Shoulder arthroplasty – commonly known as shoulder joint replacement surgery, is a remedial surgery for people suffering from shoulder pain mainly because of Arthritis. The continuous shoulder pain can restrict an individual from performing normal acts making it next to impossible to avoid this replacement surgery.
The patients endure several permanent restrictions after shoulder replacement which makes it inevitable to perform many jobs. A shoulder replacement is needed when the muscles in the shoulder start to writhe and not much mass is left for the socket and ball movement to work without friction; causing discomfort and at times excruciating pain to the suffering individual.
A reverse shoulder replacement surgery has been developed by medical experts which is less complex than traditional arthroplasty and more people can benefit from it. The reverse shoulder replacement surgery – reverses the socket and ball movement in the shoulder by changing their places. This newer design stabilizes the shoulder joints of the patient back to functionality without any extra aid needed such as a rotator cuff.
The artificial joint inside placed with the humeral head makes the shoulder movement more stable when the arm is raised by preventing the ball from sliding out of its position. As the compressive forces grow; the deltoid muscle in the shoulder comes to the rescue and lets the shoulder lift the arm with ease without any sign of prior pain.
The result is that the shoulder performs better and longer, plus it becomes less painful.
The above-mentioned attributes are the good things about reverse shoulder replacement surgery. Unfortunately, there are many permanent restrictions after shoulder replacement surgery. These permanent restrictions are for the patient’s benefit; to avoid three major health problems connected to the shoulder replacement surgery.
The three major and common problems attached with the shoulder replacement surgery are:
- The fractured bone around the implant
- Hematoma (trapping of fluid or blood around the joint)
- Neurological injury
These above-mentioned health problems may be accompanied by dislocation, infection, failure of the baseplate, or a fracture of the shoulder blade under different circumstances
Doctors and health practitioners instruct a list of permanent restrictions after shoulder replacement surgery to avoid these medical problems which may become fatal in special cases.
The Fractured Bone around the Implant
Fracturing a bone around the implant is also known as a periprosthetic fracture (PF). These fractures occur if the patient is too old or has very weak or brittle bones. At times this fracture can occur while the surgery is being performed.
Hematoma (Trapping of Fluid or Blood around the Joint)
This is a very common health complication after the surgery of shoulder replacement. It can be caused by various reasons. The surgeons make sure that this fluid accumulation is avoided which can lead to infection. For the implant to work properly after the placement, it is necessary to have the area around the empty joint also known as dead spaces.
At times, the patient might develop a deep pathway of blood and fluid drainage known as sinus tracts; which starts from the incision site. This can also cause a hematoma. The blood infection and hematoma are co-linked and can be fatal if left untreated.
Almost 10 percent of reverse shoulder arthroplasty patients are at risk of serious blood infection along with hematoma. The risk factor increases if the history of the patient shows multiple surgeries or the reverse implant had been done before as well, there is a large dead space around the joint making it harder for the medical experts to keep it fluid-free and a poor sterile technique.
The antibiotics are administered to the patient before the surgery begins to cement any after-surgery medical complications. Still, if the antibiotics fail, and the patient develops an infection, then antibiotics are instructed to fight the bacteria. The surgeon washes and rinses the joint thoroughly with saline water while scraping away any visible bacteria from the surgery spot. This process is known as debridement and irrigation.
Neurological injury– in simpler terms means pulling or contracting the nerves of the arm by a sudden movement that caused a sensation loss in the arm, fingers, or hand. The reverse shoulder surgery put an extensive strain on the arm nerves, which causes this injury; also known as brachial plexus.
Neurological injury can also be caused if the nerve plexus loses the motor or sensory function of the arm. This can be used by scar tissue anywhere in the arm causing loss of sensation.
Permanent Restrictions after Shoulder Replacement Surgery
The patients are advised to maintain a lifestyle where they do not put the implant under unnecessary strain. They are asked to avoid lifting weights or doing strenuous chores to keep the implant intact.
Any kind of muscular tension around the shoulder can result in dislocation of the shoulder joint. Once the shoulder is dislocated, the only remedy is to have another revision surgery; which is a lengthy and painful process.
Patients are advised to restrict their arm and shoulder movement such as added excursion, adduction, or any kind of supplementary internal rotation of the socket post-surgery until the surgery spot is completely healed.
The patients are restricted to scratch their back as this might dislocate their shoulder implant. Taking an arm to the back means putting pressure on the shoulder; while the arm is in an extended position causing an inner rotation of the joint.
One of the complications that occur due to malfunctioning of the implant used for the shoulder relocation is baseplate failure. This is a major problem when the round component attached to the socket does not let the patients’ bones grow to get accustomed to the added equipment inside the body. If the baseplate failure occurs, the shoulder joint will not be able to move at all.
The manufacturers of the implants are working rigorously to eradicate this failure. They have come up with a temporary solution of providing locking screws that enables the surgeons to angle the socket into denser and deeper bones of the shoulder. These locking screws help the humeral prosthesis to stay intact in the right place. Some of the other remedial solutions for baseplate failure are the usage of thick screws and the usage of more converse and tilted baseplates.
Shoulder replacement surgery is commonly conducted around the world. With the advent of the latest technology; it has become a routine surgery for surgeons dealing with shoulder replacement patients. One of the major reasons behind this surgery in elderly people is the rotator cuff tears which are so large that they cannot be treated without a replacement surgery. At times, fractures and shoulder replacements also contribute to this shoulder arthroplasty.
A surgeon should be completely aware of the pros and cons attached to the replacement surgery and must educate the patient beforehand. There are problems and complications attached to this kind of surgery and old age only makes it riskier. It is a surgeon’s job to keep in touch with the patient post-surgery to avoid any kind of mishap or infection which may result in mental distress to the patient or rare cases death.
With the advancement in technology, it is predicted that a complete solution for replacement shoulder surgery will be formulated in no time to avoid base plate failures. Studies are continuously conducted on patients who had this surgery 15 to 2- years ago to understand the life post-surgery and to prevent problems and complications attached with the surgery as the aftermath.