Total Shoulder Replacement - Research Paper Example

Total shoulder replacement of Affiliation: Total shoulder replacement or total shoulder arthroplasty(TSA) refers to a greatly helpful procedure used in treating severe pain and stiffness during the advanced stage of arthritis or simply the degenerative condition of the shoulder joint. Total shoulder replacement is most commonly performed on patients who have been diagnosed with either rheumatoid arthritis or osteoarthritis. Primarily, this procedure seeks to relief pain, but other secondary benefits have been identified and they include: restoring motion, function, strength and helping restore the patient to normal or close to normal activity level (Trail, & Conlon, 2010). For instance, sports-loving patients who have fully recovered from this condition are known to get back to their sporting activities that may include golf, tennis and swimming. Here it is important to first understand the idea behind the painful shoulder arthritis. This condition results from the disappearance of the normal smooth cartilage surface found in the shoulder. The smooth surface serves as the point over which the ball and the socket glide smoothly against one another. The loss of the cartilage covering consequent in a “bone on bone” joint and cause the great pain felt by patients. For these reason, replacement of the new surfaces comes handy for returning comfort. ANATOMY Human shoulder is comprised of three bones; humerus (the upper arm bone, scapula (the shoulder blade, and clavicle (the collarbone. The shoulder is made up of a ball- and –socket joint. Here, the ball/ head of the upper arm bone strategically fits into the shallow socket located in the shoulder blade. Glenoid is the name given to the socket. These bones have cartilages covering the areas where they make contact. The cartilage is made up of a smooth substance to help protect the bones and allow them move with ease. Synovial membrane, which is thin smooth tissue, covers the rest of the surfaces within the shoulder joint. For a healthy person, this membrane generates some fluid to lubricate the cartilage and prevents friction in the shoulder. The tendons and muscle surround the shoulder and offer stability and support. All these features make it possible for the shoulder to rotate in various ways than any other body joint. THE PROCEDURE During the procedure, the Orthopaedic Surgeon surgically approaches the front part of the shoulder area through a 6” incision, but not without either a general or regional anesthesia. Here, the deltoid and pectoral muscles are first separated to allow access to the shoulder from a wider nerve-free part and also to minimize damage caused to the nerves. Once this area is opened, a perfect view of the arthritic area of the shoulder ball and socket is accessible to the Orthopaedic Surgeon who will continue to the next procedure. The arthritic bone is then dissected from the upper arm bone or the humerus. The shoulder’s socket is set and a plastic liner cemented properly in the region in the same manner a dentist places filling on a tooth. In the next step, a metal ball that has a stem is placed down the arm bone, a process that is done in a manner to avoid the need to cement. Here, the prosthesis surface serve as a special coating onto which the human bone grow thus offering fixation without cementing. Finally, the rotator muscles are repaired followed by closure of the wound. Ideally, the whole procedure takes close to two and a half hours. RECOVERY/ REHABILITATION Following the operation, the arm is placed in an immobilizer for only 24 hours. This is often accomplished using a removable canvass arm string. Depending on the stability of the implant and the range of motion, physical therapy kicks off on the first day following the operation, but only after an x-ray that show the implant is well positioned. During the early rehabilitation, Sling immobilization is encouraged to allow healing of the tendons that were repaired. However, the sling can be removed while taking shower or doing rehabilitation exercises. Patients are free to use their hand and wrist almost immediately following the surgery, and the entire arm, the shoulder included, for light activities soon after six weeks following the surgery. Unrestricted, vigorous use of the arm is permissible after the eighth week following the operation. According to Dr, Craig, a Professor of Clinical Surgery, Weill Cornell Medical College, the patient’s outcomes depend much on the pre-surgical condition of the muscles and tendons of the shoulder. Such is the case that “If their muscles and tendons are in good shape, rehab will be less burdensome as the type and rapidity of post-surgical rehabilitation of the shoulder depends on the patient’s own muscles and tendons.” (Blacknall, & Neumann, 2009). Under the normal circumstance the patient is expected to achieve the following milestones in recovery. At three months or there about, majority of the patients depict comfort to a reasonable degree; they depict motion of about half the normal despite showing some weakness; at six months, majority of the patients are free from pain and depict motion and strength of about two-third the normal. However, patients in this stage are frequently affected by the weather. Once the patients gets to one year, majority of them(95 percent) are pain free and the other 5% only experience whether aches or rare aches when engaged in excessive activities. THE COSTINGS The ideal cost for total Shoulder replacement surgery is $7,000-$21,000 or there about. This depends much on the type of implant and the hospital where the operation is performed. A 2007 study by Johns Hopkins University researchers established that s shoulder replacement would averagely cost a total of $10,351.another recent report by Zimmer, a company that manufactures orthopedic prosthetics; those used shoulder replacements included, noted that “in 2011 Medicare typically paid between $10,919 and $13,413 for total, partial and reverse shoulder replacements.” This is slightly different from that established in Vermont community hospital which ranged from $7,000 to more than $21,000(Total Shoulder Replacement, 2012). Shoulder replacement operation typically is taken care of by the health insurance. In the case of the insured patients, out-of –pocket expenditure typically include a specialist copay, in some cases $100 hospital copay or more, and an10%-50% coinsurance for the procedure. This can potentially amount to the annual out-of-pocket maximum. Keiser Family Foundation noted that the typical hospital copay for inpatient surgery is $232 and that for outpatient is $132. Average coinsurance rate is 17%-18%. Additional costs include that incurred while undertaking physical therapy. For the insured patients the out-of pocket expenditure typically include copay that is $10 -$75 per session or coinsurance of 10%-15% or above. For the incurred patients the costs is $50 -$350 or above for every session. References Blacknall, J., & Neumann, L. (2009). Rehabilitation following reverse total shoulder replacement. Shoulder & Elbow, 232-240. Total Shoulder Replacement. (2012). Retrieved March 20, 2015, from http://umm.edu/programs/orthopaedics/services/shoulder-and-elbow/shoulder-replacement Trail, I., & Conlon, R. (2010.). Why and how we do a total shoulder replacement. Shoulder & Elbow, 123-128. Read More