Definition:
Total Shoulder Joint Replacement (TSJR) is a surgical procedure carried out to treat
arthritis in shoulder or an upper arm bone fracture. During this process, the damaged
shoulder is replaced by artificial components, i.e. prostheses. The need for this
surgery arises in times of wearing out of cartilage in the shoulder bone. When this
happens, the protected thin lining between the shoulder joints tarts wearing away
and the bones rub with each other causing extreme pain. The prostheses used in the
treatment are an artificial replacement used to replace the diseased body part,
either internally or externally.
Our shoulder is a ball and socket joint, enabling us to twist, raise and bend the
arm. The ball in the shoulder is head of the upper arm bone (humerus) and the socket
is the circular cavity (glenoid) in shoulder blade (scapula). A fleshy tissue rim
(labrum) environs and deepens the socket. Head of the humerus is also covered with
an articular cartilage. The joint, also known as acromioclavicular (AC) joint, has
a thin internal lining (synovium) facilitating movement, while surrounding muscles
and tendons that provide stability and support. The wearing off of the thin line
results in stiff shoulders, which will have adverse effect on the strength and motion
of the shoulder.
In a total shoulder joint replacement surgery, an incision is made in the shoulder
and upper arm. After that, the head of humerus is removed with a bone saw. It is
then replaced with metal implant, which is shaped like a half-moon. The metal implant
is attached to a stem that’s inserted down the center of the arm bone. The socket
portion of the joint is shaved clean and reinstated with the plastic socket placed
into the scapula.
Purpose:
The main aim of carrying this procedure is to relieve the patient from extreme shoulder
pain and stiffness. Certain should joint problems that can be treated with TSJR
are:
- Osteoarthritis: It is one of the most common joint diseases that
are caused by degeneration of cartilage and synovial membrane of the joint. This
leads to extreme pain and stiffness of the joint.
- Rheumatoid Arthritis: It is an unceasing disease that is characterized
by the attack of immune system on the joints. This results in inflammation and swelling
of the joints, resulting in loss of mobility or deformity. In fact, the tissues
throughout body can be affected.
- Osteonecrosis: It is a serious disease that is caused by the temporary
or permanent loss of blood supply to the bones. This can also result in the death
of the bone.
- Charcot’s Arthropathy: It is a progressive degeneration of the
most stress-bearing joint, resulting in loss of sensation in that joint and the
loss of nerve supply.
The prime purpose of doing this surgery is to relieve the pain by replacing diseased
joint surfaces with smooth gliding surfaces. In fact, the patient can experience
better motion of his shoulder than before.
Precautions:
After the total shoulder replacement surgery is done, your physician will ask you
to stop the use of sprays near the operated area. You will also be stopped from
lifting heavy objects. Another precaution to take care is that you will be limiting
the driving of car or any other vehicle. The doctor will ask you to do certain shoulder
exercises, slowly and continue with regular check-ups.
Pre and Post Care:
Before carrying out the surgery, you might be required to undergo a computed tomography
(CT) scan for checking glenoid wear. Your physician would start a medical revaluation
weeks before starting surgery. The doctor will ask you to take iron supplements
some weeks before the surgery. Certain types of tests will be carried out, such
as blood test, ECG, urine sample test and chest X-ray. If you are taking medication
for some other treatment; it is quite possible that the doctor might ask you to
stop them until surgery is done.
After the operation is done, the arm is placed in a sling and a pillow is positioned
under elbow to protect the repair. The drainage tube used for taking out excess
fluid is removed next day after the surgery. Your doctor will ask you to appoint
a physio-therapist for arm and shoulder exercises. Finally, you should not do high-impact
activity with your operated side arm or hand.
Risks:
Like any other surgery, total shoulder joint replacement accompanies certain risks.
Though, this surgery has very less risk factors as compared to others. They are
mentioned hereunder:
- Infection
- Intra-operative fracture of humerus
- Biceps tendon rupture
- Loosening of glenoid implant
Hospital Stay:
In order to take on the medical tests before surgery, the actual process and rehabilitation,
the patient might be required to stay in the hospital for 2 to 5 days depending
on the patient’s nature of recovery.
|