The shoulder joint is a ball (Humeral Head) and socket (Glenoid) joint. A TSR replaces the ball and socket with an artificial joint. This is called a prosthesis and there are several different types. Your consultant will select the best type for you depending on the quality and quantity of bone as well as the strength of the muscles around your shoulder joint. In certain cases a bespoke prosthesis may need to be designed and made for you.
This type of prosthesis is designed from a CT scan of your shoulder joint. This is called a CADCAM.
You will be transferred to the recovery room where you will be closely monitored as the effects of the general anaesthetic wears off. Your arm will be supported in a sling. Initially you may feel some pain or discomfort, which will be helped by medication. If you have had a nerve block, your arm and hand can feel numb and heavy, this will usually resolve itself within 24 hours. The shoulder may initially be bruised, tender and swollen and have a dressing over the wound. This will be a water-resistant dressing. However, please check with your nurses before showering.
You may also have the following:
- Small drainage tubes coming from your wound • Patient Controlled Analgesia (PCA) Device
- Oxygen mask
- A drip to replace lost fluids
These will be removed as soon as possible following the surgery.
Once the anaesthetic has worn off you will be encouraged to mobilise, with help if needed, as soon as you are able. This will prevent the risk of some post operative complications.
The following symptoms could be a sign a pressure ulcer is developing. Discoloured skin, pinkish red and/or purple bluish in colour*, which does not go pale when pressed (reddening of the skin that disappears when pressure is removed is normal and not a pressure ulcer).
- Infection All possible precautions are taken to avoid infection during your operation. Your skin is thoroughly cleaned with a disinfectant solution and all clinical staff wear masks, sterile gowns and gloves throughout the procedure. If a superficial skin infection develops post-operatively it is usually treated with oral antibiotics.
- Nerve/blood vessel damage around the shoulder The risk of this is less than 1%. If it happens we will investigate it carefully and take appropriate action to restore function.
- Dislocation Initially a TSR is not as stable as a normal shoulder joint so there is a small chance of dislocation. This means that the ball comes out of the socket and will require a doctor to correct it or further surgery to relocate it back to its correct position. To prevent this from occurring there will be post-operative movement restrictions. You will also be given a sling to wear, and instructions on how to use it, put it on and take off. Please be careful to follow these instructions.
- Stiffness This happens to nearly all TSRs early on and is treated through the physiotherapy exercise programme.
- Fracture (a break) of surrounding bone If this happens we may fix the fracture straight away, manage it non-operatively in a brace or alternatively with another operation at a later date.
- Loosening of Prosthesis Over a period of time the TSR may become loose and further surgery may be required to correct this. It may be due to infection, but more often it is simply due to using our shoulders in the course of normal daily life.
- Deep Vein Thrombosis (DVT) A DVT is a blood clot in the deep veins of the calf or thigh. To reduce the risk of developing a DVT and to help with your circulation you will be given stockings and will be fitted with special inflatable pads to wear around your legs whilst in bed. These inflate automatically and provide pressure at regular intervals, thereby increasing blood circulation in your legs. You may require blood thinning medication which will be decided by your surgeon depending on your individual risk factors. The physiotherapist and nursing staff will show you how to exercise your legs and ensure that you start to move about quickly after your operation. If a clot develops and part of it breaks away, it can travel to the lungs where it is called a Pulmonary Embolus (PE). A PE is potentially life threatening and so everything is done to prevent a DVT from developing. We ask you to help avoid this complication by wearing your stockings at all times while you are in hospital except when you are bathing.
- Sickness/nausea, heart problems, breathing problems and nervous system problems relating to the anaesthetic.
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