Home Community Member Stories Robert's Shoulder Replacement

Robert's Shoulder Replacement

Oldretiredman@aol.com 

Last year my surgeon put me on a schedule of replacing most joints over a 3-4 year period with one surgery every 3-4 months. I needed most of these joints long before now but it took a few years convincing the insurance company of the medical necessity. I think the major thing that finally worked in my favor with the insurance company was when Social Security found me to be totally and permanently disabled (this done on my first application and without the need of an attorney). 

Another problem with my insurance company is that I have to go out of the plan with my choice of RD and my choice of hospital. (My GP and my surgeon are not a problem with the insurance company.) Naturally, this means that I have to take a larger share of the burden of the hospital bill so you had better believe that I look at every item on the bill, that I keep close track of everything they do or give me, and that I carefully weigh every move before I make it. The reasons I tell you this are that, for the shoulder surgery, I needed a new chest x-ray (supposed to have one every so often--my last one 18 months ago) and a new EKG (before surgery, hospital requires one within last 6 months--my last one 9 months previous). For chest x-ray, I get that done at surgeon's office. It's much cheaper there than at the hospital and they don't charge me the extra, mysterious "reading" fee that you usually get a bill for a few months later from some radiologist you've never heard of. I get the EKG at the GP's office. It's cheaper to get it done there than at the hospital and he reads it and deciphers it or translates it or whatever it is that they do with the EKG at his office (hospital would require still an additional person added to the mix if done there). I hand carry the EKG and the results to the surgeon's office and they get a copy added to my file at the hospital. Now, I don't know if this is really allowed by the hospital or if it's just that I'm a "regular" on the orthopedics floor and all the nurses know me but I take my meds with me and they dispense them to me as required from the ones I give them rather than having the hospital pharmacy dispense them at 100 times the cost. 

Determination for Replacement: My last joint was my left knee in January and the original plan was to replace my left elbow in April. Both elbows are in severe pain all the time and the closest to straight the arms will get these days is around 90 degrees bent. The surgeon decided to replace my shoulders before replacing the elbows because he thought it would afford me more quality of life sooner. He explained that the shoulder would be a "cleaner" surgery and that I would realize improvement quicker than with an elbow. He also thought that it would afford me more pain relief sooner since my shoulders were in extreme pain all of the time. I had more range of movement with the shoulders than with the elbows but much more pain in the shoulders. The decision was to proceed with replacing the shoulders, then, before the elbows.

Surgery Day: Right up until the surgery both of my shoulders were so full of pain and there had been talk of which shoulder should be done first that we held an election amongst the people in the O.R., including the prosthetics representative, to determine which seemed the worst. They had me go through my paces. We decided on doing the right one, which happened to be the most painful that day. For shoulder surgery, I got to sit up in a chair. Now, I've been bucked over a sawhorse for lumbar surgery, had my upper body put in some contraption for cervical surgery and been on my back for knee surgery, but this was the first one where I got to sit up in the "beach chair". The surgery went very well (I slept through it) and, when I woke up in recovery, I didn't try to get up and leave the hospital like I did after the knees. The surgery consisted of an incision about 6" long, just big enough to pop the arm bone out. The socket part of the joint was cleaned up. No cartiledge was left but the surgeon removed the bone spurs and calcium deposits that had built up. He glued in some type of prosthetic piece into the socket to help form the new socket. The arm bone was cut off, drilled out down to the elbow and filled with bone cement. He then inserted the metal rod prosthesis with new ball into the bone, checked it out and closed up the incision. I understand that he only had to make one cut on the bone versus the several cuts made to both bones in the knee replacement. 

Recovery: When I woke up in recovery, what I really felt was more like discomfort than pain. I was pretty slow coming around so I was in recovery for about 1 1/2 hours. I got to sit up and converse with the different doctors and nurses. My arm was in a sling and I was told that I needed to keep it as still as possible for a little while. I would have to say that my recovery room experience after the shoulder was infinitely preferable to waking up from a knee replacement. Surgeon and anesthesiologist both stopped in to chat and reminded me "only 8 more to go". Can't wait.

