Background Information:

What are the other Names for the Procedure?

• Shoulder Replacement Surgery
• Total Shoulder Arthroplasty (TSA)
• Total Shoulder Replacement

What is Arthroplasty of the Shoulder surgical procedure?

• Arthroplasty of Shoulder is a type of surgical procedure that involves replacing one of the shoulder joints with a prosthetic device or an implant
• It is generally performed to repair the shoulder joints and/or surrounding tissue, muscles, cartilage, etc. Depending on the shoulder condition, the desired procedure is selected

What part of the Body does the Procedure involve?

Arthroplasty of Shoulder procedure involves the shoulder joints, bones and neighboring tissues, cartilage, etc.

Why is the Arthroplasty of the Shoulder surgical procedure Performed?

There could be various reasons for performing an Arthroplasty of Shoulder. Some of these are:

• Severe arthritis of the shoulder joint
• Osteoarthritis
• Rheumatoid arthritis
• Osteonecrosis (death of the bone cells and its components, due to lack of blood supply)
• Severe joint dislocations
• Damage to tendons, ligaments, and surrounding tissue
• Past fractures or trauma to the shoulder joint
• Congenital defects
• A failed prosthetic implant from past Arthroplasty procedure

What are some Alternative Choices for the Procedure?

• Depending on the severity of the condition, one may choose non-surgical options too, which includes medication, exercises, physical therapy, non-steroidal anti-inflammatory medications (NSAIDs), periodic cortisone injections (excess dose of cortisone may lead to adverse effects)
• If the condition worsens, Shoulder Replacement surgery is considered a good alternative

What are the Recent Advances in the Procedure?

Arthroplasty of Shoulder in itself is an advanced and effective treatment for severe shoulder joint damage or arthritis.

What is the Cost of performing the Arthroplasty of the Shoulder surgical procedure?

The cost of Arthroplasty of Shoulder procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Arthroplasty and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://healthpages.org/surgical-care/shoulder-replacement/

http://www.surgeon-and-safari.co.za/procedures/ortho-shoulder-replacement.html

http://www.mdguidelines.com/arthroplasty-shoulder/prognosis

Prior to Arthroplasty of the Shoulder surgical procedure:

How is the Arthroplasty of the Shoulder surgical procedure Performed?

• Arthroplasty of Shoulder procedure involves making a 4-6 inch incision on the affected shoulder under general or regional anesthesia; depending upon the severity of the case and the patient’s medical history
• The type of surgical procedure further performed, depends on the underlying condition. In severe cases where there is an arm mobility problem leading to a disability; Total Arthroplasty is performed
• In such cases, depending on the condition of the joint, the surgeon may replace a part of the joint, or the whole of it with a prosthetic device (made of metal and/or plastic)
• The incision is then sutured and bandaged
• In order to prevent any injury and ensure total recovery, the patient is required to wear a sling or a cast, for a minimum of 2-3 weeks
• Immediately after the surgery, compression bandages are placed over the area to avoid swelling, to control pain, and prevent blood clots

Where is the Procedure Performed?

An Arthroplasty of Shoulder procedure is carried out at an orthopedic hospital or an out-patient surgery center facility that is equipped suitably.

Who Performs the Procedure?

An orthopedic surgeon performs the procedure, suitably assisted by an anesthesiologist.

How long will the Procedure take?

The surgery can take anywhere between 3-6 hours and this is dependent upon the type of surgery and the pre-operative surgery preparation time.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc. 

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Medications for arthritis have to be stopped and this has to be informed to the surgeon. Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• If the patient suffers from any heart condition, their surgeon may request them to visit a cardiologist to ensure a stable heart condition and indicate a readiness for surgery
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
• If the person suffers from any infection or have mild cold flu just before their surgery is due, the surgeon must be notified of the same
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed

What is the Consent Process before the Procedure?

A physician will request your consent for Arthroplasty of Shoulder procedure using an informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Arthroplasty of the Shoulder surgical procedure?

Depending on the patient’s health and medical history the following tests may be recommended:

• Routine blood & urine tests
• Chest X-ray
• CT scan or an MRI scan
• ECG
• Urine analysis

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is an Arthroplasty of Shoulder?
• What choices do I have, apart from Arthroplasty?
• Can oral medications solve the problem?
• In case of a replacement; what are the different types of prosthetic devices used?
• What is the cost of the prosthesis?
• Can the human body develop any reaction to the prosthetic device or implant?
• For how long can the prosthetic help? Is there a time period after which it needs replacement?
• With the help of the prosthetic, will I regain complete shoulder mobility?
• Are there any chances for failure of the surgery? What happens in such a case?
• What are the risks involved?
• What are the costs involved pre- and post- Arthroplasty?
• Will I need post-surgery therapy? What would it cost?
• What are the possible complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?

During the Arthroplasty of the Shoulder surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Generally, for Total Replacement Surgery, regional anesthesia is used.

How much Blood will you lose, during the Procedure?

The amount of blood loss is generally controlled; but if complications arise during the procedure, it could lead to further loss of blood.

What are the possible Risks and Complications during Arthroplasty of the Shoulder surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

Some of the complications that may develop during the surgery are:

• Excessive bleeding
• Blood clot formation
• Surgical infection
• Failure of the surgery (this is quite rare)
• Nerve damage
• Shoulder stiffness
• Accidental fracture of the joint being treated

What Post-Operative Care is needed at the Healthcare Facility after Arthroplasty of the Shoulder surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. However, the patient may be kept under general observation to monitor the following:

• Patient’s health status, after the effects of anesthesia has subsided
• Anti-clotting medications may be administered to prevent any blood clot formations
• Pain killers may be given either through the oral route or intravenously
• Ice packs or an icing machine may be used to fit around the shoulder to prevent pain and swelling
• Care must be taken to avoid any movement of the shoulder joint and this would mean wearing a sling support with a plaster cast for a few weeks
• Rehabilitation program or physical therapy will help ensure that the correct method of exercising has been learnt by the recovering patient. This can help enable maximum mobility of the shoulder

After the Arthroplasty of the Shoulder surgical procedure:

What are the possible Risks and Complications after Arthroplasty of the Shoulder surgical procedure?

Post Arthroscopy, the following complications may arise:

• Infection in the surgical wound
• Bleeding into or around the joint
• Slow healing
• Swelling
• Joint stiffness

What is the Prognosis after the Surgery?

• The prognosis is good in majority of the cases; however, many experience a disabling pain until recovery is complete
• In cases of osteonecrosis, the patient may be able to lift his arm up to 160 degree (meaning to hold the arm almost vertical, over their head), after completely recovering from the surgery

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Excessive shoulder pain
• Swelling around the surgical wound and or the shoulder
• Sign of infection on the surgical wound.
• Bleeding from the wound
• Redness around the surgical wound
• Muscular pain around the shoulder
• Dizziness

What Post-Operative Care is needed at Home after Arthroplasty of the Shoulder surgical procedure?

At home, the following post-operative care is recommended, after an Arthroplasty of Shoulder procedure:

• Avoid activities that will exert your shoulder or arm muscles
• Oral medications must be taken, as advised by the physician

How long does it normally take to fully recover, from the Procedure?

It takes about six months to completely recover from an Arthroplasty of Shoulder procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Any tissue or bone that has been removed will be sent for further examination and eventually disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue or bone removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Arthroplasty of the Shoulder surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• The orthopedic surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before Arthroplasty of Shoulder procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA