Shoulder and Elbow Replacement

You may need a joint replacement if your pain can't be reduced enough by other treatments (such as drugs, injections orphysiotherapy) and it's affecting your quality of life.

Increasingly, joint replacements are carried out to deal with fractures close to the joints. This is only the case if the fracture can't be fixed reliably and your lifestyle and other factors make you suitable for a shoulder or elbow replacement.

Joint replacement surgery should be considered carefully in consultation with your surgeon and any other healthcare professionals who are helping you (such as a GP, physiotherapist or nurse) and with your family and friends. Your surgeon will be able to advise you on what the surgery involves and on the pros and cons of having or delaying an operation.

肩膀或肘关节更换的可能优势和好处包括：

• reduced joint pain
• an improved range of joint movement in some cases
• 改善生活质量。

肩膀和肘关节更换非常成功，大多数人对结果和生活质量的改善感到高兴。但是，您应该期望它需要几个月的时间才能获得全部利益，并且有些人会比其他人获得更好的结果。

替换接头永远不会像通常功能的天然关节一样好。

运动范围将比健康的自然关节少。尽管大多数人将能够继续进行正常的日常活动，但可能无法进行一些运动，例如伸手在您的头顶上。您应该在手术前与外科医生讨论他们的期望有多少改善，因为每种情况都略有不同。

Replacement joints will also wear out after a time, but it's likely that they'll last for 10 years.

大多数患有肩膀或肘关节关节炎的人都会从医生那里接受其他治疗物理治疗师or a风湿病学家before they see a surgeon for a joint replacement. These include:

• 非甾体类抗炎药（NSAIDS）
• disease-modifying anti-rheumatic drugs (DMARDs)
• 类固醇注射
• injections of local麻药麻木神经
• physiotherapy。

如果这些治疗方法无法缓解疼痛，则可能需要手术。但是，关节替换并不总是最合适的选择。其他可能的手术治疗包括：

• cleaning out the joint (debridement) to ease pain
• 如果非常发炎，则去除关节衬里（滑膜切除术）（通常在肩关节上进行）
• removal of part of the bone (the radial head) at the elbow.

哪种类型的肩膀和肘关节更换？

肩部更换

肩膀是球窝关节。上臂骨（肱骨头）的末端形成球，而肩blade骨的一部分（格洛动物）则形成插座。

肩部更换surgery replaces the ball and sometimes the socket with man-made parts. There are several types of shoulder replacement surgery:

Hemiarthroplasty is where the ball part of the joint (the humeral head) is replaced with an artificial ball component with a stem that extends into the shaft part of the bone. This is usually used for fractures but is also used in many cases of arthritis.

Shoulder resurfacing is a different type of hemiarthroplasty where, instead of removing the humeral head and replacing it with an artificial ball on a stem, a metal cap is fitted over the ball part of the joint. This means less bone has to be removed during the operation.

Total arthroplasty is where both the ball (of the upper arm) and socket (of the shoulder blade) are replaced. This is increasingly used for very specific kinds of arthritis depending on your age, how badly worn the natural joint is and the state of the tendons around the joint. Occasionally a total arthroplasty will be carried out using a resurfacing component.

Reverse shoulder replacement is where the artificial components are fitted in reverse – that is, the socket to the upper arm bone and the ball to the shoulder blade. Currently this is only used in patients with severe arthritis of the shoulder joint and very poor tendon cover around the joint. It can sometimes be used if a patient has both a severe joint fracture and poor tendon function.

Your surgeon will consider which type of joint replacement will be most suitable for your shoulder problem. They'll discuss this and the possible complications with you, and you'll then have time to think things through before you decide whether to go ahead.

The operation will be carried out using a general anaesthetic (in which case you’ll be asleep) and/or a local anaesthetic (which numbs the nerves to the arm and shoulder). The shoulder joint is normally opened from the front or top and the muscles moved out of the way (retracted). The damaged bone of the humeral head is then removed and the remaining bone is prepared for the artificial component to be fitted.

