As the shoulder's function demands a wide range of motion to accommodate the various arm and hand movements and also strength to allow for actions such as lifting, pushing and pulling, the difference between these two functions results in a large number of shoulder problems not faced by other joints such as the hip.

Shoulder Replacement
Replacing the damaged and painful joint surfaces with artificial components shaped to allow continued motion of the shoulder is a procedure known as Shoulder Replacement and may be recommended and undertaken by an orthopaedic surgeon. A stem with a rounded metal head is the component that replaces the ball (humeral head). A smooth plastic concave shell that matches the round head of the ball is the component that replaces the socket. Total shoulder replacement involves resurfacing both sides of the joint. If only the humeral side of the joint (ball) needs to be resurfaced, a partial shoulder replacement may be performed.

Preparing for Surgery
Once the decision has been made to pursue a shoulder replacement, the patient will need to complete a series of tasks in order to properly prepare for the surgery.

• A physical exam by your primary care physician may be requested in order to confirm your general health and ability to undergo the surgery.
• Smokers will need to discuss their habit with their physician as smoking increases certain risks in relation to surgery.
• Arrange to complete any dental work that may be in progress to avoid infections from the mouth from entering the bloodstream and therefore entering the new joint.

The Surgery
Necessary medications and fluids will be administered to the patient through an I.V. during the surgery. The patient is taken to the operating room and given anesthesia. Once the anesthesia takes effect, a special solution is used to scrub and sterilize the shoulder area.

Depending on the severity of the shoulder condition, the surgery will take approximately one to three hours. An incision is made over the shoulder to expose the joint. The surgeon will use special, precision guides and instruments to cut the humeral head (ball) and prepare the bone to accept the implant. The metal ball and stem component are then inserted and put into place. If resurfacing of the socket is necessary, the damaged surface is smoothed and the plastic surface component is inserted and put into place. The surgeon will then join the ball and socket. The incision will be closed and covered with dressings once the surgeon is satisfied with the fit and function of the new components. For the fluids that naturally develop at the surgical site, a special drain may be inserted into the wound site for drainage. A sterile bandage is then applied to the surgery site.

The patient will be sent to the recovery room following the completion of the surgery. There, they will slowly regain consciousness as the anesthesia wears off. The nurse accompanying the patient will instruct the patient to cough or breathe deeply to help clear the lungs. The patient's arm will be secured in a sling or brace, and an ice pack may be applied to the area to help relieve the pain and swelling. Pain medication will be administered. When the patient has regained full consciousness, they are taken to their hospital room.

Following Surgery
Patients begin a gentle rehabilitation program in their hospital room following their surgery. The muscles around the new shoulder need to be relaxed. Patients are usually instructed to stand and take a few steps the same day, following surgery. Pain medication will continue to be administered as needed. Two days after the surgery, the bandage will be removed.

Prior to hospital dismissal, a physical therapist will give the patient instructions on the correct performance techniques for rehabilitation exercises which are essential for the patient's proper recovery. Tenderness and warmth in the shoulder area may ensue for several weeks.

Activity Resumption
For the majority of cases, successful joint replacement surgery relieves the pain and stiffness experienced prior to the operation. Resumption of many of the patient's normal daily activities is to be expected. However, some activities will be restricted. The patient should avoid contact sports or activities with a "jamming" motion such as hammering, repetitive heavy lifting, or activities that put excessive strain on the shoulder. While the artificial joint can be replaced, the second implant is rarely as effective as the first replacement. So maximizing the wear of the original replacement is paramount.

Artificial Shoulder Endurance
The period of time that the artificial shoulder will remain intact and functional depends on many factors and varies for each patient. Some of the factors include:

• the patient's physical condition
• the patient's activity level
• the accuracy of the implant placement
• the endurance of the materials in the artificial joint

Artificial joints are not as strong and durable as the patient's original, healthy joint; and there is no guarantee that the new joint will endure to the end of the patient's life.

Shoulder replacement surgery today is typically a safe, successful procedure. Compared to the pain and immobility experienced prior to the surgery, most patients enjoy relief from pain and improved range of motion. With this new mobility and pain ease, some patients may have a tendency to overdo their physical activity. The new synthetic joint will provide a smooth joint movement. The fluid in the joint, the synovial fluid, will lubricate the joint, just as it did in the natural joint. Some wear will occur over time in the synthetic joint depending on the use of the joint. Extremely stressful activities will cause the joint to wear more quickly and reduce the service life of the artificial joint. Should the joint components become loose or undergo wear on the plastic portions of the implant, the necessity of revision surgery to replace the worn components, or all of the components may become apparent. Your surgeon can discuss this potential with you taking into account your particular clinical circumstances, the type of implants used, and your post-surgical lifestyle.

Following your surgery, you should become informed by your surgeon about the following situations which may affect the longevity and success of your shoulder replacement:

• maintaining your general physical condition
• adjusting your activity level
• avoiding repetitive heavy lifting
• avoiding high impact sports and "jamming" activities such as hammering or activities that put excessive strain on your shoulder
• consulting your physician before beginning a new sport or activity
• being smart about everyday movements
• avoiding "impact loading" sports such as boxing
• not lifting or pushing heavy objects

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