You can replace aching joints. You can’t replace precious moments. Deciding to have a shoulder replacement is a big decision, but in this podcast, Dr. Scott Wisotsky will guide you through the process and share what to expect following a shoulder replacement.
Learn more about BayCare’s joint replacement surgery programs
What to Expect After a Shoulder Replacement
Featured Speaker:
Learn more about Scott Wisotsky, MD
Scott Wisotsky, MD
Scott Wisotsky, MD has his certification in hand and upper extremity surgery. He earned his Doctor of Medicine from The George Washington University in Washington, DC. He completed an orthopedic surgery residency at the University of Vermont, Fletcher Allen Health Care in Burlington, VT and a hand and upper extremity surgery fellowship at Allegheny General Hospital in Pittsburgh, PA. Dr. Wisotsky specializes in complex hand and upper extremity conditions, sports related upper extremity conditions, rotator cuff injuries and arthroscopic repair, primary and revision shoulder replacements, reverse total shoulder replacements and treatment of arthritis, carpal tunnel, trigger finger and Dupuytren’s disease.Learn more about Scott Wisotsky, MD
Transcription:
What to Expect After a Shoulder Replacement
This is BayCare HealthChat, another podcast from BayCare Health System.
Deborah Howell: Welcome to BayCare HealthChat. I'm Deborah Howell, and I invite you to listen today as we discuss whether it's time to start thinking about shoulder replacement surgery, I'm joined today by Dr. Scott Wisotsky, an orthopedic surgeon with BayCare Health System, Dr. Wisotsky, it's a true pleasure to have you on with us today. Let's jump right in. Who needs a total shoulder replacement?
Dr. Scott Wisotsky: Well, Deborah, it's great to be here. You know, who needs a total shoulder replacement is a great question. I have a lot of patients that come into my office and say, "Hey, am I ready for a total shoulder replacement?" There's really two main reasons why people need a shoulder replacement. One is if they've got really painful shoulder secondary to arthritis. And the second one is if they have a really massive irreparable tear in the rotator cuff.
Deborah Howell: Got it. Now, are there different types of shoulder replacements??
Dr. Scott Wisotsky: There are. There's actually two different types of shoulder replacements. So whether a patient needs each type really depends on what their symptomatology is and what the underlying problem is. So your shoulder is made up of a ball and a socket, and the socket part is very shallow. So there's an anatomic replacement, which replaces the ball with a ball and the socket with a socket. And then there's what's called a reverse total shoulder replacement, which basically reverses or flip-flops the ball and socket joint. And you have a socket where the ball is and a ball where the socket is.
Now, in an anatomic replacement, it's most beneficial if patients have an intact rotator cuff. So what holds the shoulder in place in a normal shoulder is the rotator cuff and capsule. So if you have bad arthritis, but a very good and intact rotator cuff, then an anatomic replacement is the right operation for you. In terms of a reverse replacement, patients benefit most from those if they've got a very bad rotator cuff with arthritis or an irreparable rotator cuff with a very non-functioning shoulder.
Deborah Howell: That is beautifully put and I can just see it in my mind. Thank you for that. What's the surgery like?
Dr. Scott Wisotsky: The surgery itself over the years has gotten better and better as the technology techniques have improved over the years. So the surgery for the most part is usually done in a hospital setting. It can be done either as an inpatient or even nowadays we're doing a lot of these surgeries as outpatient. The surgery itself involves an incision in the front of the shoulder and then replacing the damaged parts and then rehabbing the shoulder.
Deborah Howell: Meaning PT and all kinds of exercises, stretches.
Dr. Scott Wisotsky: Yeah. Yes, it does. So in terms of rehabbing the shoulder, some studies have actually shown that initially patients do very well rehabbing the shoulder on their own, and then attending formal physical therapy as time goes on, depending how the initial results are done. In terms of the hospitalization, most patients just spend the night in the hospital, but as we discussed before, even outpatient total shoulders are becoming more and more popular.
Deborah Howell: Sure. And I know we touched on this, the recovery, a little bit more about that, please.
Dr. Scott Wisotsky: Sure. In terms of the recovery, on average patients maintain their shoulder in a sling for approximately the first four weeks, mainly just to protect the shoulder itself. Now, we have patients actually doing a lot of their normal activities of daily living very early on. Right away, the patients will get an instructed home exercise program to start using their hands, elbow, fingers, and even gentle exercises with their shoulders coming out of the sling. The sling initially protects the shoulder from the shoulder actually dislocating itself. After about four weeks, the patients can wean out of the sling and then start a more vigorous and aggressive therapy regimen to try to regain as much mobility and strength as possible.
Deborah Howell: Sure. So probably not driving for a month or so.
Dr. Scott Wisotsky: On average, I'd say that, but you'll be surprised, I have a lot of patients that are very comfortable driving with one hand a little bit limited after about two to three weeks or so.