Room: As with everything else, the room experience was completely different than from a knee. Knee was a very bloody surgery but shoulder wasn't. As with the knee, I had this thing that captured the blood that escaped from the joint but in 24 hours, they dumped it twice and it only had a capful of blood in it each time. With the knee, the thing was dumped three times a day and the blood was given back to me with my IV. I was in hospital for 4 days with knee but the shoulder was considered day surgery and I was supposed to be released next morning. The surgeon had planned on my being there two days so he used the excuse of my bowels not waking up to get the insurance company to approve an extra day. Also, for some reason, this time of being under anesthesia kept me kind of disoriented for a day and a half so that played into my getting to stay in hospital. I didn't have to take the blood thinners with the shoulder like the knee so I didn't have to have blood drawn at all hours and all of that lab work. I also didn't have physical therapists, occupational therapists, case workers and everybody else coming in and out all of the time like with knees. On release from the hospital an appointment was made for me to see the surgeon 10 days after the surgery.

Home: By the time I got home it was two days after the surgery and there was absolutely no pain in the shoulder. NO PAIN!!! Even though I wasn't able to move it yet, this was the first time in as long as I could remember that there was no pain in my shoulder. I had forgotten what that was like and, I gotta tell you, it's a feeling I like very much. Today, 10 days later I saw the surgeon and the staples were removed. As with the knees, an x-ray was made of the new joint at this time and looking at this x-ray didn't startle me. After seeing an x-ray of my first new knee, I realized then why it had hurt so bad and, if I had seen it before the knee surgery, I might have had second thoughts. I also found out at this time that my shoulder rod and ball were the largest that the prosthetics company made. Good thing I wasn't any bigger than I am. Anyway, I get to do therapy on my own with this one instead of having to have a meanie therapist. Starting today, I get to wear the sling only as I feel the need for support and am supposed to start making pendelum motions with the arm. Next week I get to start using the fingers to take the arm up the wall and try to get the arm overhead. This I will be good at because, for years, that's how I would get my arms up in the mornings anyway. Still how I have to get the left one up in the a.m. My wife got me one of those pulley/weight things that hang over a door so that, after I've made sufficient progress, I can start working on regaining some upper body strength. 

Future: As with every other surgery I've had, I'm going to work very hard at recuperation and I will be getting the most out of my new joint. Although "complete" recovery of a shoulder replacement is supposed to take many, many months, the surgeon thinks that I will be sufficiently recovered in 3-4 months to replace the other shoulder. Can't wait. 

Adjustments Made: Before the shoulder replacement I needed both arms to drive a car so I am not able to drive right now. Because of the severity of elbow deformity combined with the elbow and shoulder pain, I have lost tremendous amounts of upper body strength over the years. Additionally, all of the fingers hurt very bad. That is why I need two arms to drive. Took both of them to turn the steering wheel.

I've had to learn to become inventive in how I deal with having one arm, especially since the one arm ain't that great. Instead of 1/2-gallon pitchers of juice or milk in the refrigerator that I can't lift with my one infirmed arm/shoulder/elbow/hand, my wife has poured them into some tupperware cups that I can fight the plastic lid off of with one hand. I have to put the shampoo bottle between my knees and squeeze shampoo into my one useable hand and I have to use those sponges-on-sticks to wash most places on my body using the one hand. All of our doors in the house have levers instead of knobs so that hasn't been a problem so far. I have to keep a "grabber" handy since I invariably put something that I will need on my right side instead of my left. Also have found out that grabbers don't work well for picking up pillows or cordless telephones. I am right handed and have never been able to do anything with my left hand. Now I'm having to learn. It stinks but I'm working on it. Can't use both hands to type yet. Have to type with one finger, although, I can sneak a finger out of the sling to use on the "shift" key now. Have to have help to put on a shirt but I'm working on that, too.