I've had both hips replaced. My left one I had redone three times due to dislocations. Now I need my shoulders and elbows replaced. However - initially, because I have a huge history of infections - the surgeon told me he (and also his partner said the same) that he would not operate on me. However, I just had hip surgery without infection so it is possible that they would reconsider. But I do not know if it is worth all the pain and struggle to get my shoulder replaced. I have limited ROM with it now and quite a lot of pain. But from what I hear, many people , even after surgery, have the same. So is it worth it? Will it eventually become dislocated? freeze up? will the pain become intolerable?? I don't know. I"m going to make another appointment with the arm surgeon to reconsider it all. If any of you have any insight, please comment
I haven’t had to have any surgeries resulted to PsA damage as of yet, but I wanted to respond anyway. 
Any surgeon is going to be skittish with a joint surgery in a patient who has a history of infection. This is frustrating for the patient, but good too. Infections in a joint replacement are a big deal, and you want a surgeon who is concerned with that risk.
All joint replacements require the patient to be super involved in their recovery. Patients who don’t, end up with decreased range of motion in the joint and pain. So you end up back where you started! From what I understand of shoulder replacements, there is some reduced range of motion due to the way that the surgery is done, so even if you are the best patient in the world and do all of your rehab like a champ this is still the end result. However, this is likely still better than where you are now. Also, when the surgeon is able to get into the joint, clean everything out that’s irritating it, and give you some new parts, you should have less/ no pain once you are through the recovery period.
The other thing to consider is your surgeon. They aren’t all equal. And I think we are kind of special :-P. because of what we already have going on in our joints and risk of flare from physical traumas (surgery),
We should be very careful picking a surgeon. You want a really good one who can see the whole picture and will take into consideration all of the other stuff we have going on. Someone who has a plan to get you through therapy in case you have a flare, someone who is planning for your increased risk of infection, etc…
I know an excellent shoulder guy. It would be a trip for you, but if you’d like the info I will definitely get it to you.
Just another thought, but have you had any steroid injections into the joints? They can provide some temporary relief. I dont know if it would be appropriate for you or not, but there is another non-surgical therapy called a platelet rich plasma injection which can provide some longer term relief. Also, if you decide not to do surgery, you probably needs to look into PT so that you can retain the motion that you do have.
Good luck!
Thank you GC....I have had steroid injections without any success or relief so that is out. The plasma injection sounds interesting - even if only to hold me over in case I decide to wait. I really cannot take advantage of your shoulder guy because my husband is employed by a hospital and we pretty much are locked into using them for all our medical needs. This does drastically reduce my number of choices of surgeons. The two that are at this hospital have good reputations amongst the doctors at this facility but I know that is a limited factor. I really need to first of all, decide whether I want to procede with the surgery because honestly I'm scared to death at the thought of being so limited and disabled during the recovery time. I'm home by myself 99% of the time and don't know how I would manage honestly. The thought of the pain scares me too, but I think it scares me less than the disability. I've made a followup appointment with the shoulder surgeon for March 4th so we will see what he has to say then. I've recently had hip surgery and this was the first surgery where I did not have a post op infection. So maybe, now that he sees it can be done, he will be more willing.....who knows. '
Thanks for your sage words....I will keep them in mind. Blessings.
Q
Q,
I wonder if you were to decide to have surgery, if you could get some help at home? Schedule it for summer when there are high school and college kids available and hire one to help you out. Sometimes insurance will pay for a medial aid to come to your home as well. They can also have a physical therapist come to your home for rehab, because with this surgery, you’ll probably have a longer driving restriction.
A nursing student would be ideal for some home help. I would go to your local community college that has an RN program to advertise for that. They have some nursing training, have their cootie shots, and background checks done. A lot of them would be really excited to have a job like that, even if it is temporary. In fact, a temp job probably works best with their school schedule. They could take you to your appointments, act as your advocate, and help around the house.
This is my thought on the pain. Post surgical pain is different from the pain you have now. It is also temporary. The pain you have now is because you have parts grinding against other parts, torn soft tissue, and inflammation related to PsA, and all of that irritation going on. After surgery, the joint is nice and cleaned up. There is no more torn soft tissue, no more bone on bone making the area irritated and painful. It is replaced with surgical pain. Yes, it hurts, but it hurts in a different way. It’s also a little easier to deal with because it is finite and gets better a little each day.
