As the cartilage lining wears away, the protective lining between the bones is lost. When this happens, painful bone-on-bone arthritis develops. Severe shoulder arthritis is quite painful, and can cause restriction of motion. While this may be tolerated with some medications and lifestyle adjustments, there may come a time when surgical treatment is necessary.
There are a few major approaches to access the shoulder joint. The first is the deltopectoral approach, which saves the deltoid, but requires the subscapularis to be cut. However, during this approach the deltoid is put at risk for potential damage. The next notable case in the evolution of shoulder replacement procedures was in when Charles Neer conducted the first hemiarthroplasty, essentially replacing only the humeral head, leaving the natural shoulder socket, or glenoid, intact. This prompted the development of a procedure to replace not only the humeral component, but the glenoid component as well.
Throughout the development of the procedures, it became well accepted that the rotator cuff muscles were essential to producing the best outcomes in terms of strength, range of motion, and a decrease in pain. In addition to this finding, physical constraints of the normal ball-and-socket anatomy of the shoulder limited most developments in one way or another. For example, a heavily constrained system limited range of motion. The s saw an exponential increase in surgical approaches using this methodology, and the number and variation of surgical techniques are many.
However, in Paul Grammont emerged with a superior technique that is the basis for most reverse shoulder replacement procedures today.
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In others, a conventional shoulder replacement may be indicated. Although Grammont continued to develop and refine his new technique to address minor complications that arose, it relied on 4 basic concepts that included the inherent stability and shape of the implant, as well as the placement of the implant relative to the natural glenohumeral joint.
The progression to shoulder replacement usually begins with the development of pain with movement of the shoulder and stiffness which will be conservatively managed with activity modification, physical therapy and nonsteroidal anti-inflammatory NSAID drugs. Various studies on shoulder replacements have confirmed this indication, noting specifically that severe glenohumeral arthritis as the cause.
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In traditional total shoulder arthroplasty the approach begins with separating the deltoid muscle from the pectoral muscles, facilitating access to the shoulder glenohumeral joint through a relatively nerve free passageway. Typically a single rotator cuff muscle is identified and cut to allow direct access to the shoulder joint.
As this point, the surgeon can remove the arthritic portions of the joint and then secure the ball and socket prostheses within the joint. The development of safer, more effective techniques have led to the increased use of reverse total shoulder arthroplasty. Rest when you feel tired. You may take a nap, but don't stay in bed all day.
Work with your physiotherapist to learn the best way to exercise. You will have a sling to wear at night. And it's a good idea to also put a small stack of folded sheets or towels under your upper arm while you are in bed to keep your arm from dropping too far back. Your arm should stay next to your body or in front of it for several weeks, both while you are up and during sleep. Don't lift anything with the affected arm for 6 weeks. Ask your doctor when you can drive again. Ask your doctor when it is okay for you to have sex. Your doctor may advise you to give up activities that put stress on that shoulder.
This includes sports such as weight lifting or tennis, unless your tennis arm was not the one affected. By the time you leave the hospital, you will probably be eating your normal diet.
Total Shoulder Arthroplasty - Shoulder & Elbow - Orthobullets
If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Your doctor may recommend that you take iron and vitamin supplements. Drink plenty of fluids unless your doctor tells you not to. You may notice that your bowel movements are not regular right after your surgery.
This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines. If you take blood thinners, such as warfarin Coumadin , clopidogrel Plavix , or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
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Be safe with medicines. Take pain medicines exactly as directed. If the doctor gave you a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine. If you think your pain medicine is making you sick to your stomach: Take your medicine after meals unless your doctor has told you not to. Ask your doctor for a different pain medicine. If your doctor prescribed antibiotics, take them as directed. Don't stop taking them just because you feel better.
You need to take the full course of antibiotics. If you take a blood thinner, be sure you get instructions about how to take your medicine safely.
Blood thinners can cause serious bleeding problems. If your doctor told you how to care for your cut incision , follow your doctor's instructions. Peter Millett, orthopedic specialist and sports medicine surgeon at his office in Vail, Colorado. Total Shoulder Arthroplasty For Shoulder Osteoarthritis Osteoarthritis in the shoulder is a gradual and progressive degeneration of various joints also see arthritis of the shoulder. The surgical technique of Total Shoulder Arthroplasty is further explained in this short video.
Related Shoulder Arthroplasty
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