What Is Minimally Invasive Total Shoulder Replacement Surgery?
Total Shoulder Replacement, also known as Total Shoulder Arthroplasty (TSA), is a tremendously successful procedure for treating the severe pain and stiffness.
The pain and stiffness are often the result of end stage forms of osteoarthritis, rheumatoid arthritis, degenerative joint disease of the shoulder joint or when the shoulder is severely fractured or broken.
The primary goal of shoulder replacement surgery is pain relief, with a secondary benefit of restoring motion, strength, function, and assisting with returning patients to an activity level as near to normal as possible.
There are 2 Minimally Invasive approaches for these patients:
Conventional Minimally Invasive Total Shoulder Replacement
Conventional Minimally Invasive Total Shoulder Replacement device mimics the normal anatomy of the shoulder: a plastic "cup" is fitted into the shoulder socket (glenoid), and a metal "ball" is attached to the top of the upper arm bone (humerus). In a reverse total shoulder replacement, the socket and metal ball are switched. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus.
Reverse Minimally Invasive Total Shoulder Replacement
Reverse Minimally Invasive Total Shoulder Replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion. A conventional replacement device also uses the rotator cuff muscles to function properly. In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm.
Many patients return to the sports they love like tennis, golf, and swimming, while also pursuing personal health initiatives such as individual training, yoga and Pilates.
THE PROCEDURE
There are many different types of implants that are used for Minimally Invasive Total Shoulder Replacement. They all, however, share the same basic components: a metal ball that rests against a plastic (polyethylene) socket.
The shoulder is a ball and socket joint where the ball is the upper part of the humerus and is called the humeral head. The socket is smaller and is part of the shoulder blade (scaptila).
The ball is held in the socket by ligaments and by the rotator cuff tendons. The rotator cuff muscles start on the shoulder blade and turn into tendons which attach to the ball.
In Minimally Invasive Total Shoulder Replacement surgery the ball is replaced with a metal ball attached to a stem.
The stem is inserted down the shaft of the humerus and cement is sometimes used to keep the stem in place.
The socket is sometimes replaced with a plastic piece which is usually fixed to a groove in the socket with cement. Whether a socket is used or not depends upon how bad the arthritis is in the shoulder and whether the rotator cuff tendons are intact.
The procedure takes approximately two hours.
The Minimally Invasive Total Shoulder Replacement Advantages
Preparation for Minimally Invasive Total Shoulder Replacement
Before your departure your records will be reviewed thoroughly by our orthopedic surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will also review your hip replacement procedure and answer any questions.
Getting your house ready before your surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
MINIMAL INVASIVE TOTAL SHOULDER REPLACEMENT RECOVERY
After surgery, you will be moved into the recovery room where you will stay for approximately two hours. During this time, you will be monitored until you awaken from anesthesia, at which time you will be taken to your hospital room. Your operated arm will be numb from the regional anesthesia, which also can provide good pain relief for the next day. Another side effect of the anesthesia is that you will not be able to move the fingers or wrist on the operated arm.
Typically, you will stay in the hospital for two to three days, but this depends on each individual and how quickly he or she progresses. After surgery, you may feel some pain that will be managed with medication to make you feel as comfortable as possible. This will be given either by injection or pump and should be used as needed. To avoid lung congestion after surgery, you should breathe deeply and cough frequently to clear your lungs.
Your arm will be in a sling for four to six weeks after surgery. If you have regional anesthesia, it will take 12 to 18 hours to wear off, during which time your hand and arm will be numb. When you are able to move your hand, begin making a fist and holding it for five seconds. This small exercise helps to keep your blood circulating and should be done frequently.
Arm and shoulder movements are very important for recovery. Usually the first day after surgery, your orthopedic surgeon or another doctor will begin to work with you and teach you specific exercises to regain full arm and shoulder movement.
The doctor will provide you with a list of exercises that you can do to keep your muscles strong without damaging the replaced shoulder. These exercises are necessary to prevent your elbow and shoulder from getting stiff. They will be difficult to perform in the beginning, but will get easier every day. You also will be visited by a physical therapist who will reinforce these exercises while you are in the hospital. During your hospital stay, you will attend physical therapy one to two times a day. An occupational therapist and nurse discharge planner also will help you prepare for your homecoming.
Physical therapy begins the day after surgery and begins with moving the fingers, wrist and elbow.
LIFE AFTER MINIMALLY INVASIVE TOTAL SHOULDER REPACEMENT SURGERY
Physical Therapy
Physical therapy plays an extremely important role in the Minimally Invasive Total Shoulder Replacement recuperation. A physical therapist teaches the patient exercises designed to help regain flexibility and strength in the injured shoulder.
Most patients begin physical therapy before leaving the hospital. The physical therapist is an educator their role is to teach the patient appropriate exercises that can be done safely at home to speed the recovery from Total Shoulder Replacement Surgery. He or she will also teach the patient how to avoid re-injuring the surgically repaired shoulder.
Because physical therapy can be difficult and physically demanding, our therapists usually like to meet with members of the patient’s family in the hospital so they can learn to help the patient with physical therapy at home.
Home Instructions
At home, it is extremely important to perform physical therapy exercises as directed, usually five times a day.
Patients should begin moving the shoulder through its full range of motion as soon as possible after surgery in order to prevent the formation of scar tissue. This is performed passively, or with the use of the opposite arm to assist. If the shoulder is not moved properly, scarring may cause it to stiffen. Stiffness may cause discomfort and limit the ability of the shoulder to function. Ice should be applied to the shoulder after exercising.
Patients often notice some skin discoloration near the wound or in the upper arm. There’s no need to worry. The hand or forearm may also swell. This is normal and results from the swelling and bruising from your shoulder, which travels down the arm. Usually this swelling will go down if the arm is elevated appropriately.
The First Twelve Weeks After Surgery
During the first twelve weeks after surgery, it’s important to follow two basic principles: