Knee, Hip, Shoulder surgery

I Couldn’t Even Wipe My Bottom

Today thousands of patients are having hip and knee replacement surgery that allows them to return to a more active and pain free life. But what happens to the hip and knee can also strike the shoulder. So why is it that people are more likely to shy away from shoulder surgery when it can be a crippling condition?

One woman recently said to me with great hesitancy, “Doctor, the pain in my shoulder has become so severe it’s difficult to move my arm. I’m embarrassed to tell you, it’s now even hard for me to wipe my bottom.” If you don’t believe this is a medical emergency, you’ve never had this problem.

But how does such an embarrassing situation happen? The shoulder joint is a complex anatomical area consisting of the humerus bone of the upper arm along with the shoulder blade and collarbone. And muscles are attached to bone by tendons.

During our life all of our joints are subjected to a huge amount of wear-and-tear often resulting in osteoarthritis. Sometimes the cause is repetitive use of the arm by baseball pitchers, painters and those lifting heavy objects. Or it’s the result of the repeated trauma from shooting a shotgun.

Others set the stage for later shoulder problems when they suffer a traumatic fracture or a shoulder dislocation. Or when they damage or tear the rotator cuff that holds the upper arm securely in its ball and socket joint. In addition, rubber band-like ligaments and tendons attached to bone can be torn when they’re subjected to severe stress or are overworked.

During a shoulder replacement orthopedic surgeons remove the damaged head of the humerus bone. This is replaced by a prosthetic ball normally made of metal, attached to a stem, that’s inserted into the humerus.

The majority of patients have a speedy recovery, being able to move their arm right after surgery, feed themselves and write. But it requires several months of dedicated rehabilitation to ensure a good range of motion.

Why, then, isn’t shoulder surgery as popular as that of other joints? Dr. Edward McFarland, Professor of Orthopedics and Shoulder Surgery at John Hopkins University, says some patients are not aware of shoulder joint replacement surgery. Others have been lead to believe that this operation is painful and results questionable. But he claims these fears are unfounded.

To dispel these myths Dr. McFarland reviewed the medical records of 50,000 men and women who had undergone shoulder, hip and knee replacements in the state of Maryland.

This study revealed that patients who had shoulder replacements were less likely to require treatment for hospital complications while in hospital. They were also able to leave the hospital in 2.5 days rather than 4 days required for hip and knee replacements.

But how do patients feel after shoulder replacement surgery? McFarland says the major difference that patients can expect is in their level of pain.

He adds, “I have found that 99 percent of patients undergoing shoulder joint replacements find pain relief. Patients can do daily tasks that were too painful to perform before, like washing their hair, or reaching into a cabinet. Improvements in range of motion may not be as impressive as the improvement in pain relief, but most patients do have better function.”

McFarland says that most shoulder joint replacements last a long time. One study done 15 years after this surgery showed that only five percent of patients had required a revision operation.

Remember that, anyone contemplating surgery should never forget the wise counsel, “Caveat empor” , let the buyer beware. Like any operation, there can be complications such as a loosening of the artificial joint or the less frequent chance of infection.

Timing the surgery is also important. Some patients tend to think these operations are minor surgery and rush into them too quickly. However, Dr. McFarland says that some people with shoulder pain wait so long to seek a new joint that it’s impossible to do the surgery.

However, I’m certain my patient would agree that when you can no longer wipe your bottom it’s surely time to act. 

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Dr. Gifford Jones  Bio

Dr. Gifford Jones Most recent columns W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He’s been a ship’s surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: http://www.mydoctor.ca/gifford-jones. He can be reached at: