Joint replacement is almost ho-hum these days — at least when it comes to knees and hips. But only about a tenth as many shoulder replacements are done as hip or knee replacements. One reason for this is that even among physicians, the buzz is that shoulder replacement is difficult and not very successful, something it’s best to avoid. But as I recently discovered, the buzz couldn’t be more wrong. A new study from Johns Hopkins in Baltimore revealed that shoulder replacement surgery actually has fewer complications and shorter hospital stays than either knee or hip replacement. As to the success rate, the study concludes that most patients who have shoulder replacement are only sorry they didn’t do it sooner.
ARM YOURSELF WITH FACTS ON SHOULDER REPLACEMENT
To find out more I called one of the country’s leading experts on shoulder problems and repair, orthopedic surgeon Peter J. Millett, MD, MSc, who directs the shoulder program at the Steadman-Hawkins Clinic in Vail, Colorado, and who was formerly the co-director of the Harvard Shoulder Service. He confirmed that fewer shoulder replacements are performed — in large part because the need for them isn’t as great. The reason: Arthritis, the malady that erodes joints and often makes them unbearably painful, doesn’t affect the shoulder as frequently as it does hips and knees… since we don’t walk on our hands, we don’t wear down the shoulder as much as we do our lower joints. But also, shoulder replacements may be rarer because many people don’t realize it’s an option or they lack access to doctors who perform shoulder replacement surgery… and, there aren’t as many different repair options, such as partial replacements. Furthermore, few doctors have the training to perform the surgery and many have not seen the excellent results that can be achieved, so they are often reluctant to advise it for their patients.
As with all joint replacements — indeed, all surgeries — having an experienced surgeon vastly improves the odds that the operation will be a success. This is a particularly complex surgery, Dr. Millett says, so it is mandatory to find a highly skilled surgeon working at a major medical center or a medical center specializing in orthopedics only, who does a significant volume of shoulder replacements each year.
ABOUT THE SURGERY
The reason total shoulder replacement is such a challenging operation is that it involves removing the humeral head (the top of the upper arm bone)… replacing it with a new prosthetic ball… and then resurfacing the shoulder socket (the glenoid) by affixing a second dish-shaped plastic component to the shoulder blade, explains Dr. Millett. The shoulder is smaller and more complex than knees and hips, so it is more difficult to place the prostheses exactly right. Access to the joint is complicated by the numerous nerves, tendons and blood vessels in the area. Also, the anatomy of this joint varies considerably from person to person so standardized parts don’t fit well. Dr. Millett says that prostheses today are more flexible and can adapt to the individual’s structure, but placement of the implant is still very demanding from a surgical standpoint. Done properly, shoulder replacement results in a high-functioning shoulder with excellent durability of the implant. And most important, the surgery immediately and reliably eliminates the arthritis pain — Dr. Millett has seen patients wake up from surgery pain-free for the first time in years.
After surgery, patients can begin to move their shoulder immediately, though they generally remain in the hospital for two days. Several months of physical therapy will be necessary to gain full functioning and range of motion. Dr. Millett says that most patients can raise their arm by six weeks and resume full activities after three or four months. Although patients experience the most dramatic improvement in the first four months, Dr. Millett says that progress continues for a full year — by then patients can return to their previous activities, including, for some, doubles tennis, skiing and golf. He cautions that excessive overuse of the joint will wear it out faster, but he says he has had patients who returned to jobs that require repetitive overhead lifting, and they’ve done so without harm thus far.
WHO SHOULD CONSIDER REPLACEMENT
You may be a candidate for shoulder replacement if you have significant arthritis with pain that is disabling or interfering with sleep and functioning of the shoulder. Since arthritis is often age-related, Dr. Millett says the surgery is also mostly for older patients, who must, of course, be healthy enough to withstand it. Since prostheses currently are expected to last an average of 15 to 20 years, he usually advises waiting until at least age 50 — or even 60 or more if possible. While second-time joint replacements can certainly be done if and when the implants fail, those surgeries are riskier and more complex so younger patients might do better starting out with other procedures to relieve pain. For example, surgeons can arthroscopically clear debris from the joint… readjust tendons… resurface… or stimulate new growth of the cartilage that cushions the shoulder joint. In some cases patients even choose to have their shoulder fused to eliminate pain — but there’s significant compromise in that option. It stops the pain, but also severely limits shoulder function.
Dr. Millett is eager to dispel the notion that shoulder replacement doesn’t have good outcomes. People who’ve done their homework to find a highly qualified surgeon and who commit themselves to healing properly and working hard on their physical therapy have described the operation as being “truly life-altering,” he says.

Source(s): ??Peter J. Millett, MD, MSc, director of shoulder surgery, Steadman-Hawkins Clinic, Vail, Colorado.

Michelle

Sir

I have just completed my first circuit run in the Raivon solar system. It is composed of 14 planets with numerous moons. Most of the planets inhabitants have long since used up their planets resources or polluted their planets beyond habitation so they now live on the moons of the planet.

For some of the planets the moons that they have occupied are so distant as to have created distinct evolved beings. Tal says that happened because of the physiological influences of the moons on sequence generations. The result is that the planet’s inhabitants look so different because of the different moons that they live on. They have different diets and gaseous needs.

It made me wonder what generations of earthlings would look like after they became generations of moonlings. It is incredible! All the climates on the moons are different from what the planet had and different from the other moons.

It seems that they split up and each took different moons. They were not able to communicate or travel to the other moons. The trips were one time excursions. Some did not make it to their moon of choice. They either exploded in route or crash landed on the surface.

We are providing for the first time in 18,000 years the opportunity for the people of the mother planet Unviel the opportunity to visit the people who went to the other 9 moons. The reunions were stiff at first, but the recognition of the same artifacts from their mother planet has thawed them out and they seem to be truly rejoicing in their reunion.

The physiological differences in some cases are so startling that it is almost impossible to believe they had the same ancestors on the planet unviel. Speaking of the planet Unviel, the reason we arrived here is that our instruments showed that it was a planet that would be inhabitable to humans.

Their pollution and destruction of their planet as a place that could sustain their life forms created a planet that can now sustain human life. The overhead ozone layer that their pollution created has acted to produce a very green and ice capped planet. It is about twice the size of earth but pristine in every way. We will return to earth and bring animals and sea creatures to occupy its land and seas.

Tal says that we must insure not to bring any of the earth’s insects as they would have not nature enemies here. We are at present devising a subchamber to delice the animals and sea creatures that we bring aboard. The planet has some bird life. It seems that only the birds were able to withstand the changes by the formation of an ozone layer on a planet that previously had none.

Sir

Shana

I tried to post the above. It acted as if it posted but it was not there. I am trying again. I tried and it still didn’t post. I get this message instead “Duplicate comment detected; it looks as though you’ve already said that!”

Shana