Outpatient Total Shoulder Arthroplasty: What you need to know
What is shoulder arthroplasty?
Shoulder arthritis is a disease where the cartilage that covers the shoulder bones degenerates over time. When this protective cartilage starts to wear down, your shoulder bones are in direct contact with each other and cause damage due to the increased friction produced. This results in severe pain and stiffness that make moving the shoulder incredibly difficult.
Shoulder arthroplasty, or shoulder joint replacement, is a procedure commonly used to treat end-stage arthritis in the shoulder. The surgery involves removing portions of your shoulder joint which are then replaced with artificial implants to reduce pain and restore range of motion in your shoulder. It has been a successful procedure used to treat the severe pain and dysfunction caused by arthritis.
How do I know if I have end-stage arthritis?
Arthritis is characterized by progressive pain and stiffness in your shoulder. Generally, this occurs in patients who are over age 50, but may occur in younger patients particularly as a result of prior trauma. Patients have pain in their shoulder, often worse at night. In addition, they experience loss of motion, grinding and pain.
To confirm the diagnose shoulder arthritis, x-rays of the shoulder will be obtained. They will be taken at different angles and positions to allow him to obtain the best view of your shoulder joint. He may also have you get a CT scan to evaluate the quality of the bone and allow for better visualization of the shoulder joint.
When should I consider undergoing shoulder arthroplasty?
You should consider shoulder arthroplasty if the commonly used conservative treatments (i.e. rest, non-steroid anti-inflammatory medications, physical therapy, cortisone injections into the joint) are no longer effective in managing your shoulder pain. Additionally, if end-stage arthritis has been diagnosed through imaging studies. In general shoulder replacement is needed when pain impacts your activities of daily living, desired level of function, or work or recreational activities. I often ask patients; can you live with it the way that it is? If the answer is no, it may be time to consider surgery.
What are the risks and complications of shoulder arthroplasty?
The risks and complications are rare in shoulder arthroplasty but can include infection, nerve damage, stiffness, and instability (the shoulder head slipping out of its socket). Extreme caution and care are taken during surgery to prevent these complications from occurring. In addition, complications such as stiffness can be easily avoided if you work consistently with physical therapy after surgery. To date, I have performed nearly 1000 shoulder replacements and it is one of the most successful surgical procedures in my practice!
How long will it take to recover from a shoulder replacement surgery?
After your surgery a directed physical therapy plan will be established, and for most patients, you can expect to be pain-free and have motion and strength near normal level by around 6 months. This can vary from patient to patient. By one year, almost all patients will be completely pain free. A sling is required for the first six weeks after the procedure, but most patients can begin some daily activities with two to three days after surgery.
What are the benefits of outpatient shoulder arthroplasty versus being admitted into the hospital?
One of the worst parts of having surgery is having to stay overnight in the hospital. It can be uncomfortable for patients, inconvenient for family members, and in may increase risk of surgery such as hospital acquired infections. In the past five years, we have developed a surgical protocol to allow us to perform this complex procedure in the outpatient setting!
The surgery takes about 90minutes, and most patients are headed home about two hours after surgery is finished.
I have found the benefits of outpatient surgery to be multiple. First and foremost, I have found it to be safe and effective, with lower risk of complications. In addition, patients are so happy to be able to recover in the comfort of their own home! The main priorities in our protocol are:
- identifying any medical conditions in a patient’s history that may make it safer for them to have surgery in the hospital
- day of surgery pain protocols that make sure patients are comfortable when they go home and in the days following surgery
- patient education protocols that provide the information needed for patients to recover at home both before surgery, on the day of surgery and after.
- Physical therapy protocols that maximize functional recovery.
In addition, these procedures are performed in orthopedic specialty centers which means the anesthesiologist, nursing staff and recovery room staff are all focused on providing orthopedic care with years of experience. The result for the patient is a smooth surgical experience and lower risk of complications. Finally, because the procedure can be performed in an outpatient environment the cost of the procedure is decreased which means lower out of pocket costs for patients.
What is the current data to support outpatient shoulder arthroplasty?
Along with my team at rush, we have performed a second study looking specifically at outcomes of outpatient total shoulder replacement and compared those outcomes to those after inpatient total shoulder replacement. We found that patients who underwent outpatient shoulder replacement had a lower rate of complications after surgery compared to inpatients. Most importantly, patients reported very high levels of satisfaction with the surgical experience and their outcome after surgery. If you wish to consider outpatient shoulder replacement surgery further and see if you are an eligible candidate for outpatient surgery, I would encourage you to make a clinic appointment with him to evaluate your shoulder and determine the best treatment option for you!
More information regarding this research study can be found here: https://www.ncbi.nlm.nih.gov/pubmed/28663400
If you have any other questions about shoulder arthroplasty, or to see if this procedure is right for you and your shoulder pain, please contact the offices of Dr. Nikhil Verma, orthopedic surgery and sports medicine specialist serving patients in Chicago, Westchester, Oakbrook and Hinsdale, IL. Additionally, please visit Dr. Verma’s website: sportssurgerychicago.com and follow him on Instagram @nikhilvermamd for more information regarding other biologics and orthopedic care!