Sentara Martha Jefferson Summer 2022 Magazine - Joint Replacement Surgery Revitalizes Patients

Joint Replacement Surgery Revitalizes Patients

New materials and techniques help speed up recoveries

As a senior trooper for the Virginia State Police, Troy Johnson places fitness as one of his top priorities. In addition to regularly spending time in the gym working on strength training and cardio, he has been involved in martial arts for nearly 30 years.

So, it’s perhaps not surprising that Johnson’s shoulders eventually began to ache from normal wear and tear over the years.

“I’ve always been active and a ‘gym rat,’” says Johnson, 55, who has been in law enforcement for 12 years. “Over time, both of my shoulders began to hurt due to overuse and exercise.”

To address the issue, Johnson went to see an orthopedic surgeon, who recommended shoulder replacements to help relieve his pain and keep him in top shape for work and other activities.

Advances in Joint Replacements

According to the Agency for Healthcare Research and Quality, about 53,000 people have shoulder replacement surgery each year in the United States, and more than 900,000 Americans undergo knee or hip replacement surgery annually.

Joint replacement surgery also can be performed on the ankles and elbows.

Over the years, we’ve seen great advancements in materials and techniques for joint replacements,” says Clark Baumbusch, MD, an orthopedic surgeon at Sentara Martha Jefferson Hospital. “We also have more effective anesthetics to control pain. As a result, our patient recovery times have improved.”

Hospital stays following joint replacement have shortened as well, says Dr. Baumbusch. Today, in fact, many patients go home the same day they have surgery.

What Causes Shoulder Pain?

The shoulder is composed of a ball- and-socket joint, much like the hip. The muscles and tendons that make up the rotator cuff keep the ball of the upper-arm bone (humerus) in the shoulder socket and also help raise and rotate the arm.

One major cause of shoulder pain falls under the umbrella of rotator cuff diseases, which include:

• Bursitis occurs when the bursae—small, fluid-filled sacs that cushion the bones, tendons and muscles near the joints—become inflamed.

• Tendonitis results due to inflammation of the rotator cuff tendons.

• Rotator cuff tears can develop when tendons in the rotator cuff become physically damaged.

Osteoarthritis, another cause of shoulder pain, occurs when the cartilage that provides cushioning between bones in the joint wears down, causing bone to rub against bone.

“For those with arthritis, symptoms usually progress over months and years, and the resulting pain can become disabling,” Dr. Baumbusch explains. “People frequently report cracking or popping when moving the shoulder—that happens when the smooth surface of the cartilage between the bones disappears.”

Imaging, such as X-rays and CT scans, plus an examination by an orthopedic surgeon, are used to determine the root cause of shoulder pain.

Nonsurgical Solutions

Before recommending surgery, physicians look for nonsurgical solutions whenever possible, according to Dr. Baumbusch.

Nonsurgical treatment options include:

• Anti-inflammatory medication

• Cortisone injections

• Modifying activities to reduce pain and let the area heal

• Physical therapy (PT) and occupational therapy

Physical and occupational therapists can work with patients to stretch and strengthen muscles. They can also help in other ways—for example, by analyzing a patient’s workplace ergonomics to help improve sitting posture, or by recommending other activity modifications to minimize strain and pain.

When nonsurgical options aren’t enough, orthopedic surgeons may recommend joint replacement.

Relieving Years of Pain

Johnson first experienced pain in his right arm—his dominant side—in 2013.

“It got to the point where I had bone spurs, and my shoulder kept locking up,” he recalls. “There was no way I could move it without a lot of discomfort.”

When the pain became really disruptive, Johnson’s surgeon recommended a partial shoulder replacement. During this procedure, the surgeon replaces the damaged top section of the humerus bone with a metal ball, and the natural socket is left intact.

Although Johnson had healed from the previous surgery on his right shoulder and was able to resume his activities, he figured it was just a matter of time before the other shoulder wore out.

Sure enough, his left shoulder began to worsen in early 2021.

“Before that, I could move my left shoulder in certain ways without pain,” he recalls. “But eventually it started hurting all the time. The pain went from my shoulder to the tip of my hand and up my neck into my head.”

Johnson also had trouble finding a comfortable position to sleep in, and was no longer able to lift weights during his gym workouts.

He met with Dr. Baumbusch, who recommended a total shoulder replacement on the left side. During this procedure, which is typically a two-hour surgery, the surgeon replaces arthritic joint surfaces in both the ball and socket areas of the shoulder joint.

Johnson’s outpatient surgery took place at Sentara Martha Jefferson in May 2021.

To help prevent postsurgical pain, the anesthesiologist administered a nerve block around the nerves that enter the neck.

“I had no pain whatsoever,” recalls Johnson. “It was like night and day. When I walked out of the hospital after surgery, it was the last day I had any shoulder pain.”

Postsurgical Recovery

While doctors tailor each patient’s recovery individually, Dr. Baumbusch asks patients to follow these general postsurgical instructions:

• Keep the affected shoulder in a sling for six weeks. The sling can come off for certain activities, including bathing, getting dressed, eating, typing and watching television.

• Schedule a doctor visit for a week after surgery, at which point the physician likely will take an X-ray and check the wound.

• Start PT about a week after surgery. After that, expect to have PT two to three times a week for two to three months, depending on how quickly mobility and strength return to the affected area.

At about the six-week mark following surgery, the physical therapist will begin to work on strengthening, according to Dr. Baumbusch. Overall, recovery from shoulder replacement surgery can take three to six months.

“It’s important for people to listen to their therapists,” Johnson advises. “They will decide how quickly to progress—when to push you and when not to push you.”

These days, about a year after surgery, Johnson is still working on adding weights to his exercise routine. Recently he was able to bench-press 225 pounds for a couple of reps.

“Dr. Baumbusch did a heck of a job,” he says. “I am so impressed and amazed.”

Dr. Baumbusch encourages patients with joint pain not to wait to see an orthopedic surgeon, noting that with some injuries, outcomes are better the sooner they are treated, and that joint replacement surgery can offer quick relief to patients who may have been in pain for years.

“People experience relief pretty quickly after surgery because we take out a severely damaged joint and replace it with a nice, new one,” Dr. Baumbusch explains. “The difference can be life-changing.”