Deborah Howell: Let's talk a little bit about results and expectations. What are some typical results and what are the common expectations?
Dr. Scott Wisotsky: So in both operations, whether it be an anatomic shoulder replacement or a reverse shoulder replacement, the main goal that patients want is pain relief. And both of these operations provide excellent pain relief. In terms of activity and function, if people have a very good rotator cuff, an anatomic replacement does excellent for return to sports, golf, tennis, swimming, those types of activities, and even a reverse shoulder replacement gets patients back on the court and swimming as well with some modifications. In fact, patients can go back to doing their normal activities of daily living very early on.
Deborah Howell: Beautiful. I love it. Will I need another operation after my shoulder replacement though?
Dr. Scott Wisotsky: It's actually very rare or uncommon that patients need to have revision surgery. Now, there are obviously some unforeseen circumstances such as hardware failure, or infection that may necessitate a second operation, but both operations, whether it be an anatomic replacement or a reverse total shoulder replacement, have a very low revision rate overtime.
Deborah Howell: And do you do the surgery anteriorly or posteriorly?
Dr. Scott Wisotsky: Unlike hip replacements, all total shoulder replacements are done from an anterior incision.
Deborah Howell: And what's the reason for that?
Dr. Scott Wisotsky: Anatomically, that's the interval to be able to get into the shoulder muscles.
Deborah Howell: At what point do I think, "Oh boy, I really need to go in and see about my shoulder."
Dr. Scott Wisotsky: I think in terms of patients seeing a physician, they can come as early or as late as they want to. Really symptomatology of a patient denotes when they actually seek medical attention. Some patients that have very mild arthritis and bad rotator cuffs may necessitate surgery, even sooner than patients that have severe arthritis and intact rotator cuffs. It really just depends on the symptomatology. And in fact, there are a lot of other non-operative things that we can do such as injections and therapy that can try to stave off the need for a shoulder replacement.
Deborah Howell: So when you go in, you'll look at the whole shoulder and the whole patient and decide what regimen is best for them.
Dr. Scott Wisotsky: Absolutely. Young active patients may want to wait on shoulder replacement. But if they're really having a hard time doing the things that they love to do, they really may benefit from it earlier than let's say somebody that is not as active.
Deborah Howell: And final question, should we be worried about scar tissue from the surgery?
Dr. Scott Wisotsky: Scar tissue is a factor after any surgery, but doing a home therapy regimen or a physical therapy regimen helps to limit the scar tissue that forms in a shoulder itself. So actually, early range of motion has been shown to improve mobility in these surgeries.
Deborah Howell: Right. Well, Dr. Wisotsky, this has been really enlightening. Thank you so much for all the good information.
Dr. Scott Wisotsky: It's my pleasure, Deborah. It's nice talking to you.
Deborah Howell: And head on over to our website at BayCare.org for more information and to get connected with one of our providers.
And that wraps up this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together. This is Deborah Howell. Have yourself a terrific day.
What to Expect After a Shoulder Replacement
This is BayCare HealthChat, another podcast from BayCare Health System.
Deborah Howell: Welcome to BayCare HealthChat. I'm Deborah Howell, and I invite you to listen today as we discuss whether it's time to start thinking about shoulder replacement surgery, I'm joined today by Dr. Scott Wisotsky, an orthopedic surgeon with BayCare Health System, Dr. Wisotsky, it's a true pleasure to have you on with us today. Let's jump right in. Who needs a total shoulder replacement?
Dr. Scott Wisotsky: Well, Deborah, it's great to be here. You know, who needs a total shoulder replacement is a great question. I have a lot of patients that come into my office and say, "Hey, am I ready for a total shoulder replacement?" There's really two main reasons why people need a shoulder replacement. One is if they've got really painful shoulder secondary to arthritis. And the second one is if they have a really massive irreparable tear in the rotator cuff.
Deborah Howell: Got it. Now, are there different types of shoulder replacements??
Dr. Scott Wisotsky: There are. There's actually two different types of shoulder replacements. So whether a patient needs each type really depends on what their symptomatology is and what the underlying problem is. So your shoulder is made up of a ball and a socket, and the socket part is very shallow. So there's an anatomic replacement, which replaces the ball with a ball and the socket with a socket. And then there's what's called a reverse total shoulder replacement, which basically reverses or flip-flops the ball and socket joint. And you have a socket where the ball is and a ball where the socket is.
Now, in an anatomic replacement, it's most beneficial if patients have an intact rotator cuff. So what holds the shoulder in place in a normal shoulder is the rotator cuff and capsule. So if you have bad arthritis, but a very good and intact rotator cuff, then an anatomic replacement is the right operation for you. In terms of a reverse replacement, patients benefit most from those if they've got a very bad rotator cuff with arthritis or an irreparable rotator cuff with a very non-functioning shoulder.
