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Shoulder Replacement:

Shoulder Replacement:



Although shoulder prosthesis is performed less frequently than knee or hip replacement surgery, it is very successful in relieving the pain of arthrosis and at the same time improves mobility considerably.


The shoulder joint is made up of three bones: your upper arm bone (humerus), scapula (scapula), and collarbone (clavicle). The head of your upper arm bone articulates with a shallow slot in your shoulder blade. This slot is called the 'glenoid'. It is not a deep socket like the hip joint. The reward for this is that our shoulder joint has a fairly wide range of motion. But for the same reason, we see more dislocations of the shoulder joint. There is a cartilage around the shoulder joint that creates a vacuum effect like a kind of gasket. When this dislocation or tears for any reason, the movements of the shoulder joint begin to be difficult. The ends of the bones are covered with articular cartilage, a smooth substance that protects the bones and allows them to move easily. A membrane that surrounds the joint, like the thin membrane of the egg, is called the 'synovial membrane', it forms a small amount of fluid that lubricates the cartilage and eliminates almost all friction on the shoulder. If happiness cannot be achieved with other treatment methods at the end of the situations that disrupt the balance of these structures and cause the shoulder joint to work with a nice friction, shoulder prosthesis comes into question.


Reasons leading to shoulder prosthesis:


Osteoarthritis: This is an age-related "wear and tear" type of arthritis. It usually occurs in people aged 50 and over, but can also be seen in young people. The cartilage at the ends of the shoulder bones softens and erodes. The bones then rub against each other. Over time, the shoulder joint gradually becomes stiff and painful.

Shoulder Muscle Tears: Patients who have had a rotating sheath tear for a long time develop cartilage and bone erosion due to damaged friction and this causes irreparable pain, eventually making the shoulder prosthesis mandatory.

Post-traumatic abrasion: This was a joint disorder caused by abrasion after a serious fall, impact, or loss of bone and cartilage. A shoulder fracture or tears of the shoulder tendons or ligaments can damage the joint cartilage over time. This causes shoulder pain and limits shoulder function.

Rheumatoid Arthritis: This is a disease in which the synovial membrane surrounding the joint becomes inflamed and thickened. This chronic inflammation can damage cartilage tissue and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of conditions called "inflammatory arthritis."

Avascular Necrosis: Death occurs in the heart muscle when the blood vessels to the heart are interrupted, and if there is an infarction, when the blood flow to a certain area of ​​the bone stops, death occurs in that area in the bone. Then, even if the body tries to repair and shape it again, it does not return to its former state. Here is avascular necrosis, a painful condition that occurs when blood flow to the bone is interrupted. Because bone cells die without blood supply, osteonecrosis eventually causes shoulder joint destruction and arthritis. Chronic steroid use, deep sea diving, severe shoulder fractures, sickle cell disease,

and heavy alcohol use are risk factors for avascular necrosis. When the joint becomes unusable at the end of this disease, the solution is a shoulder prosthesis.

Infections: Ancient tuberculosis or other osteomyelitis can lead to destruction of bone and cartilage tissue and may require prosthetic surgery.


Why is a shoulder prosthesis necessary?


The decision for shoulder replacement surgery should be a collaborative decision between you, your family, your family doctor and your surgeon.

There may be situations that make it necessary to have a shoulder prosthesis. First of all, a shoulder joint that hurts with movement makes life narrow enough. But the shoulder joint has other important functions other than comfortable drinking tea. First of all, during a fall, the arm should be extended to the side and used to protect our head. An arm swinging while walking allows us to walk in balance And it is ready to make reflex movements that will protect us from the effects of falling from right to left. This situation is not noticeable in daily life when the shoulder joint is normal. If we leave this emergency aside, more and more help is needed for situations such as reaching out on the shelves, dressing, and cleaning the toilet. Eventually, there will be pain even at rest. The daily life is started with painkillers, and this pain can be severe enough to prevent a good night's sleep. Since the movement cannot be done sufficiently, the shoulder muscles that have remained intact also begin to lose strength and the joint becomes stiff.


