Indications:
This procedure is indicated for arthritis of the shoulder joint or an unreconstructable fracture of the upper end of the arm bone. Common causes for shoulder arthritis are osteoarthritis (age related), cuff tear arthropathy (due to unrepaired tears of the tendons around the shoulder), rheumatoid arthritis and instability arthritis (due to untreated shoulder instability).
What to expect before surgery
If you are to undergo this procedure with Dr Bala you will usually consult a member from the anaesthetic team a few days prior to the surgery. You may be required to bring some of your more recent investigations including a chest x-ray, ECG and routine blood tests. If required the nurse or physician may order more tests if required. The procedure is usually performed under general anaesthesia with the addition of a nerve block at the base of the neck (interscalene block). The anaesthetist may further discuss these with you. The procedure and anaesthesia are usually for 2 or 3 hours. Most shoulder replacement surgeries require overnight stay for a day or 2. You may require specialist physician clearances depending on your condition prior to surgery. You must also inform the team if you have had a pacemaker placed on the side of surgery.
The nurse will instruct you on the time should start fasting prior to the surgery start time, the reporting time into the hospital and the possible discharge time. It’s a good idea to shower the night before surgery and remove jewellery.
In major fractures Dr Bala may opt to keep all options available for use during surgery such as nails, plates, headless screws, suture anchors, external fixators and joint replacement options with a fracture stem. Dr Bala will choose the implant/ prothesis that is best suited for your condition.
On the day of surgery
It is good to report a couple of hours prior to the scheduled operation time to enable time for you to change into the hospital gown and be reviewed by the anaesthetist and the surgeon. The only prick you might feel is that of the IV line prior to anaesthesia. A ‘timeout’ is done to ensure that the entire team is satisfied with the side, procedure and equipment. The anaesthetist will give you some sleep medicines 1st to make you comfortable and you may request for your choice of music as drowse off to sleep. You will usually be given automatic calf compressors which massage the calf muscles during the duration of the surgery to prevent blood clots from forming. You will also be given an electrical warming blanket to ensure your body remains warm during the duration of the surgery. Some anaesthetists prefer to give the nerve block prior to the general anaesthesia while others prefer it the other way around. An IV antibiotic (usually cefazolin) is administered prior to surgical incision.
Surgery
Anaesthesia is usually given on the operating table. A special table with attachments to position the neck and support the arm is used. The procedure maybe done with you either lying on your side or sitting up. Dr Bala prefers the beach chair position with the ‘T max’ table attachment and any commercially available arm holding device (‘Spider’/ ‘Trimano”) for fractures involving the shoulder joint, upper arm bone and mid arm bone. Sometimes a lower arm bone fracture may have to approached from the back of the arm and a lateral position with a support under the arm is chosen. Once you are comfortably positioned on the operating table with adequate cushioning, a C arm (intra operative x-ray machine) is used to check if the fracture site is visible. Then the operating side is cleaned and draped the procedure is begun. The shoulder is approached usually from the front or side. At the end of the procedure the joint is irrigated and stability checked before closing the wounds. Dr Bala closes the wounds with an absorbable suture and steristrips. An arm sling is usually provided to support the arm after surgery. The drapes are removed and you will be shifted back to the trolley from the operating table after the procedure is complete.
For more details of specific procedure performed you may visit the following pages of this website
Shoulder arthritis https://pradeepbala.com/conditions-treated/shoulder-arthritis/
Proximal Humerus fracture https://pradeepbala.com/conditions-treated/proximal-humerus-fracture/
After surgery
You are usually kept in the observation bay in the operating theatre for a couple of hours and may either be shifted to the ward or ICU from the theatre. A post op x-ray is taken in the holding bay to ensure the joint and all of its components are in place before you leave. Once you are fully awake, have had a few sips of water without throwing up, can move all of your fingers comfortably without pain you may be mobilized.
You will usually be given IV antibiotics for the next 24 to 48 hours. You will be allowed to wipe the operated arm and shoulder with a wet towel on the following day and will be allowed to shower a couple of days after the surgery. The physiotherapist will instruct you to as to what movements you can and cannot do after surgery. In general, try to avoid elevating the arm above 90 degrees and external rotation beyond neutral for the 1st 6 weeks.
Dr Bala may either phone your closest relative or see you before you are discharged.
Follow up
Dr Bala sees his post op patients at around 2 weeks after surgery. Usually there are no sutures to remove. You may require some sessions of physiotherapy after surgery to optimize the function of your shoulder over the next 4 to 6 weeks.
X-rays are taken at 2 weeks, 3 months, 6 months, 1 year and then yearly thereafter. A shoulder joint replacement should serve you well for a good 2 decades.