This is the last of three posts about total shoulder replacement.
1. I am allergic to metals, such as jewelry. Is there any risk of people being allergic to the shoulder device parts?
It would be most unusual as there is no nickel in the material, which is either titanium or cobalt-chrome. So, as far as this goes – there is no need to worry unless you have a significant history of metal allergy in the past.
2. You recommended a shoulder replacement. In my case, what are the alternatives? Pros and Cons of each?
Every case is different and we pride ourselves on providing you with the most professional individualized care you can receive. That being said, there are some general rules that apply to most patients.
The alternatives include an “anatomic total shoulder replacement” (the most typical type of replacement) – that requires a functioning rotator cuff, and has a design that is consistent with as near normal “biomechanics/kinematics” as possible. The advantages are a long history of excellent outcomes with this. Another option would be a hemiarthroplasty or “half” of a shoulder replacement. With a hemiarthroplasty, only the head of the humerus is replaced, or resurfaced and your normal glenoid is left intact. However, if your xrays show even mild glenoid wear, a total shoulder replacement has been shown to provide better pain relied. One reason to advise a hemi would be fear of early glenoid component failure, usually in patients who need or want to continue with heavy activity or younger age. The final option is a Reverse design, which is “nonanatomic” – and is a good option for patients without a functioning rotator cuff. This is recommended when the rotator cuff is either irreparably torn, or atrophied and not functional. Our short-term success has been excellent but long term follow-up is still unavailable. That having been said, when little else is available, and one would like to be able to raise the arm overhead, it is a great potential option – so long as the deltoid muscle is healthy.
3. What are the consequences if I don’t have surgery?
Unless you are dealing with a tumor or infection (heaven forbid), surgery is a quality of life choice and not an emergent necessity. Firstly, you will continue to experience the symptoms you are having – pain, loss of motion etc. However, if your symptoms are tolerable, there is little downside to waiting on the replacement until you feel as though you are ready. In other words, there is little if any risk that you would progress in such a way that a replacement would not be an option in the future. If, during a period of several years your rotator cuff function declined, and an anatomic unconstrained replacement was no longer an option, you would still likely be a candidate for a Reverse design.
4. What are the chances of infection from the surgery? Also, what are the consequences if I get a bone infection?
While an acute infection is possible, the risk is less than 2-3%. If this happens in the immediate postoperative period, you would require surgery to debride and wash out the infection, and several weeks of antibiotics. If the components are well fixed and the bacteria is sensitive, the components can potentially be retained. However, if they need to be removed, replacement can often be performed again after a few months, so long as the infection has been erradicated. If the infection lingers–there is a small chance that you would not be able to have a revision, and you would be left with a “flail” shoulder – that is, no replacement would be reimplanted and function would be severely limited.
5. What precautions do you take to prevent infection?
Everyone receives preoperative and postoperative antibiotics. After surgery, we prescribe antibiotics before any dental or GI procedure, as well. Further, we make sure that you do not have any infections, for example, a urinary tract infection, prior to your surgery.
6. I have attended 5 physical therapy sessions. I have authorization for 3 more. Should I complete all 8 previously authorized sessions?
Physical therapy is a critical component of optimizing your outcome after total shoulder replacement. A skilled therapist is better able to identify issues before they develop into problems. I always recommend continuing therapy until your strength and range of motion has improved. When you have reached a point where you can safely perform the exercise on your own, we will help you setup a program you can work on at home
7. If I have surgery, how long do you typically schedule patient visits after surgery?
I usually see you at 1-2 weeks after surgery, at 6 weeks, 3 months, and either at 6 months and/or at 12 months – depending on how you are doing. This is flexible, however, depending on whether you live out of town or not. We then do yearly follow-ups to check the prosthesis for about 3 years.
8. How long do the various prosthetic devices last?
How long these replacements last is variable – we hope for a lifetime, but know that failures – which if not from infection- related problems, are usually due to loosening of the glenoid component, and can develop after 10-15 years. But of course, this often does not happen. Long term research shows that 96% of all total shoulder replacements are in place and functioning at 5 years, 92% at 10 years and 86% at 15 years.
9. You didn’t mention a reverse prosthesis, or a partial replacement. Are these procedures considered in my case?
I have addressed these above – if your case has specific or special needs, we will discuss them at your pre-op visit and I will explain all of the options..
10. What are the restrictions for shoulder replacement (and/or other options) that I should consider in my decision? Can I expect to play golf with a shoulder replacement?
I do not like patients to lift more than 50 pounds regularly. Golf and tennis are typically not a problem but may need to be modified slightly. You would certainly be able to swim and do most other activities – within reason. Its safest to ask about the individual activities you like to participate in as the questions arise.