Elbow replacement

在肘部替换中，接头的两侧被更换。上臂和前臂组件（肱骨和尺寸组件）由金属和塑料制成。该操作将使用一般和/或局部麻醉剂进行。肘关节通常从背面打开，肌肉向后移动。然后去除骨骼的部分，并取出损坏的关节表面，并插入制备的尺骨和肱骨的轴，通常将其固定在两半之间。

If the arthritis affects only the radial head then a metal radial head replacement is occasionally used. This leaves the rest of your elbow joint unchanged. This may also be used for some fractures.

决定进行手术后，您的名字将被列入等候名单，医院通常会在6-12周内与您联系。

It's a good idea to have a dental check-up and get any problems dealt with well before your operation. This is because bacteria from dental problems could cause an infection if they get into the bloodstream.

入学前诊所

Most hospitals invite you to a pre-admission clinic, usually about 2–3 weeks before the surgery. A pre-admission clinic is a chance to discuss any questions or worries you have about the operation and find out more about preparing for, and recovering from, surgery. During the clinic you’ll be examined to make sure you’re generally well enough for the anaesthetic and the operation. This may involve the following tests:

• 血液检查以检查贫血并确保肾脏正常工作
• x-rays of the affected body part
• a urine sample to rule out infection
• an electrocardiogram (ECG) scan to make sure your heart is healthy.

The hospital team will probably tell you at this stage whether the operation will go ahead as planned.

You should discuss with your surgeon, anaesthetist or nurse at the pre-admission clinic whether you should stop taking any of your medications before you have surgery.

You may also be invited to see an occupational therapist to discuss how you’ll manage at home in the weeks after your operation. They can advise you on aids and appliances that might help. If you're not invited to see an occupational therapist and you're worried about coping at home after the operation then you should ask about this at your pre-admission clinic.

在一些医院,你会看到一个理疗师this clinic as well. You’ll be able to discuss your exercise regime before and after your operation.

Going into hospital

Before you go into hospital you should think about the following:

• 手术后，您是否有人要带您去医院并带您回家？
• 是否在家中设置了一切准备好回报 - 您需要在易于实现的范围内所需的一切吗？
• Do you have any special equipment ready for when you come home?
• Do you need someone to stay with you for a while after your operation?

You’ll probably be admitted to hospital early on the day of surgery, but it may be earlier if you haven’t attended a pre-admission clinic or if you have another medical condition that needs to be cleared up before surgery can go ahead. You’ll be asked to sign a form consenting to surgery.

Just before your operation you’ll be taken (usually in your bed, but you may be walked) from the admission ward to the operating theatre. If you're feeling worried, you may be given a sedative medication (a pre-med) while you’re in the ward, which will make you feel a little drowsy.

You’ll then be given an anaesthetic. This may be either a general anaesthetic or a local anaesthetic (regional block):

• A general anaesthetic will affect your whole body and make you lose consciousness or put you 'to sleep'.
• A local anaesthetic doesn't put you to sleep but stops you feeling anything in the affected area. It's usually given by an injection into the base of your neck or in the armpit. Some anaesthetists use an ultrasound scan to help guide the needle to the right spot. You can take a book or some music along to help you relax during the operation, but you may also be sedated if need be.

After the operation

The operations usually take around an hour and a half. Giving the anaesthetic takes about half an hour, and recovery before going back to the ward takes another half an hour to an hour.

You'll be taken to a recovery room or high-care unit until you're fully awake and the doctors feel that your general condition is stable. Then you'll be taken back to the ward.

有时，该手术中的局部麻醉剂在深夜会消失。这会导致睡眠和疲倦。在入睡之前，您可能会得到止痛药，以确保您会更舒适。滴水和任何排水管通常在24小时内被除去。之后，您将能够再次轻轻移动手臂。

You'll usually be in hospital for 2–3 nights after your surgery. During this time medical, nursing, physiotherapy and occupational therapy staff will be involved in your care. You'll be given drugs after the operation to keep your arm as free from pain as possible. These may include:

• local anaesthetic
• “患者控制的镇痛”（PCA） - 您可以通过按下按钮来控制自己的止痛药供应的系统
• 止痛注射或片剂。

X-rays of your new joint will be taken during your stay in the hospital. Your arm will be in a sling or splint to protect it. If a tube was placed in the wound during the operation to allow blood to drain out, it's normally removed after 1–2 days (this isn't painful and is usually done on the ward).