Deborah Howell: That is beautifully put and I can just see it in my mind. Thank you for that. What's the surgery like?
Dr. Scott Wisotsky: The surgery itself over the years has gotten better and better as the technology techniques have improved over the years. So the surgery for the most part is usually done in a hospital setting. It can be done either as an inpatient or even nowadays we're doing a lot of these surgeries as outpatient. The surgery itself involves an incision in the front of the shoulder and then replacing the damaged parts and then rehabbing the shoulder.
Deborah Howell: Meaning PT and all kinds of exercises, stretches.
Dr. Scott Wisotsky: Yeah. Yes, it does. So in terms of rehabbing the shoulder, some studies have actually shown that initially patients do very well rehabbing the shoulder on their own, and then attending formal physical therapy as time goes on, depending how the initial results are done. In terms of the hospitalization, most patients just spend the night in the hospital, but as we discussed before, even outpatient total shoulders are becoming more and more popular.
Deborah Howell: Sure. And I know we touched on this, the recovery, a little bit more about that, please.
Dr. Scott Wisotsky: Sure. In terms of the recovery, on average patients maintain their shoulder in a sling for approximately the first four weeks, mainly just to protect the shoulder itself. Now, we have patients actually doing a lot of their normal activities of daily living very early on. Right away, the patients will get an instructed home exercise program to start using their hands, elbow, fingers, and even gentle exercises with their shoulders coming out of the sling. The sling initially protects the shoulder from the shoulder actually dislocating itself. After about four weeks, the patients can wean out of the sling and then start a more vigorous and aggressive therapy regimen to try to regain as much mobility and strength as possible.
Deborah Howell: Sure. So probably not driving for a month or so.
Dr. Scott Wisotsky: On average, I'd say that, but you'll be surprised, I have a lot of patients that are very comfortable driving with one hand a little bit limited after about two to three weeks or so.
Deborah Howell: Let's talk a little bit about results and expectations. What are some typical results and what are the common expectations?
Dr. Scott Wisotsky: So in both operations, whether it be an anatomic shoulder replacement or a reverse shoulder replacement, the main goal that patients want is pain relief. And both of these operations provide excellent pain relief. In terms of activity and function, if people have a very good rotator cuff, an anatomic replacement does excellent for return to sports, golf, tennis, swimming, those types of activities, and even a reverse shoulder replacement gets patients back on the court and swimming as well with some modifications. In fact, patients can go back to doing their normal activities of daily living very early on.
Deborah Howell: Beautiful. I love it. Will I need another operation after my shoulder replacement though?
Dr. Scott Wisotsky: It's actually very rare or uncommon that patients need to have revision surgery. Now, there are obviously some unforeseen circumstances such as hardware failure, or infection that may necessitate a second operation, but both operations, whether it be an anatomic replacement or a reverse total shoulder replacement, have a very low revision rate overtime.
Deborah Howell: And do you do the surgery anteriorly or posteriorly?
Dr. Scott Wisotsky: Unlike hip replacements, all total shoulder replacements are done from an anterior incision.
Deborah Howell: And what's the reason for that?
Dr. Scott Wisotsky: Anatomically, that's the interval to be able to get into the shoulder muscles.
Deborah Howell: At what point do I think, "Oh boy, I really need to go in and see about my shoulder."
Dr. Scott Wisotsky: I think in terms of patients seeing a physician, they can come as early or as late as they want to. Really symptomatology of a patient denotes when they actually seek medical attention. Some patients that have very mild arthritis and bad rotator cuffs may necessitate surgery, even sooner than patients that have severe arthritis and intact rotator cuffs. It really just depends on the symptomatology. And in fact, there are a lot of other non-operative things that we can do such as injections and therapy that can try to stave off the need for a shoulder replacement.
Deborah Howell: So when you go in, you'll look at the whole shoulder and the whole patient and decide what regimen is best for them.
Dr. Scott Wisotsky: Absolutely. Young active patients may want to wait on shoulder replacement. But if they're really having a hard time doing the things that they love to do, they really may benefit from it earlier than let's say somebody that is not as active.
Deborah Howell: And final question, should we be worried about scar tissue from the surgery?
Dr. Scott Wisotsky: Scar tissue is a factor after any surgery, but doing a home therapy regimen or a physical therapy regimen helps to limit the scar tissue that forms in a shoulder itself. So actually, early range of motion has been shown to improve mobility in these surgeries.
Deborah Howell: Right. Well, Dr. Wisotsky, this has been really enlightening. Thank you so much for all the good information.
Dr. Scott Wisotsky: It's my pleasure, Deborah. It's nice talking to you.
Deborah Howell: And head on over to our website at BayCare.org for more information and to get connected with one of our providers.
And that wraps up this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together. This is Deborah Howell. Have yourself a terrific day.