What does surgery involve?

On the day of surgery you will be admitted to the ward or surgical admission area. You will once again meet Mr Moverley who will ensure you are still happy to proceed and that you understand the risks and benefits of the procedure. This is a good opportunity for you to ask any further questions. You will be asked to sign a consent form if you have not already done so.

You will meet your anaesthetist who will explain the type of anaesthetic you will receive. Shoulder replacement surgery usually requires a general anaesthetic (you will be asleep) and a nerve block so that the arm will be numb for approximately 12 hours post operatively.

A shoulder replacement usually requires a hospital stay ranging between 1-3 days depending on your medical history and home situation.

A shoulder replacement is an ‘open’ procedure performed through a single incision measuring approximately 10-15cm made over the front of your shoulder. The wound is repaired with dissolving stitches and covered with a splash proof dressing. The wound should be kept dry for 10-14 days.

Which type of shoulder replacement is right for me?

There are three types of shoulder replacement.

• Hemiarthroplasty (Half shoulder replacement): Only the humeral head (the ball) is replaced with a similar shaped artificial head. Hemiarthroplasty is used if there is limited damage to the cartilage on the glenoid (socket), in certain types of fracture or if your medical condition means that more extensive surgery would be excessively risky.

  
  

• Anatomic Total Shoulder Replacement: The humeral head (the ball) is replaced with an artificial round metal head and the glenoid (socket) is replaced with a smooth plastic cup that is held usually in place with cement.

  Anatomic Total Shoulder Replacement is required if there is extensive damage to both the ball and socket of the shoulder. It requires the tendons (rotator cuff) of the shoulder to be intact so is not suitable for everyone.

  
  

• Reverse Total Shoulder Replacement: A reverse geometry shoulder replacement has the ball of the shoulder joint where the socket should be and the socket where the ball usually is in normal anatomy. Thus the anatomy is reversed, which helps to stabilise the shoulder joint and it also helps to further optimise the function of the shoulder muscles so that both pain and shoulder function can be improved.

  Reverse Total Shoulder Replacement is required if there is both arthritis and the rotator cuff is torn (also known as rotator cuff tear arthropathy), if there is extensive bone loss to the glenoid (socket) or in revision surgery. Reverse shoulder replacement can be a good option in severe fractures of the shoulder that cannot be reconstructed with plates and screws

Mr Moverley will discuss with you the most appropriate action for you based on your age, activity level, form of arthritis, and the amount of bone affected.

What happens post operatively?

Immediately after surgery your arm will be in a sling and will usually feel heavy and numb as a result of the nerve block. You will be given painkillers if you are in any pain, and these will also be provided upon discharge. A physiotherapist will assess you to make sure that you can remove and apply the sling safely. They will provide some early exercises to help prevent stiffness of the hand, wrist and shoulder.

How long is the rehabilitation process?

You will require extensive physiotherapy to maximise the benefit from your shoulder replacement. The final result from a shoulder replacement often takes 6-12 months to be achieved. Physiotherapy is individualised to your specific needs and will progress with the following goals

• Early(0-6 weeks): Minimize post-operative stiffness, initiating a range of movement and gentle strengthening program, while protecting the shoulder replacement and soft tissues during the early phase of healing.

• Middle (7-12 weeks): Continue to improve range of movement, stability and strength to functional levels.

• Late (12 weeks and beyond): Return to all previous functional and recreation activities.

What are the potential risks and complications?

As with any operation, a small number of people may have problems after a shoulder replacement. Most of these problems are quite minor and can be treated easily but occasionally further surgery is needed.

The main problems and their approximate frequencies are:

• Infection (less than 1% of cases). Infection can occasionally be treated with antibiotics but usually requires revision surgery over two stages, removal of the implants and clearance of the infection, antibiotics and then re-insertion of an implant 6-8 weeks later.

• Stiffness (5% of cases)

• Loosening of the shoulder replacement components in the long term (6% of cases)

• Fracture of the bone during or after surgery (2% of cases)

• Damage to nearby nerves causing temporary or, rarely, permanent loss of function (less than 1% of cases).

  The exact risk of complications is specific to your age and the type of shoulder replacement you are having. Mr Moverley will discuss this with you in detail to help you decide whether shoulder replacement is right for you.

Is shoulder replacement always successful?

National data suggests that 92% of patients have an improvement in their shoulder pain and function after a shoulder replacement. The results of a shoulder replacement are therefore not guaranteed which is why Mr Moverley will want to ensure that all non-operative measures have been exhausted first.