Indications-

When the quality of your life has gone down too low and you are not able to do routine activities of daily living due to arthritis and a fair trial of conservative management with medications and physiotherapy has failed, then total shoulder replacement surgery is to be considered.

• Contra-indications (this surgery is not to be considered):
• Arthritis due to rotator cuff deficiency
• Morbid Obesity
• Parkinson’s disease
• Diabetes
• Depression
• Multiple previous shoulder surgeries

Humeral component fixation to the bone-

The metal ball has a stem in an ice cream cone fashion that is inserted into the humerus bone in a press-fit fashion after the removal of the worn and torn head of the humerus bone. Fixation of metal stems to the bone can be done either by using cement or hydroxyapatite (HA)-coated metal stems (HA promotes bone ingrowth and helps in the natural biologic fixation of metal implants to bone). Nowadays, we prefer using the latter one as it is more biologic and we get a robust fixation.

Glenoid Component Fixation to Bone-

After the worn and torn portion of the Glenoid (socket bone) has been scraped out, ultra-high-molecular-weight polyethene, which is backed by a Co-Cr metal socket, is fixed to the bone in a press-fit manner. The metal socket also has pegs (hooks), which help with additional stabilisation.

Post Surgery-

Patients are started on physical therapy involving passive stretches and active-assisted exercises from the next day of surgery. Patients are encouraged to be up and out of bed on the next day of surgery. Discharge is planned after 2-4 days of surgery. Routine activities of daily living can be resumed soon after patients go home with minimum assistance in the initial 2-3 weeks, followed by no assistance. Patients are not supposed to lift more than 5 kg; push and pull activities are to be avoided for the initial 6 weeks of surgery. Driving can be resumed after 4-6 weeks of surgery.  High-demand activities like swimming and golf can be resumed 4-6 months after surgery.

Rehabilitation –

Arthritic shoulder joints are usually very stiff. Removal of scar tissues and releasing adhesions help in achieving the lost range of motion at the time of surgery. Hence, the rehab programme in the initial 4-6 weeks is all about the maintenance of this recovered mobility through passive stretches. Strengthening exercises are not done in this initial phase, as tendon repairs done to the metal prosthesis will be hampered. Once the shoulder is supple and active, strengthening exercises and additional activities are started.