Shoulder Joint Replacement

There are two types of shoulder joint replacements; the conventional Total Shoulder Replacement surgery which has been around since 1950 in the United States and the Reverse Shoulder Joint Replacement Surgery which was approved by the FDA in 2004 and is used when the rotary cuff is also damaged. The goals of both shoulder replacement surgeries are to lessen pain and improve motion, strength and function. These shoulder replacements should last approximately 15 years.

 

The Surgeries

The Total Shoulder Replacement surgery is where the shoulder blade socket is replaced with a plastic socket and a metal ball replaces the ball at the top of the arm bone.  The Reverse Shoulder replacement surgery reverses this and put the metal ball on the top of the shoulder blade and the plastic socket at the top of the arm bone.  This allows the deltoid muscle to raise the arm instead of the weakened rotator cuff muscle. The surgeries take approximately two to three hours and are usually done under a general anesthesia.

After Surgery

Prior to surgery it is a good idea to see a physical therapist to receive some exercises to strengthen the muscles around the joint. Your hospital stay will be short, only 2-3 days. After surgery you will need to wear a sling to minimize movement for a few weeks. Your physical therapy will continue starting with range of motion exercises as the soft tissue heals and then you will gradually move on to strengthening exercises for your shoulder muscles.   Depending on the type of work you do you may need to take up to six months off to recover. Someone working in an office most likely can return to work after 2-3 months recuperation, where as a construction work would not be able to return to work until after 6 months of recuperation. It will take approximately six months before your shoulder will have completely recovered and the pain subsided. You will gain back most of your range of motion but not all.

Complications

Complications are rare but could include the following:  

• Unexpected reaction to the anesthetic
• Infection
• Excessive bleeding or developing a blood clot, usually in a vein in the leg
• Shoulder instability
• Tearing of the rotator cuff
• Fracture and loosening of the prosthesis
• Injury to nerves and blood vessels

Shoulder Joint Replacements surgeries are not preformed as often as hip and knee surgeries as they are not weight bearing joints, so they do not deteriorate as fast. Also, the majority of people are not aware that shoulder joint replacement is possible.  

Hip Joint Replacement

 Hip Joint Replacement

Hip joint replacement is one of the most successful and safest procedures in orthopaedic surgery performed today.  It is mainly done for people 60 or older and is rarely suggested for younger people because of the stress they can put on the replacement hip, causing it to fail sooner than anticipated. Osteoarthritis and rheumatoid arthritis are the main causes for a deteriorating hip joint, but other causes include bone tumors, injury and lack of blood supply causing loss of bone.

Hip Joint Replacement Parts

The hip joint is called a ball-and-socket joint since the spherical head from the thighbone moves inside the cup-shaped concave socket of the pelvis. To imitate this action, a total hip replacement implant has three parts: the stem, which inserts into the femur; the ball, which takes the place of the sphere-shaped head of the femur; and then the cup, which takes the place of the damaged hip socket.

The Surgery

With a total hip replacement surgeons operate from the side or the back of the hip. This extensively disturbs the joint and connecting tissues and necessitates an incision approximately 8-12 inches long. In contrast, the direct anterior hip joint replacement approach needs an incision that is only 3-4 inches in length at the front of the hip. Using this approach, the surgeon does not need to detach any of the muscles or tendons. Talk to your surgeon regarding which one is best for you.

Originally elephant ivories were used to make the artificial joint but now it is made from ceramic, metal or plastic. The operation in general is at least an hour; however the hospital stay depends upon the person's overall health but normally is between 3 to 5 days.

Risks

• Potential  blood clots in the leg
• Trouble with urination,
• Skin or joint infection,
• Bone fracture,
• Scarring and restricted hip movement,
• Loosening of the hip joint

After Surgery

To protect your hip after surgery, it is important that you do not sit past a 90-degree angle. To help with sitting, you will need a raised chair (use pillows or raised lifts for the legs of the chair) and a raised toilet (or a raised toilet seat attachment). This allows your hip to be at the same height or a little higher than your knee while sitting. An occupational therapist will show you how to dress, get in and out of bed and how to use a walker or crutches properly without hurting or dislocating your hip. At home you must continue your exercises to strengthen your leg and hip muscles.

Ankle Joint Replacement

 Total ankle replacement surgeries are on the rise due to implant improvements over the last 10 years. Previously only ankle fusion was available to those suffering from ankle pain often caused by trauma, chronic ankle sprain, rheumatoid arthritis and osteoarthritis.

Total Ankle Joint Replacement (ankle arthroplasty)

Ankle joint replacement involves removing both sides of the ankle joint and replacing them with specifically designed synthetic parts. The one that fits on the end of the tibia is made of a medical alloy covered with a long lasting medical grade plastic. The other is made of medical alloy and fits on top of the talus and slides against the tibia. These parts come in varies sizes in order to give the proper fit.   

The surgery takes a few hours and the patient will either be given a spinal anesthetic and a little something to help you relax or a general anesthesia which will put you to sleep.

Ankle Fusion

When performing an ankle fusion, the surgeon removes the damaged bone and cartilage between the tibia and talus bones and then fuses the two together using screws, plates and bone cement. When necessary a rod may also be used to help strengthen the joint as well. Mobility with an ankle fusion is never fully regained but the pain and discomfort is improved dramatically. 

Recovery

After surgery, the hospital stay will be for approximately 3-5 days depending on the support system the patient has at home. The foot will be in a cast for 4 to 6 weeks to protect the new ankle to keep it in the exact position and allow the bone to grow around the metal and cement. During this time the patient will use a walker or crutches and be able to do a little weight bearing. Gradually over the next few months with the help of a physiotherapist the ankle and surrounding muscles will become strong enough for full weight bearing.  Rehabilitation exercises, once the stitches have been removed and the incision has healed include bicycle and swimming therapy. Although it takes the ankle about a year to heal completely the patient should be able to return to their normal lifestyle within six months.  

 Risks Before, During & After Surgery

• Poor circulation in the leg
• Patients with diabetes
• Patients with nerve conditions of the leg
• Poor bone quality of the ankle possibly causing bone breaking during surgery
• Allergic reactions to medicines
• Breathing problems
• Blood clot infection
• Loosening of the artificial joint over time
• Ankle weakness, stiffness, instability dislocation of the synthetic ankle 
• Incision/ankle infection if severe may need the ankle amputated
• Joint allergic reaction to the synthetic joint

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 Which one is right for you?

The weighing in factors are your pre-surgery health, your lifestyle and your expectations after surgery. Ankle replacement does provide more normal movement, but the life span of the joint is only between 8-12 years and then the joint will need to be replaced again or fused depending on the damage done. Ankle fusion is permanent and does limit the range of motion. However it does add stress to other ankle/foot joints which in return may also need to be fused. The choice of total ankle replacement or ankle fusion or no surgery is a serious and complicated one. Be sure to discuss with your rheumatologist and orthopedic surgeon any concerns or questions you have.