重要的是在第一次几天后r surgery that you keep your hand and forearm raised (preferably above the level of your heart) and exercise your fingers on a regular basis. These exercises are simple to do and include making a full fist and stretching your fingers.

If you had a shoulder replacement you'll be in a sling to support your shoulder. You may need to keep this on for up to 4 weeks but different surgeons have different procedures.

After an elbow replacement, some surgeons use a plaster support (called a slab) behind the elbow to keep it in a fairly straight position for a few days. You won't be able to move your elbow in the slab, but once it's removed you can start moving your elbow again.

Physiotherapy and occupational therapy

Your physiotherapist will see you in hospital after the operation to help get you moving and advise you on exercises to strengthen your muscles. Either your物理治疗师or职业治疗师will tell you the dos and don'ts after your surgery. It's very important to follow this advice.

Because there are several different types of shoulder and elbow surgery, there's no single aftercare programme. Your post-op therapy will differ depending on the procedure you've had and also between different units and surgeons, so we can't recommend specific exercise plans. We suggest that you discuss with your surgeon what to expect after the operation.

Going home

Most people are ready to leave hospital within 2–3 days. How soon you can go home depends on how well the wound is healing and whether you'll be able to get about safely. After about 2 weeks you'll need to attend the outpatient department for a routine check-up to make sure your recovery is going well and your wound is healed. You may also be offered outpatient physiotherapy if your doctors feel that this will help your recovery.

If you stopped taking any of your regular medications or had to alter the dose before the operation, it's very important to talk to your rheumatologist or another healthcare professional for advice on when to start taking them again.

After elbow replacement surgery, you shouldn't lift objects heavier than a small bag of sugar for the rest of your life. The current artificial elbow joints aren't designed for any heavier work and the new joint probably won't last as long if you over-stress it.

If you had both sides of your shoulder joint replaced (total shoulder replacement), you should also avoid heavy loads to help your new joint last longer. This is especially important if you've had a reverse anatomy arthroplasty.

Getting back to normal

Some patients spend longer in rehab than others. Usually after 6 weeks the pain has subsided enough for you to lift your arm and perform daily activities such as dressing, feeding and washing yourself.

Can I work and drive afterwards?

根据您的工作类型，您可能需要长达3个月的时间才能返回工作。不建议在肩膀或肘部更换后任何时候进行大量手动活动。这是因为重型活动可以松开骨头中的替换部分并损坏人造关节。

只要您可以安全地控制车辆并进行紧急停止，您就可以在接头更换后开车。与您的保险公司联系很重要，您需要确信您可以始终控制车辆。

As with any operation, a very small number of people may have problems after a shoulder or elbow joint replacement. Most of these problems are quite minor and can be treated easily. The main problems include:

• 感染
• 刚性
• pain
• loosening of the replacement parts
• fracture of the bone during or after surgery
• poor healing of the wound
• wound haematoma (bleeding)
• damage to nearby nerves causing temporary or, rarely, permanent loss of function.

Your骨科医生will discuss the risks with you in detail before you decide to have the operation.

In most cases, infections can be cleared up with tablets or injections of antibiotics. For a more serious infection you may need another operation to treat the infection and replace the components.

There's a very good chance that your shoulder or elbow replacement will last for 10 years. After this time it may loosen or wear out. A second joint replacement (revision surgery) may then be possible, although it's usually not so effective in easing symptoms.

翻新手术

在修订操作中，将删除原始组件以及可能使用的任何水泥。在需要翻新手术时，肱骨的轴通常会变得更薄，并且由于手术过程中进一步的骨头被去除，因此肱骨更容易骨折。

如果原始手术是肩部重铺手术，则修订手术通常会容易一些，因为在第一次手术中，骨骼会减少。在这种情况下，形成新骨表面的成分通常被茎分量代替。

The number of reverse shoulder arthroplasty surgeries has increased dramatically over recent years. It's not clear how long this type of joint replacement lasts, and this is currently being studied.