Cuff tear arthropathy - CTA - prosthesis for shoulder arthritis: Surgery with a cementless CTA prosthesis can lessen pain and improve function in shoulders with the combination of arthritis and rotator cuff tears.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Monday, October 09, 2006
Recovering from surgeryPain and pain management Recovery of comfort and function after humeral prosthetic
arthroplasty with a cuff tear arthropathy head is progressive after the
surgery. Often the benefits become apparent to the individual after two
to six weeks.
This partial joint replacement procedure is a major surgical
procedure that involves cutting of skin, tendon and bone and removal of
scar tissue, as well as resuturing of tendon back to 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 and by mouth as needed. Within a
day or so, oral pain medications (such as hydrocodone or Tylenol with
codeine) are usually sufficient. On the other hand, some individuals
need surprisingly little pain medication after this procedure. In older
individuals it is often safer to use relatively less pain medication. Use of medications Initially after surgery pain medication can administered by mouth, in
the vein (intravenously), or in the muscle (intramuscularly). Sometimes
patient controlled analgesia (PCA) is used to allow the individual 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. Some individuals need surprisingly little pain medication
after this procedure. In older individuals it is often safer to use
relatively less pain medication.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 (such as slowed breathing, sleepiness, nausea,
constipation, or difficulty urinating). 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. Individuals who have taken substantial narcotic
medications in the recent past may find that usual doses of pain
medication are less effective. For some individuals, balancing the
benefit and the side effects of pain medication is challenging.
Individuals should notify their surgeon if they have had previous
difficulties with pain medication or pain control.
Hospital stay After surgery the individual spends an hour or so in the recovery
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.
Individuals are discharged as soon as the incision is dry, the
shoulder is comfortable with oral pain medications, the individual can
perform the range of motion exercises, and the home support systems for
the individual are in place. Discharge is usually on the third or
fourth day after surgery.
Recovery and rehabilitation in the hospital Early motion after shoulder replacement is helps achieve the best
possible shoulder function. Arthritic shoulders are stiff. One of the
major goals of shoulder replacement surgery is to relieve much of this
stiffness. However, after surgery scar tissue will tend to recur and
limit movement unless motion is started promptly. This early motion is
facilitated by the complete surgical release of the tight tissues so
that after surgery the individual has only to maintain the range of
motion achieved at the operation.
A continuous passive motion (CPM) machine is often used to gently
move the shoulder in the recovery room immediately after surgery. A
continuous passive motion (CPM) machine is used for the first few days
after surgery whenever the individual is in bed. [Figure 36].
During the hospitalization, the individual learns a simple
rehabilitation program that will be used for maintaining the range of
motion at home after discharge. [Figure 37] On the day of surgery or on
the day after, the physical therapist teaches the individual gentle
range of motion exercises to prevent 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 individual 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 tendon not
be challenged until it has had a chance to heal. Usually the individual
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 Individuals usually require some assistance with self-care,
activities of daily living, shopping and driving for at least six weeks
after surgery. They usually go directly 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 arthroplasty
continues for many months after the procedure. Improvement in some
activities may be evident as early as six weeks. With persistent
effort, individuals can make progress for as long as a year after
surgery. Surgery for Rotator cuff tear arthropathy (arthritis with a massive rotator cuff tear) 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-BONE (2663) to make an appointment.
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