Patient surgery overview: The Global® C.A.P.® Resurfacing Humeral Head Implant

If you are suffering from rheumatoid arthritis or osteoarthritis of the shoulder, you may consider talking to your surgeon about joint resurfacing using the Global^® C.A.P.^® Resurfacing Humeral Head Implant. This article will explain the steps of joint resurfacing.

Your shoulder is a two-part joint that contains a ball and a socket. The bone at the top of the arm (humerus) has a ball that fits into the top of the shoulder blade socket, called the glenoid socket. The collarbone (clavicle) is at the top of the joint. The end of the ball and socket are lined with a glistening cushion called joint cartilage. The cartilage creates a smooth surface for the ball to rotate in the socket without much friction.

Arthritis and other conditions can degrade the cartilage and eventually degrade the joint. When other treatments like medication and therapy are ineffective, surgery may be needed. Options include total joint replacement, which replaces the entire joint, and a newer option called joint resurfacing. Joint resurfacing removes the diseased tissue from the shoulder joint but retains much of the patient’s natural tissue. Joint resurfacing is appropriate for patients with mild to moderate humeral head wear. If the humeral head wear is extensive, a traditional hemiarthroplasty, where the head of the humeral is replaced, may be more appropriate.

Before the operation

Once you and your surgeon have decided that shoulder resurfacing is needed, you will be asked to give information regarding your general health, and a physical examination is required to make sure you are in good health for an operation.

Shoulder resurfacing surgery can be done at the hospital or at a separate surgical center where you will most likely stay overnight as an inpatient. The surgery can be done with you asleep (general anesthesia) or awake (local anesthesia).

Surgical procedure

In preparation for surgery, your shoulder will be cleansed using a disinfectant solution.

Your shoulder, chest and arm will be draped with sterile cloths in a way that allows the surgeon to best perform the surgery. The surgeon will then make an incision on the front of your shoulder and separate the muscles and other soft tissues until the joint can be seen.

The surgeon uses special instruments to remove diseased tissue from the humeral head. The surgeon measures the humeral head size to verify the correct size of the implant needed. The diseased tissue is removed with a special instrument and the humeral head is shaped to fit the Global C.A.P. implant.

The Global C.A.P. implant features a press-fit stem design. This means the implant will be put into place without cement. The patient’s tissue naturally grows onto the implant’s rough porous covering, securing the implant.

A cruciform (cross-shaped) hole is tapped into the humeral bone. This special shape improves the rotational stability of the implant. The cross-shaped stem of the implant is aligned with the cruciform hole and inserted. The surgeon makes sure the implant is secured properly and closes the incision either with stitches or staples. The wound is bandaged to protect the area while it heals. A small plastic drain may be used to drain fluids that may gather near the incision. This reduces swelling.

In the recovery room, nurses will assess you to make sure you are waking up, if you were asleep during the surgery, or comfortable if you have been awake. Your heart and lungs will be checked by determining your temperature, breathing rate, pulse rate, and blood pressure, until you are stable.
After your initial recovery from the surgery, you will be checked again to make sure you are comfortable, and your bandages will be evaluated.

Your surgeon will prescribe pain medications after the surgery to help keep you as comfortable as possible and to help you in healing. It is important to take the medications as prescribed by your surgeon.

You will be given an appointment to see the surgeon again in seven to 10 days. You will be instructed on possible problems that could occur and what to do in that event. You will be encouraged to call if there is a problem or if you have a pressing question.

You will also need to follow the exercise program your surgeon recommends to regain strength, mobility, and function.

Note

Only an orthopaedic surgeon trained in total shoulder replacement can provide advice about whether surgery is right for you. See your physician to learn more.

Individual results with any medical treatment may vary from the outcomes mentioned in this article. Please consult with your physician about the advisability of any medical treatment that you are considering.

Warnings and precautions

The use of a glenoid prosthesis in patients with cuff tear arthropathy could increase the risk of glenoid component loosening due to non-anatomic loading conditions. The following conditions tend to adversely affect shoulder replacement implants: excessive patient weight, high levels of patient activity, likelihood of falls, poor bone stock, metabolic disorders, and disabilities of other joints.

Adverse events

The following are the most frequent adverse events after shoulder arthroplasty: change in position of the components, loosening of components, dislocation, infection, hematoma, pneumonia, and cardiovascular disorders.

Last Updated: 09/26/2008