Patient's Guide To Shoulder Replacement

What is a Total Shoulder Replacement? Preparations to be Made Before Surgery Getting Ready for Surgery Personal Preparations for Surgery Finalizing Arrangements Before Surgery

Hospital Stay After Surgery: Day-by-Day Leaving the Hospital Follow-Up Visit General Care Do's and Don'ts After Shoulder Replacement Surgery

What is a Total Shoulder Replacement Surgery?

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Your shoulder joint is composed of two parts: the round head of the humerus (the ball) and the glenoid (the cup or socket).

In a normal shoulder joint these two bones are coated with smooth articular cartilage that allows them to move against each other without friction or pain. In an arthritic shoulder, the cartilage layers are destroyed. Bone rubs against bone in the arthritic shoulder joint, causing pain and limitation of motion.

Shoulder replacement surgery replaces your arthritic shoulder joint with an artificial shoulder joint, composed of a metal ball and a plastic socket. The metal ball is attached to a stem, which is fixed into the shaft of the humerus or arm bone. The socket is secured to the shoulder blade. Once in place the artificial ball and socket function in essentially the same manner as your natural shoulder. Depending on your specific shoulder problem, your surgeon may replace the ball and socket or just the ball.

Preparations to be Made Before Surgery

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In consultation with your orthopedic surgeon, you have decided that shoulder replacement surgery is appropriate treatment for your shoulder condition. It is important to understand that this is elective surgery. Shoulder replacement surgery is not something that you must do. Other treatment options are available for arthritic shoulders that do not involve surgery. Nonoperative treatment for your shoulder includes medicine for pain and inflammation, physical therapy, and restricting your activities. Many patients try these nonsurgical measures before choosing surgery. Generally, shoulder replacement surgery is very successful. In most cases shoulder pain is relieved and patients can resume many activities. It is not clear how long a shoulder replacement will last. The long-term success rate will vary depending on your age, and your activity level.

Shoulder replacement is considered major surgery. When making the choice for shoulder replacement surgery, it is important that you are aware that there are potential risks and complications. These include problems from anesthesia, infection, surgical bleeding, damage to nerves or blood vessels, and, very rarely, death. The artificial shoulder can dislocate if the ball comes out of the socket. With time, a shoulder replacement can become loose or wear out, requiring further surgery. These and other potential problems are uncommon but possible. Whenever possible, precautions are taken to avoid complications.

Getting Ready for Surgery

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Once you have decided to have your shoulder replaced, there is much to do to prepare for the Lahey Clinic provides a team approach to your care,day of surgery. Lahey Clinic provides a team approach to your care. You will have a chance to meet many of the team members before surgery. They will answer your questions and help make necessary arrangements so that your surgery and hospital stay go as smoothly as possible.

Physical Examination Tests

Generally, a physical examination by an internal medicine doctor is recommended to ensure that you are well enough to undergo major surgery. Consultation with other medical specialists may also be necessary. Several diagnostic tests, including chest x-ray, EKG, and blood and urine tests will be scheduled for you.

Blood Transfusion and Shoulder Replacement

Shoulder replacement typically does not require a blood transfusion. The decision to donate blood preoperatively should be discussed with

Meeting Your Physical Therapist

It is helpful if you can see a physical therapist before surgery. Your therapist can give you a preview of the kind of physical therapy you will receive in the hospital after your surgery. You will learn about the exercises you will be asked to perform after your surgery. Successful shoulder replacement requires successful surgery and successful rehabilitation.

Your Social Service Worker

It may also be helpful for you to visit with a member of the Lahey Clinic Social Service team before surgery. The social service person can help you plan your discharge from the hospital. He or she can tell you about options for physical therapy and nursing support when you return home. He or she can also discuss with you whether you should be transferred to a rehabilitation hospital at the time of discharge from Lahey Clinic. This kind of advance planning helps alleviate concerns you and your family may have about what will happen after you leave the hospital with your new shoulder.

Meeting the Anesthesiologist

You may have a chance to visit with an anesthesiologist or nurse representative before surgery. He or she will review your medical records and answer any questions you have about anesthesia.

Personal Preparations for Surgery

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Eat well-balanced meals. This is not the time for serious weight loss. Get plenty of rest. Cut back or eliminate alcohol. Exercise to improve and maintain muscle tone and joint motion. Cut back or eliminate smoking. Have fun and develop a positive attitude for shoulder replacement.

