Shoulder Replacement in Singapore

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Shoulder Replacement?

Shoulder replacement is a surgical procedure designed to alleviate pain and restore function in the shoulder. This involves replacing damaged parts with artificial components. These replacements usually involve either the ball of the humerus or both the ball and socket of the shoulder joint.

This procedure is generally considered effective and is intended to help individuals return to their normal activities.

Reasons for Shoulder Replacement

Shoulder replacement surgery is typically recommended for patients experiencing a range of symptoms and conditions. There are no absolute age restrictions for this procedure, though it is most commonly performed on individuals aged between 60 to 80 years. Each patient’s suitability for shoulder replacement is evaluated carefully, considering various health aspects.

  • Severe Shoulder Pain
    Severe pain may limit everyday activities, such as movement and lifting. This may warrant shoulder replacement to restore function.
  • Persistent Resting Pain
    Moderate to severe pain that continues even during rest periods may indicate advanced joint issues. This may require shoulder replacement if other treatment methods fail to provide relief.
  • Loss of Motion or Weakness
    A decrease in shoulder mobility or strength can severely affect function and performance of daily tasks. This may be a sign that a replacement surgery is necessary.

Assessing Suitability for Shoulder Replacement

The suitability for shoulder replacement surgery can be assessed through a series of diagnostic procedures.

  • Medical History: The shoulder specialist evaluates the patient’s general health history, the extent of shoulder pain, and their functional capabilities​​.
  • Physical Examination: A physical assessment is conducted, to evaluate shoulder motion, stability and strength.
  • Diagnostic Imaging: X-rays are utilised to assess the extent of damage within the shoulder. They help identify loss of joint space, bone irregularities, bone spurs, and any loose pieces of cartilage or bone within the joint​​. An MRI scan may also be used to assess the condition of the bone and soft tissues in the shoulder​​.

Planning for Shoulder Replacement

Before undergoing shoulder replacement, several preparatory steps are taken to prepare the patient for surgery.

Medical Evaluations

The patient’s general medical condition will be assessed, through blood tests, chest X-rays, or an electrocardiogram​​.

Following Pre-Surgical Instructions

Specific instructions will be provided by the shoulder specialist. These may include cessation of certain medications like blood thinners, and managing general medical conditions before surgery​​.

Making Temporary Support Arrangements

Patients should arrange in advance for help in daily activities such as bathing and cooking, as these may be challenging post-surgery​​.

Anaesthesia Plan

Before the surgery, the shoulder specialist will discuss the anaesthesia type most appropriate for your specific condition. Commonly, general anaesthesia is used during shoulder replacement surgeries, which may be supplemented with nerve blocks or local anaesthetic injections to reduce pain​​.

Surgical Procedure

The surgical procedure for shoulder replacement involves several steps:


Selecting the Implants

The type of implant chosen directly influences the surgery’s success and the patient’s subsequent quality of life. The selection depends on the patient’s specific condition.

  • Total Shoulder Replacement: This involves replacing the arthritic joint surfaces with a polished metal ball attached to a stem and a plastic socket. It is suitable for patients with joint surface damage​​.
  • Reverse Total Shoulder Replacement: Here, the positions of the socket and metal ball are reversed. This is beneficial in cases of shoulder arthritis with irreparable rotator cuff tears, as it allows the deltoid muscle to lift the arm​​.
  • Stemmed Hemiarthroplasty: This option replaces the head of the humerus with a metal ball and stem, retaining the native glenoid. It’s often used for severe humeral fractures when the socket is healthy​.
  • Resurfacing Hemiarthroplasty: This technique replaces the joint surface of the humeral head with a cap-like prosthesis without a stem, preserving more of the patient’s bone​​.
Procedure

The procedure involves the following steps:

  1. Incision and Access: The shoulder specialist begins by making an incision over the shoulder to access the joint.
  2. Removal of Damaged Components: Special instruments are used to remove the damaged bone and cartilage from the shoulder joint.
  3. Implant Placement: The chosen implant components are then inserted. This can involve ‘pressing’ them into the bone, allowing for natural bone growth into the components, or cementing them into place, depending on the quality and strength of the patient’s bone​​.

The surgery typically takes around two hours in total​​.

Benefits of Shoulder Replacement

The goal of shoulder replacement is to offer patients a return to a more active and less painful life, enabling them to engage in everyday activities that were previously hindered by shoulder issues. Benefits can include:

Pain Relief

The surgery can potentially relieve shoulder pain, thereby improving the patient’s comfort and quality of life.

Improved Mobility

Patients often experience a restoration of shoulder movement, allowing them to perform daily activities with greater ease.

Increased Shoulder Strength

Post-surgery, many individuals regain strength in their shoulders, enhancing their overall physical capability.

Long-Term Functionality

Advances in surgical techniques and implant designs have contributed to the increased longevity and durability of shoulder replacements.

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Possible Complications of Shoulder Replacement

While complications are rare, there are several potential risks as with any surgical procedure.

  • Infection: A rare but possible complication, typically preventable with the use of antibiotics.
  • Fractures: There is a risk of fractures during the surgery.
  • Nerve and Vessel Injury: Although uncommon, nerve and blood vessel injuries can occur during the procedure.
  • Implant Problems: Issues with the implant, such as loosening or wear, might arise, particularly with excessive use of the arm over time.

Recovery and Outlook

Following the surgery, the recovery process usually includes:

  • Pain Management
    Initially, patients may experience some pain, which is a normal part of the healing process. Medications for short-term pain relief, such as paracetamol, non-steroidal anti-inflammatory drugs, and opioids, are prescribed​​.
  • Using a Sling to Protect the Shoulder
    Post-surgery, the arm is placed in a sling to support and protect the shoulder.
  • Physical Therapy
    Gentle physical therapy commences after the surgery to strengthen the shoulder and improve flexibility.
  • Wound Care
    Keeping the wound clean and dry can help reduce the risk of infection.
  • Activity Precautions
    A shoulder specialist may suggest avoiding lifting heavy objects for the first six weeks. Personalised home exercises should also be conducted for at least three months. Contact sports and repetitive heavy lifting should be avoided to prolong the lifespan of the replacement​​.
  • Maintaining a Balanced Diet
    A balanced diet can help promote tissue healing and muscle strength restoration.

The outlook for patients after shoulder replacement surgery is generally positive. Most individuals achieve pain relief and improved mobility, which translates into a better quality of life. While these replacements may lead to minor aches with weather changes or excessive activity, the long-term success rates are high.

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    Is Shoulder Replacement Surgery Painful?

    While some discomfort may be experienced during the recovery period, measures can be taken to manage pain effectively. Patients are provided with pain relief medications and guided on how to use them responsibly. Consult with your shoulder specialist for a comfortable recovery.

    What Happens If I Delay Shoulder Replacement?

    Delaying shoulder replacement surgery can lead to increased pain and further joint deterioration, potentially complicating future treatment. Early consultation with a shoulder specialist can help in determining the right timing for surgery to prevent the progression of the condition and preserve more of the joint.

    How Should I Sleep After Shoulder Replacement Surgery?

    After shoulder replacement surgery, try to sleep in a semi-reclined position, either in a recliner or with pillows propping you up in bed. This position helps reduce swelling and discomfort.

    What Exercises Should I Avoid After Shoulder Replacement?

    Avoid high-impact activities or exercises that put excessive strain on the shoulder, such as heavy lifting, contact sports, or repetitive overhead activities. Your shoulder specialist will provide a tailored exercise plan to ensure safe and effective rehabilitation.