Obviously, it is a big decision to get the surgery done. I don’t want you to think that I am trying to pressure you to do it. I just want you to be able to make the decision based on what you think will give you the best quality of life, and not because you are worried that you won’t be able to manage during the recovery period. I think that part can be worked out. Get in touch with your insurance company and see what they cover as far as home care, and what requirements you need to meet for them to provide it to you.
If you need anything you can message me.
Claire,
(GrumpyCat)
I spoke to my shoulder surgeon this week. He has agreed, based on the success of my recent hip replacement, to do the shoulder surgery. After discussion, we both agreed that I would wait for a while before going for the operation. As long as I can tolerate the pain I will wait. He said because I really will not want to have to repeat the surgery when I'm 65, that it is better to wait. Does that mean it's better to have the repeat surgery when I'm 70??? The logic of that escapes me. Unless he's hoping I kick off before I turn 70 and need another surgery. Who knows?? Anyway, he said the surgery's success is not jeopardized by waiting....so wait, I will.
You have a progressive disease. As such even a "new Joint" will be effected in time depending on how the damage is occuring. Thats prolly why he wants to put it off. Sometimes these diseases slow down as one ages. Certainly we aggravate things less as we slow down.
The materials in replacement joints also often wear out in 10 years give or take.
My son had shoulder surgery due to a rock wall injury and let me tell you I would not do a shoulder surgery if I did not have to.
I had a frozen shoulder due to enthesis and it hurt like heck. PT helped get it stretched out.
I don't fully understand. If replacement is already on the table, and you pain level is high, what should you do, wait 10 years or so? I know someone who suffered for that long, needing both knees replaced. What type of life did she have in the meantime. I'd rather get it done earlier, and enjoy my middle years, and face possible disability later in life again, rather than disability and pain for years and years.
Qadosh2him said:
I spoke to my shoulder surgeon this week. He has agreed, based on the success of my recent hip replacement, to do the shoulder surgery. After discussion, we both agreed that I would wait for a while before going for the operation. As long as I can tolerate the pain I will wait. He said because I really will not want to have to repeat the surgery when I'm 65, that it is better to wait. Does that mean it's better to have the repeat surgery when I'm 70??? The logic of that escapes me. Unless he's hoping I kick off before I turn 70 and need another surgery. Who knows?? Anyway, he said the surgery's success is not jeopardized by waiting....so wait, I will.
I waited 2 years to have my knees replaced. Once I had the first one done there was no way I was waiting. I had the other done 8 months later. Pain was out this world but thats what pain meds are for. Physio was tough but I did everything they wanted of me. I just medded up before an appt. I know there is more surgery in my future. I will not hesitate to use that tool for better mobility but in the mean time I have steriod shots to keep me going :). Plasma huh??? going to look that one up for my hip thanks for the info.
good luck with whatever you decide Q2. Always a big decision to have surgery. I would definitely investigate your next surgeon. do not be afraid to ask how many of his patients have had infections. Get his percentage.
The doctor told me he's only had one patient that got an infection and needed to have the joint replaced. He's done hundreds of surgeries so that is not bad odds.
I know what you mean about wanting good years now and risking the later years. Honestly I don't think I will live to be very old so what the heck am I saving for? Honestly though, I'm pretty chicken about this surgery. I've heard pretty awful things about what to expect. My doctor told me , "You're always in pain anyway....and you're a trooper so it will not bother you." Trooper or not, I don't LIKE pain and am not looking forward to it.
Of course there will be pain, it’s surgery! But the pain is finite with surgery. As long as everything goes according to plan, the result will be less pain. And, let’s face it, we cope with pain every day and somehow manage to go on. I think we are pretty tough!
Surgeons do like to wait on joint replacements, even with “normal” patients. Like Lamb said, the parts to wear out in 10 years or so. The waiting reduces the number of surgeries you will need in your life. I understand this logic, but for me I would choose to have surgery at a younger age. There is less risk, and I would be more physically able to handle the recovery period. I would look at the odds for me needing subsequent surgeries on that joint too. Even if I needed a second surgery, I would rather have THAT at a younger age too for the same reason I mentioned earlier.
Like I said before, make sure that you line up plenty of help so that you can focus on YOU. It helps to have support, even if it’s just someone to dinner.
I can't lie to you and say the surgery wasn't tough. It was definitely worth it.