Total Shoulder Replacement
The Best Thing I Ever Did
For months, Carol Beccia, 74, of Milford would jolt awake at night from a sharp pain in her left shoulder. During the day, it would force her to stop whatever she was doing. The pain all stemmed from her work in a nursing home back in 2006 when Carol tripped over a call light cord near a patient’s bedside and broke her humerus, a bone in the upper arm. Shoulder surgery followed with the addition of a metal plate and screws. Over the next decade, Carol would still experience occasional discomfort, until the fall of 2015 when the pain intensified.
“My daughter is a nursing professor and said that maybe I should have the plate taken out since I was having so much trouble with my shoulder,” recalls Carol. “I went to see Dr. John Mulroy [of Mulroy Orthopaedic Surgery & Sports Medicine, PC, in Milford] and he X-rayed it and told me it was full of arthritis.”
Although Carol tried cortisone shots first to lessen the pain, it didn’t bring her relief. Dr. Mulroy explains that in Carol’s case, her previous fracture caused avascular necrosis, the death of bone tissue due to a lack of blood supply. This, in turn, caused secondary arthritis.
At this point, it appeared that Carol was a candidate for total shoulder replacement surgery. Dr. Mulroy notes that almost all patients who need a shoulder replacement have arthritis. “It can either be primary arthritis– which develops over time–and a normal rotator cuff, or secondary arthritis to a torn rotator cuff,” he says.
Although Carol needed total shoulder replacement surgery due to her complicated case, Dr. Mulroy points out that some patients do find luck with less aggressive methods. “Unlike the hip or knee, you don’t walk on your shoulder, so [less aggressive] treatments will often work better for the shoulder since you’re not putting stress on it,” says Dr. Mulroy. “An exception is people who use walkers, because they will put stress on the shoulder when they walk.”
Carol arranged to have a total shoulder replacement, along with the removal of the plates and screws, at Milford Regional on May 8, 2016. While an athlete with a rotator cuff tear may have arthroscopic surgery, which is a minimally invasive procedure with small incisions, total shoulder replacement surgery is an open procedure. “It’s basically replacing the surfaces with metal and plastic,” relates Dr. Mulroy. “The surgery requires one good-sized incision.”
Dr. Mulroy performs two kinds of total shoulder replacement surgery: traditional and reverse. He performs “traditional” surgery for a normal rotator cuff while “reverse” is used for a rotator cuff tear. With a traditional shoulder replacement, a plastic "cup" is fitted into the shoulder socket and a metal "ball" is attached to the top of the humerus. Carol, however, underwent the reverse procedure. “You put the ball where the cup is and the cup where the ball is,” explains Dr. Mulroy. “By switching them, you change the mechanics of the shoulder so that you don’t need a rotator cuff.”
Dr. Mulroy notes that the surgery takes about 60-90 minutes and typically requires a one-night stay at the hospital. “The patient wears a sling and rests for a week, and then we start passive range of motion with a physical therapist,” he says. “It’s a lot of physical therapy, at least three months. You can do active motion much more quickly with the reverse surgery. With traditional shoulder replacement, you have to wait for the muscles and ligaments to heal before you put stress on it. You still work on motion, but it’s passive, with the therapist moving the shoulder as opposed to the patient moving it.”
After several weeks of rest, Carol began more active physical therapy sessions, which involved doing exercise routines with pulleys, a big ball and a towel. At home, she slowly eased back into her activities as her range of motion improved. She returned to driving after two months. Throughout her therapy, she continued to see Dr. Mulroy for follow-ups. He checks in with patients at one week, six weeks, three months, six months, and a year.
“Dr. Mulroy is incredible,” Carol states. “I feel so confident with him. My shoulder is wonderful, just like the other one. I can reach the ceiling and dust, and I can do work out in my yard. He worked so hard with me, and I followed his instructions to the letter. Anything Dr. Mulroy instructed me to do, I did, as I have a lot of confidence in his experience. He lays it right out for you, and it worked out exactly as he said.”
“I could have gone to Boston for surgery, but I didn’t need to,” Carol remarks. “I knew where I was going to have my surgery and who was going to perform it. Dr. Mulroy is the best you can get, and everyone at Milford Regional was wonderful also.”
Today, Carol has full use of her arm and shoulder. She no longer suffers from shoulder pain and has resumed all normal activities. She enjoys taking walks and playing scales on the piano, and no longer has to rely on her children to carry heavy laundry baskets or to take out the trash. She is especially happy about babysitting her infant great-grandson.
“I feel so good about being able to hold him and change him,” Carol says. “I wouldn’t have been able to do that before. If you do the surgery and go through the rehab, you’re going to come out on the other end without the pain you’re having right now. It was the best thing I ever did.”
Read more about John Mulroy, MD or call his office to make an appointment at 508-478-7135.
