Ream and Run non-prosthetic glenoid arthroplasty for shoulder arthritis: Regenerative cementless surgery designed for individuals desiring higher levels of activity than recommended for traditional total joint replacement.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Monday, June 23, 2008
Figure 14 - Continuous passive motion machine Recovering from surgeryPain and pain management After the non-prosthetic glenoid arthroplasty, the reamed glenoid
surface must heal. This process may require up to a year to complete.
Thus, recovery of comfort and function after shoulder hemiarthroplasty
with non-prosthetic glenoid arthroplasty continues for the first year
after surgery. The rehabilitation is carried out largely by the patient
under the supervision of the surgeon.
Shoulder replacement of this type is a major surgical procedure that
involves cutting of skin, tendons and bone. The pain from this surgery
is managed by the anesthetic and by pain medications. Immediately after
surgery, strong medications (such as morphine or Demerol) are often
given by injection. Within a day or so, oral pain medications (such as
hydrocodone or Tylenol with codeine) are usually sufficient.
Because a plastic socket is not inserted when a non-prosthetic
glenoid arthroplasty is performed, there may be some initial added
discomfort from the metal ball articulating with the bone. When the
glenoid is reamed, small fractures in the surface bone are
intentionally created. These tiny surface fractures initiate a healing
response that improves the smoothness of the socket and may help
distribute force from the arm to the body. This healing process may
make the first 6 weeks more uncomfortable than a total shoulder
replacement surgery. This discomfort should be only temporary and, as
the healing process completes, comfort levels are expected to approach
that of total shoulder arthroplasty.
Use of medications Initially pain medication is usually administered intravenously or
intramuscularly. Sometimes patient controlled analgesia (PCA) is used
to allow the patient to administer the medication as it is needed.
Hydrocodone or Tylenol with codeine are taken by mouth. Intravenous
pain medications are usually needed only for the first day or two after
the procedure. Oral pain medications are usually needed only for the
first two weeks after the procedure.Effectiveness of medications Pain medications can be very powerful and effective. Their proper use
lies in the balancing of their pain relieving effect and their other,
less desirable effects. Good pain control is an important part of the
postoperative management.Important side effects Pain medications can cause drowsiness, slowness of breathing,
difficulties in emptying the bladder and bowel, nausea, vomiting and
allergic reactions. Patients who have taken substantial narcotic
medications in the recent past may find that usual doses of pain
medication are less effective. For some patients, balancing the benefit
and the side effects of pain medication is challenging. Patients should
notify their surgeon if they have had previous difficulties with pain
medication or pain control.Hospital stay After surgery the patient spends an hour or so in the recovery room and
is then transferred to a private room. A drainage tube is usually used
to remove excess fluid from the surgical area. The drain is usually
removed on the second day after surgery. Bandages cover the incision.
They are usually changed the second day after surgery.
Patients are discharged as soon as the incision is dry, the shoulder is
comfortable with oral pain medications, the patient can perform the
range of motion exercises, and the home support systems for the patient
are in place. Discharge is usually on the third or fourth day after
surgery.Recovery and rehabilitation in the hospital Early motion after shoulder hemiarthroplasty with non-prosthetic
glenoid arthroplasty helps achieve the best possible shoulder function.
Arthritic shoulders are stiff. Early motion is facilitated by the
complete surgical release of the tight tissues so that after surgery
the patient has only to maintain the range of motion achieved at the
operation. However, after surgery, scar tissue will tend to recur and
limit movement unless motion is started immediately. Early motion also
facilitates healing of the glenoid bone and ensures that a smooth bony
surface will form to articulate with the metal ball.
A continuous passive motion (CPM) machine is often used to gently
move the shoulder in the recovery room immediately after surgery. The
CPM machine, shown in figure 14, is used for the first few days after
surgery whenever the patient is in bed.
During the hospitalization, the patient learns a simple
rehabilitation program that will be used for maintaining the range of
motion at home after discharge. Figures 15 and 16 show the exercises
used to maintain elevation and rotation of the arm. On the day of
surgery or on the day after, the physical therapist teaches the patient
gentle range of motion exercises. The patient is usually shown how to
stretch the shoulder forward and out to the side, preventing stiffness
and adhesions.
Walking and use of the arm for gentle activities are encouraged soon after surgery. Hospital discharge At the time of discharge, the patient should be relatively
comfortable on oral medications, should have a dry incision, should
understand their exercises and should feel comfortable with the plans
for managing the shoulder. For the first month or so after this
procedure, the operated arm may be less useful than it was immediately
beforehand.
The specific limitations can be specified only by the surgeon who
performed the procedure. It is important that the repaired tendons not
be challenged until they have had a chance to heal. Usually the patient
is asked to lift nothing heavier than a cup of coffee for six weeks
after the surgery.
Management of these limitations requires advance planning to
accomplish the activities of daily living during the period of recovery.
Convalescent assistance Patients usually require some assistance with self-care, activities
of daily living, shopping and driving for approximately six weeks after
surgery. Patients usually go home after this surgery, especially if
there are people at home who can provide the necessary assistance, or
if such assistance can be arranged through an agency. In the absence of
home support, a convalescent facility may provide a safe environment
for recovery.
Recovery of comfort and function after shoulder hemiarthroplasty
with non-prosthetic glenoid arthroplasty continues for many months
after the surgery. Improvement in some activities may be evident as
early as six weeks. With persistent effort, patients make progress for
as long as a year after surgery. Surgery for Arthritis of the Shoulder at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-7416 to make an appointment.
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