Shoulder cemented hemiarthroplasty is most commonly referred to as a shoulder replacement. Several different varieties and options are available to your surgeon depending upon your impairments and medical history. Therapy is a vital component of your recovery and one of the largest factors affecting the quality of your recovery and the life of your new joint. Discussing your progress thoroughly with your orthopedic surgeon and your physical and occupational therapist is essential when deciding how much therapy you need.
The Surgery
Candidates for surgery include those with arthritis, rotator cuff tear and trauma such as severe shoulder dislocation. Your surgeon will remove part or all of the top of the humerus bone, which is in your upper arm, and replace it with a prosthetic shoulder joint, cementing the prosthesis to your remaining humerus. Next, your muscles, tendons and ligaments will be reattached to the prosthesis. The time you will spend in the hospital varies but is often from three to seven days. During this time, your arm will remain in a sling.
Benefits of Rehabiliation
Therapy after your surgery can be provided in several settings. Some hospitals offer special wings for orthopedic therapy for two to four weeks. Many surgeons recommend inpatient therapy at a skilled nursing facility or rehabilitation center. No matter where you receive your initial phase of therapy, you will also need outpatient therapy upon your discharge. Outpatient therapy is not generally recommended in the initial phase as the treatment frequency decreases from five to seven days per week, often twice per day, down to two or three sessions total per week. Compliance with your therapist's home exercise program is important when receiving outpatient therapy as you will have less therapy time. Without therapy, you will recover much slower and you will regain little range of motion. Over time you may even destroy the joint further. However, with proper therapy and exercise, you will likely regain a functional range of motion, which facilitates your independence with self-care and home management, even if your range of motion is not completely restored.
What to Expect in Therapy and During Your Recovery
Your arm will be placed in a sling for four to six weeks to provide rest to the surrounding tissues. With your therapist's assistance, you'll perform pendulum, or arm dangling, exercises and must limit your lifting to a maximum of 8 lbs. for eight weeks. Additionally, your range of motion is limited by your surgeon for four to eight weeks, depending upon your healing. Your hand is also exercised and strengthened in this phase. In the second month, your therapist gradually increases your assisted range of motion and begins strengthening your upper arm muscles, the biceps and triceps. Often, your sling will only need to be worn while you sleep.
From the third month, your therapy consists of strengthening the entire arm and restoring full range of motion to the shoulder as you are able. Your exact course of therapy will be determined by your surgeon and therapist who consider the rate of healing of your replacement and any post-surgical complications. For the long term, there are usually only a few activities you will have to avoid, including a fast, jerking movement like starting a lawn mower, or repetative loading actions such as chopping wood.
Outcomes
Your success following surgery is contingent upon many factors, including your overall health, the blood supply you have to the shoulder to aid in healing and your compliance with therapy and your doctor's orders. Additionally, there is a risk of infection or your immune system rejecting the prosthetic device, both of which are rare but can result in additional surgeries and long-term complications. On average, your shoulder replacement has an 80 percent chance of being functional 10 years after surgery. Final range of motion ranges greatly from patient to patient but can be restored to normal limits. The best outcomes are seen by those with osteoarthritis or rheumatoid arthritis, and the least satisfactory outcomes reported for those with a traumatic injury to the shoulder precipitating the surgery.
Reverse Shoulder Arthroplasty
A reverse shoulder arthroplasty is a surgical option used for complex cases or as a revision on a previous failed shoulder replacement, when other traditional methods are ineffectual. In this procedure, your surgeon will actually reverse the architecture of your shoulder joint, placing the ball of the joint at the end of your scapula and the socket of your joint in your upper arm bone, the humerus. By using alternative muscle fibers which attach to the prosthetic joint, your surgeon can maximize your results, with 90 to 100 degrees flexion range of motion reported on average. Additionally, in the absence of complications such as infection, your overall recovery and therapy time is reduced, usually approximately 4 weeks of inpatient and 2 to 4 weeks of outpatient therapy if necessary.
