Joint Replacement Arthroplasty: Basic Science, Elbow, and Shoulder, Fourth Edition

Lawrence V. Gulotta, MD

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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 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 may be 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. 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.

Joint Replacement Arthroplasty: Volume 2

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. 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. 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 care for the shoulder and the home support systems for the individual are in place. Discharge is usually on the third or fourth day after surgery.

Patient Stories

Early, protected, and restricted motion after shoulder replacement with a reversed reverse Delta prosthesis helps achieve the best possible shoulder function. The surgeon will provide detailed information on the optimal program after the particular surgical procedure. During the hospitalization the individual learns a simple rehabilitation program that will be used at home after discharge.

The arm is kept in a sling for several weeks after surgery to allow for early healing. 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 reconstructed shoulder 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. 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.

Limited use after total shoulder replacement with a reversed prosthesis is critical for protection during the early phases of healing. In most cases we keep the arm in a sling for six weeks after the procedure to allow for healing of the soft tissues. Most individuals find the recovery of comfort and function can be accomplished without formal physical therapy. It is often most effective for the individual to carry out her or his own rehabilitation at home.

Total Shoulder Arthroplasty

Often no physical therapy is recommended. In general the rehabilitation is best performed by the individual at home. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program. Individuals are almost always satisfied with the increases in comfort and function that are achieved with the rehabilitation program.

If the exercises are uncomfortable difficult or painful the individual should contact the surgeon promptly. Once the rehabilitation goals are achieved the exercise program can be cut back to a minimal level.

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In general individuals are able to perform gentle activities of daily living with the operated arm at the side starting four weeks after surgery. Walking with the arm protected is strongly encouraged. Driving should wait until the individual can perform the necessary functions comfortably and confidently. This may take up to six weeks if the surgery has been performed on the right shoulder because of the increased demands on the right shoulder for shifting gears. With the consent of their surgeon individuals may be able to return to certain activities at six months after surgery.

Joint Replacement Arthroplasty: Basic Science, Elbow, and Shoulder - Google книги

It is important to remember that shoulder arthroplasty with a reversed prosthesis does not restore the function of the degenerated rotator cuff tendons so that the shoulder will never totally regain full comfort strength range of motion or function. Stressful activities and activities with the arm in extreme positions may never be possible after this procedure. Individuals should avoid activities that involve major impact chopping wood contact sports activities with major risk of falls or heavy loads lifting of heavy weights heavy resistance exercises after this surgery.

In this way the risk of re-injury is minimized.

Reverse Shoulder Replacement for arthritis and massive rotator cuff tears

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Tribology In Total Hip Arthroplasty. Report item - opens in a new window or tab. Seller assumes all responsibility for this listing. Item specifics Condition: Brand New: A new, unread, unused book in perfect condition with no missing or damaged pages. See all condition definitions - opens in a new window or tab Read more about the condition.

About this product. This definitive text is written by world-renowned experts from the Mayo Clinic and other leading institutions and includes data from the Mayo Clinic's extensive patient records from through This second volume covers the hip, knee, and ankle and includes online access to 30 chapters on the basic science that supports joint replacement.

Sections on each joint cover anatomy and surgical approaches, navigation, biomechanics, prosthesis design, primary arthroplasty, complications, revision arthroplasty, and alternative procedures. This edition includes more practical advice on diagnosing and managing the underlying problems and more step-by-step operative guidelines. The companion website allows you to search across both Volume 1, covering the elbow and shoulder, and Volume 2. The online-only basic science chapters provide thorough coverage of materials used for joint replacements and management of patients with various medical conditions.

Shipping and handling. The seller has not specified a shipping method to Germany. Contact the seller - opens in a new window or tab and request shipping to your location. Shipping cost cannot be calculated. Please enter a valid ZIP Code. Chapter 10F Fibromyalgia Hemiarthroplasty of the Elbow Arthroscopic Osteocapsular.

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