Patient Blood Management and Shoulder Replacement Surgery

An Interview with Thomas Hughes, MD

Thomas Hughes, MD, is an orthopaedic surgeon specializing in upper extremity surgery at Orthopaedic Specialists–UPMC.

How common is shoulder replacement surgery?

Shoulder replacements have become more common over the last decade. Initially, they were used to treat arthritis and severely damaged shoulders after fractures. While we still use shoulder replacement for these reasons, a newer, “reverse” shoulder replacement is now available for irreparable rotator cuff tears. This has led to an increase in shoulder arthroplasty in recent years.

Why do people consider having this surgery?

The most common problem leading to shoulder pain is rotator cuff dysfunction or tearing. This can typically be treated non-operatively or with minimally invasive arthroscopic techniques. People consider shoulder replacement surgery when pain and limited function begin to impact their activities of daily living. Eventually, those with severe arthritis and rotator cuff dysfunction experience significant limits to their range of motion and strength. They begin to have pain with minimal activities and difficulty sleeping through the night.

What are the different types of shoulder replacement surgery?

There are three main types of shoulder replacement. Hemi-arthroplasty, or partial replacement, is when only the arm bone portion, and not the socket portion, is replaced. This is typically used with fractures of the arm at the shoulder.

Total shoulder arthroplasty is replacement of both the arm bone portion (the “ball”) and the socket portion of the shoulder, and is typically done for arthritis.

Finally, reverse shoulder arthroplasty replaces the ball with a socket, and the socket with a ball. It is used primarily for large, unfixable rotator cuff tears that lead to a special type of arthritis.

How long does it take to recover from shoulder replacement surgery?

It takes a significant amount of time to completely recover from shoulder replacement surgery. While every patient is different, there are several phases to the recovery.

First, there is the hospital phase. Patients typically enter the hospital on the day of the surgery and are discharged between one to three days later.

Most patients are required to wear a sling and limit activities for at least six weeks. However, patients with severe pain preoperatively typically find that the pain is significantly better within a week or two of surgery.

Finally, to completely recover, patients need to build up strength in their arm. This takes many months.

After three months, most people are feeling much more functional than before the surgery. But overhead strength continues to improve for at least a year after surgery.

What can be done to reduce the need for blood transfusion for shoulder replacement surgery?

Initially, patients are evaluated for anemia and steps are taken preoperatively to correct their low blood count. If there are exceptional concerns about blood loss, then medications can be given preoperatively to elevate the blood count. Other techniques can be used to dilute the blood at the time of surgery so that each drop of blood lost contains fewer red blood cells.

During the surgery, meticulous attention to controlling bleeding is performed. Blood can be collected using cell-saver techniques and immediately reinfused to patients during surgery. With shoulder replacement surgery, blood loss is typically not so severe that patients require all of these techniques.

How do you feel about treating patients who are unable to accept a blood transfusion?

I feel that a patient’s decision to accept or reject blood transfusion is their own. My job is to educate my patients about the treatment options available. If a patient is at too great of a risk to undergo a procedure for any reason, whether it be anemia or another medical problem, I will counsel them to safer methods of treatment. If a patient chooses not to have transfusions, there are many techniques available to be able to treat them safely using surgical means.

How can I schedule an evaluation?

Call 1-877-471-0935 to schedule an appointment. Patients are seen at our McCandless, Moon, South Side, Murrysville, and Steubenville, Oh. locations.

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