface with a cap-like prosthesis. 
• Anatomic total shoulder replacement involves replacing an arthritic joint with a highly polished metal ball.
• Stemless total shoulder arthroplasty involves attaching a metal ball to the upper arm without a stem.
• Reverse total shoulder replacement involves placing the metal ball in place of the glenoid socket and attaching a plastic cup to the stem to move it to the humerus.

A shoulder replacement surgery is performed in the following conditions:

• Osteoarthritis, which is the wearing down of the cartilage (protective tissue at the ends of the bone)
• Rotator cuff injuries, which are the injuries caused to the group of muscles and tendons surrounding the shoulder joint
• Fractures of the humerus 
• Rheumatoid arthritis, which is a condition in which the immune system of the body attacks the joints and internal organs
• Osteonecrosis, which is the death of bone tissue due to blood supply reduction
• Other inflammatory conditions 

The following symptoms associated with the shoulder joint may indicate a need for shoulder replacement surgery:

• Severe pain in the shoulder which is not relieved by using anti-inflammatory drugs or medications 
• Stiffness of the shoulder joint
• Pain that limits everyday activities
• Inability to lift anything
• Inability to move the shoulder joint

The following diagnostic tests may be performed before a shoulder replacement surgery:

• Physical examination: The symptoms of the patient along with the medical history and family history are noted by the doctor. The alignment of the shoulder, shoulder strength, and shoulder stiffness are also evaluated by the doctor.
• X-ray: Changes in the structure of the shoulder joint, joint erosion, cartilage loss, tissue tear, and inflammation in the shoulder area can be evaluated by an x-ray.
• Imaging tests: CT scans and MRI scans may be performed to check the bone condition in the shoulder region.

The following preparation is done for a shoulder replacement surgery:

• If the patient has any pre-existing medical illnesses, the doctor should know about the same.
• If the patient is taking any medications, supplements, or herbs, tell the doctor about the same.
• If the patient is allergic to any medications, anesthesia, iodine, latex, or tape, inform the doctor about the same.
• Quit smoking as early as possible.
• A patient taking blood thinners, like aspirin and warfarin, is asked to stop taking these medicines a few days before the surgery.
• The patient is instructed to not eat or drink anything after midnight, the day before the surgery.

A shoulder replacement surgery is generally done under general anesthesia, that is, the patient is made unconscious during the procedure. The following steps are followed during a shoulder replacement surgery:

• A 4 to 10 inches long incision is made near the shoulder region.
• The damaged bone and attached cartilage are cut out by the surgeon.
• The shoulder blade socket is now resurfaced.
• The surgeon replaces the shoulder joint using a plastic or metal prosthesis.
• The procedure takes about two to three hours to complete.

The following post-procedure steps are followed after a shoulder replacement surgery:

• The patient is normally discharged from the hospital one to three days after the surgery. 
• Pain-relieving medications are given to the patient to ease the pain and discomfort after the surgery.
• Physiotherapy sessions are provided to the patient in the hospital to prevent muscle stiffness around the shoulder area.
• The patient is taught how to move the operated arm with the help of the non-operated arm.
• The operated arm needs to stay in a sling for two to six weeks following the surgery. 
• The patient should avoid lifting heavy objects and performing strenuous activities involving pushing or pulling after the surgery.
• Most patients can resume their daily activities two to six weeks after the surgery.
• The patient is told to avoid driving for approximately six weeks after the procedure.
• Home exercises are taught to the patient to help in rapid recovery.
• Vigorous activities golfing and swimming can be resumed six months after the surgery.

The following complications are associated with a shoulder replacement surgery:

• Dislocation of the shoulder joint
• Fracture of the bone
• Loosening of the implant prosthesis 
• Failure of the rotator cuff muscles 
• Nerve damage
• Formation of blood clots
• Bleeding
• Infection 
• Allergic reaction to the anesthesia 
• Pain that refuses to decrease or go away 
• Requirement for another surgery

A shoulder replacement surgery is performed by an orthopedic surgeon.

The cost of a shoulder replacement surgery varies depending on the type of surgery performed, the condition of the patient, and the overall health status of the patient.
The cost of shoulder replacement surgery varies amongst different doctors in different hospitals. Normally, the cost of shoulder replacement surgery in India is between INR 60,000 to INR 2,50,000.