Osteoarthritis (OA) of the shoulder is a painful condition that can cause a significant loss of function over time. The condition is usually characterised by a loss of the normal smooth surface of the ball and socket joint, which make up the shoulder. The cartilage that usually provides this smooth surface cannot be restored once arthritis has become established, thus the result is a loss of comfort and function of the shoulder, which is difficult to regain.
Surgery; what to expect and the procedure
What to expect from surgery
Joint surface replacement surgery can help to improve the mechanics of the shoulder by providing a smooth surface, which is often less painful. It cannot however, make the joint as good as it was prior to the arthritis. The effectiveness of your surgery depends on your level of motivation, the condition of the shoulder, your age, your surgeon and your Physiotherapist.
The aim of a surface replacement is primarily pain reduction; however, other benefits may include improved stability and function. These are however, very much dependent on your rehabilitation with your Physiotherapist, and the quality of the deep muscles around your shoulder.
This is usually performed under a general anaesthetic, with a small incision being made on the front of your shoulder. The surface replacement is a small metal cup like device that is attached onto the top your arm bone (humeral ball). For the majority of patients the socket (Glenoid) part of your shoulder does not have to be replaced, but can be refashioned to create a smooth surface.
During the procedure some of the muscles around the shoulder are released to enable the surgeon to get into the joint. These muscles are reattached towards the end of the procedure.
When you awake from your surgery, your arm will have been placed in a sling by the surgeon. It is usual for patients to continue wearing the sling for up to 4 weeks. It is fine to use your hand and elbow out of the sling during the day, with your arm close to your body. However when in the sling, you will probably need help with activities such as dressing, or washing your hair. It is usual for the sling to remain on at night for 4 weeks.
During your stay your post-operative pain will be controlled by prescription medication on the ward. On leaving the ward you will be given a 5 - day prescription, after this time you may be able to downgrade to over the counter analgesics, or you may need to visit your GP to continue with the prescription drugs. Ice can be used at home as a useful adjunct or alternative.
The recovery process; physiotherapy and milestones
A surface replacement is a big undertaking with regards to the rehabilitation. You will need to see your physiotherapist once or twice a week during this initial stages (depending on how well your shoulder moves) and to prevent stiffness. Following this, your physiotherapy sessions will become less frequent as you continue your exercises independently and move through the subsequent stages of rehabilitation, namely the return to functional activities and finally to hobbies and interests. This can often take up to 9 months.
- Sling up to 4 weeks
- Return to driving 4-6 weeks
- Regain passive range of movement. This can take up to 6 weeks, although it is unlikely full movement will be achieved
- Regain active range of movement. This can take up to 12 weeks, although it is unlikely full movement will be achieved
- Lifting: Avoid Heavy Lifting for 4 months.