Advice on
Shoulder Replacement
Before embarking on shoulder replacement you should
be aware of the following facts. If you have any other questions you should ask your surgeon for further information.
Benefits
-
Relief of pain:
Over 90% of
patients can expect to lose all, or virtually all, of their shoulder
pain.
-
Mobility: Gain in range of shoulder of
shoulder movement following replacement is unpredictable. In some
patients movement may return to almost normal, whereas in others
there will be significant residual stiffness.
-
Function:
Shoulder function
will normally be significantly improved following surgery. Even if
you do not regain much movement the reduction in your level of pain
will improve your function,
Risks
General risks associated with any surgery
-
Cardiovascular problems:
Heart attack and stroke can occasionally be caused by anaesthesia
and surgery. The risks of this complication is normally exceedingly
small in healthy individuals. The risk may be greater if you have
pre-existing disease, in which case your anaesthetist / surgeon will
discuss this with you.
-
Thromboembolism:
Blood
clots may sometimes form in the veins of your legs, a condition
known as 'deep vein thrombosis.' This may cause excessive swelling
of your legs and may require treatment with blood thinning drugs.
Extremely rarely the clot may become detached and travel to the
lungs; this is a potentially fatal complication known as a
'pulmonary embolus.' There are some conditions in which the risk of
thromboembolism is increased (e.g. patients on the contraceptive
pill or HRT), in which case you may be given medication to reduce
the risk.
Specific risks of shoulder replacement
-
Infection:
Infection can
complicate any surgery. It may be possible to treat this with
antibiotics alone, but more commonly further surgery and removal of
the replacement is necessary. The chance of this occurring is
approximately 1%.
-
Nerve and blood vessel injury:
There is a very small risk (<1%) of damage to nerves or blood
vessels around the shoulder.
-
Loosening:
It is
possible that with time the shoulder replacement will lose its
fixation to the bone. This may be associated with deep seated
infection, but often occurs without any apparent cause. The chance
of this occurring increases with time; there is approximately a
5-10% chance of this occurring within the first 10 years after
surgery.
-
Wear: Physical wear of the
prosthesis becomes a problem the longer it has been implanted. Wear
debris may induce loosening of the components.
-
Dislocation: Shoulder replacements may on
occasions dislocate, although this is a fairly rare occurrence. In
this event a manipulation may have to be performed under a
general anaesthetic. In rare instances revision surgery may be
required.
Revision surgery
-
If your shoulder becomes loose, worn or recurrently
dislocates further surgery may be necessary. It is normally possible
to re-insert a new replacement. This type of surgery is normally
successful, although is the complication rate is higher than that
following primary replacement surgery.
Surgery details
-
Surgery will be done under either general
anaesthesia; it is not possible to operate under regional
anaesthesia alone. Frequently a regional block will be given in
addition to general anaesthesia in which case your arm will be numb
for up to 12 hours; occasionally numbness may last for 24-36 hours.
-
The operation will take about 1 to 1½
hours
-
Following surgery you
will have an intravenous drip for up to 24 hours. Blood transfusion
is rarely required.
-
Active movement of your
shoulder will be encouraged from the first post operative day. A
sling should be worn at night for the first 2 weeks after surgery,
but at al other times you should use your arm as much as possible.
-
Most patients are
discharged from hospital within 4 to 7 days of surgery
Recovery
-
Your sling can be discarded 2 weeks following
surgery.
-
Outpatient physiotherapy is often, but not always,
required for a few weeks after surgery.
-
Most tasks of daily
living should be possible within 3 to 4 weeks.
-
Driving is normally
possible about 6 weeks following surgery.
-
Showers may be taken as soon as the wound is dry
(normally within 72 hours).
-
Your progress will be monitored by our
physiotherapists and all patients will have a routine follow up
check 6 weeks after surgery.
-
It will take 6 to 12 months to fully recover from
your surgery. You will be seen in the outpatient clinic
throughout this period.
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