Total Shoulder Replacement
Total shoulder replacement (TSR) describes a surgical procedure where a prosthesis or implant replaces the gleno-humeral joint (the shoulder joint).
The conventional TSR is also the anatomic shoulder replacement to distinguish it from a reverse total shoulder replacement.
Adelaide orthopaedic surgeon Dr Sunil Reddy specialises in shoulder surgery and performs TSR and reverse TSR. He routinely offers ‘patient-specific technology’ in shoulder arthroplasty – a CT scan-based 3D-prototyping technology that allows accurate placement of the glenoid (shoulder socket) component and may contribute to better outcomes.
Increasingly Reverse Total Shoulder Replacement ( RTSR) is being used to manage shoulder arthritis and other complex shoulder conditions with predictable and excellent long term results. This has replaced Anatomic shoulder replacement ( TSR) as the procedure of choice worldwide to manage shoulder pathologies. Here is the link to learn all about Reverse shoulder replacement.
Patient-specific technology in joint replacement
This is a CT scan-based 3D-prototyping technology where 3D models of the arthritic joint as well as jigs specific to the patient’s anatomy are manufactured. These are then used during surgery to make accurate bone cuts or bone reaming and implant the prosthesis.
Conditions
The procedure is usually required where disease or trauma have made movement of the shoulder joint painful. Typical conditions which may require this procedure include:
Osteonecrosis
Osteonecrosis (also known as avascular necrosis) is where blood supply to the bones is restricted or cut off, which can ultimately destroy the shoulder joint itself. Risk factors for this condition include any previous severe fracture, overuse of steroids, deep sea diving, and alcoholism.
Failure of previous shoulder replacement surgery
Sometimes previous shoulder surgery may fail, normally if the implant comes loose or moves out of position or gets infected. In this case, a revision TSR may be indicated.
Surgery
Surgery involves replacement of the ball (head of the humerus) and the socket the ball fits into.
The procedure itself, which is conducted using conventional open surgery, normally takes around 60-80 minutes, requires a general anaesthetic, and a hospital stay of two to three days.
During the surgery, the prosthetic components are attached to the bone(s) and once this is complete the wound is closed using absorbable sutures.
Specific risks and complications
Dr Reddy will explain the benefits, risks, and complications of a shoulder replacement in the clinic to help you make an informed decision regarding your surgery.
Possible complications of this surgery include:
- Injury to blood vessels or nerves.
- The prosthesis coming loose or dislocating.
- A ‘frozen shoulder’, where the shoulder is sore and stiff.
Post-operative recovery and rehabilitation
Dr Reddy as well as the physiotherapist will see you on day one following surgery and will demonstrate exercises to be performed as well as advise on things to do and not do.
It’s important you follow the advice and rehabilitation guidelines to give yourself the best chance of recovery and an optimal outcome.
- You would likely have a regional / nerve block for pain management apart from a general anaesthetic.
- You would usually stay in the hospital for two to three days, but may stay longer depending on the recovery.
- Please take regular pain medication as advised.
- Apply ice packs five times a day for 10 minutes each time for the first two weeks.
- You will need to wear a sling full time for four weeks, but you can remove it thrice daily for 15-20 minutes each time to perform exercises.
- Please remove the sling for a shower, resting your arm by the side. The dressings are waterproof.
- After four weeks, you can come out of the sling to perform gentle activities of daily living.
- After six weeks, you can progress with exercises as advised by your therapist.
- Strengthening exercises usually start only after three months following surgery.
- Avoid lifting weights and push-pull movements for three months following surgery. The goal is to gradually achieve normal range of movement and strength of the shoulder over a three-to-six-month period.
- Driving is permitted only once you come out of the sling and have achieved good control of the arm and a pain-free status. This is usually by the sixth week postoperative period.
- Please follow your therapist’s advice regarding exercises and follow the rehabilitation guidelines that you can view / download below.