If we summarize the situations that require a shoulder prosthesis:

Severe shoulder pain that does not allow movement

Pain at rest, pain that awakens at night

Severe loss of range of motion in the shoulder

• Physical therapy, drugs and conditions that do not respond to medical therapy


Orthopedic Examination for a shoulder replacement:

• Medical history is questioned; The presence of diseases such as diabetes, blood pressure, goiter and how this situation develops is asked.

• In physical examination, range of motion and muscle strength are measured and neurological examination is performed.

• X-ray: If the shoulder is bad enough to be a prosthesis, the situation is usually understood by X-ray without the need for MR.

• Other tests: if there is some suspected disease causing the shoulder to become present (undiagnosed rheumatoid arthritis, infection, etc.) blood tests, sometimes MRI may be ordered.












Types of Shoulder Prostheses:


Although there are many different techniques, two surgical methods are used today.

      Total Shoulder Prosthesis: It is the typical surgery method. A plastic surface is made for a prosthetic arm bone similar to the shoulder joint and the nest in front of it. These are available as a set in different sizes to suit the size of the shoulder bone of the person. If the bone quality is good, the prosthesis types that we call cementless are used, which are directly attached to the bone (which fuse with the bone over time), but if the bone quality is poor, the prosthesis must be attached to the bone with a filling similar to dental filling, and these are called cemented prostheses.


Partial Shoulder prosthesis: If the shoulder is good, there is no need to change it and prosthesis is applied only to the ball part. These are called partial-partial dentures.

REVERSE Shoulder prosthesis: It is usually performed after the rotating sheath muscles that move the shoulder are damaged. In this prosthesis, the nest surface is applied to the ball part of the shoulder and the knob is placed on the slotted part. Thus, a leverage arm is provided to the muscle that will work in the upper layer instead of the absent muscle. This prosthesis is also made in cases where total prosthesis has been made and has not been successful.


Preparation for Surgery:

Medical evaluation

If you decide to have shoulder replacement surgery, your orthopedic surgeon will schedule a full physical examination one week before the surgery. If there are other diseases, consultations are completed with relevant specialties. This is necessary to make sure you are ready for surgery and healthy enough to complete the healing process. Many patients with chronic medical conditions such as heart disease are evaluated by a cardiologist before surgery.




Be sure to provide information on all medications you are taking. Some medications may need to be stopped before surgery. For example, the following over-the-counter medications may cause excessive bleeding and should be stopped 1 week before surgery: Drugs such as aspirin, ibuprofen and naproxen sodium

If you take blood thinners, your primary care doctor or cardiologist will advise you to stop these medications before surgery.


Home Planning


Making simple changes to your home before surgery can ease your recovery time. It will be difficult to reach high shelves and cabinets for the first few weeks after your surgery. It is convenient to place items that you may need later for a while on low shelves.

When you come home from the hospital, you will need assistance for several weeks with daily chores such as dressing, bathing, cooking, and laundry.





Before Surgery


Prepare loose buttoned clothes on your way to the hospital for your surgery. After surgery, you will have a shoulder arm sling and limited use of your arm.

You will be hospitalized on the day of your surgery. Since the anesthesiologist has approved it beforehand, it is sufficient to lie on your bed 1 hour before the operation for routine service work.


Anesthesia type:


General anesthesia is generally used in shoulder surgeries. Sometimes a regional anesthesia, which we call scalene anesthesia, can also be used.

Surgery procedure

The procedure to replace your shoulder joint with an artificial device usually takes about 1-2 hours.


After Shoulder Prosthesis Surgery: Depending on the age of the patient, it may be necessary to stay in the hospital for 1 or 2 nights. Since the stitches are under the skin, they do not need to be removed. Controlled movements and exercises are started immediately after the surgery. More active and passive movements are performed each day than the previous day for exercises and active use of the arm and hand. In the 3rd week, the patient can do all the daily tasks himself.

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