Prepare Your Home:

• Obtain a cordless phone.
• Stock freezer and pantry.
• Obtain clothing that is easy to put on and take off with one arm
• Remove scatter rugs.
• Make sure all doorknobs are clear and accessible.

Prepare For Hospital Discharge:

• Discuss hospital and discharge plans with relations and friends.
• Evaluate the options of home discharge or rehabilitation facility discharge.
• Review insurance coverage as it pertains to discharge.

Prepare A Hospital Bag:

• Low-heeled supportive shoes or sneakers.
• "Walkman" type tape player if you like music.
• Loose, comfortable clothing.
• Button down shirts
• Cash for newspaper, TV, etc.

Finalizing Arrangements Before Surgery

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An appointment will be arranged for you to see a member of the Orthopedic Surgery team, who may be your attending surgeon, a resident, or the orthopedic surgery physician assistant. He or she will check to be sure that all the necessary preparations for surgery have been made and will answer any final questions that you may have. You will be asked to sign an informed consent document.

A week before surgery, you should stop taking all anti-inflammatory medication, including such medications as aspirin, Advil, Motrin (or ibuprofen), Feldene, Naprosyn (Aleve), Clinoril, Voltaren, Relafen, Tolectin, Ansaid, or lndocin, to name but a few. If you are uncertain if your pain medication is a kind of anti-inflammatory drug, contact your doctor. It is permissible to take acetaminophen (Tylenol-regular or extra strength) for pain up until the night before surgery. Also, if you get a cold or the flu in the week or two before surgery, be sure to notify your doctor. You can eat or drink anything you wish up until midnight before the day of surgery. After that you must not eat or drink anything, unless directed otherwise by your doctor.

Hospital Stay

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On the morning of surgery, you will be admitted to the hospital and you will be asked to dress in hospital clothes. A name band will be placed on your wrist. Remove any ring from your fingers before surgery. All other jewelry must be removed until after the operation. You may wish to place your valuables in the Lahey Clinic Security Department for safekeeping. The safest choice is to leave jewelry and valuables at home. Your nurse will go over a preoperative check list with you.

Your nurse will record your temperature, blood pressure, pulse rate and respiratory rate. You will be asked to empty your bladder. An intravenous line will be started. The anesthesiologist may order medications to calm you and make you drowsy.

When the operating room is ready and the operating team is assembled, you will be escorted into the operating room on a stretcher. In the operating room you will be transferred onto the operating table, where anesthesia will be induced. At this point, your shoulder replacement operation is ready to begin.

Family members who wish to wait in the hospital during your surgery may do so in the family waiting room across from the operating rooms. Your surgeon will report to them alter your surgery, if you request it. Otherwise, you can request your surgeon to call a family member or friend after surgery.

After Surgery: Day-by-Day

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To help you know what to expect during your hospital stay, we have developed the following schedule. This schedule details the sequence of events that usually follows shoulder replacement surgery. The sequence may vary from patient to patient.

Day of Surgery

When surgery is finished, you will be taken to the recovery room. You will be quite drowsy at this time, and you may not recall much about the recovery room experience. When you are ready, you will be transferred from the recovery room to your hospital room. Family members or friends may visit you in your hospital room. Sometimes it may be necessary for you to stay overnight in the recovery room. If so, family members may visit you briefly in the recovery room after 7:00 PM.

Alter surgery, you will be given liquids to drink. If you tolerate liquids, your diet will be advanced to regular foods. To control the pain you feel after surgery, you will be given strong medication through an injection or an intravenous line. Later, you will be given pills to take for pain.

The nurses will give you an incentive spirometer. This device will help you fully expand your lungs. It is important that you do this as often as you think of it—at least every hour when you are awake. You may discover that when you were anesthetized, a catheter was passed into your bladder to monitor your urine output. You will receive antibiotics to prevent infection. Your arm will be in a special sling. This sling is to be worn at all times

Planning for your discharge from the hospital begins now in earnest. except when performing physical therapy exercises.

Postoperative Day #1

• Blood tests may be drawn to monitor your recovery.
• Physical therapy begins: - You will be instructed in shoulder, elbow and hand exercises.
• The therapists and the nurses will help you out of bed and into a chair by yourself. Ideally, you will be able to get out of bed and into a chair two or three times on postoperative day one. You can walk around with your arm in a sling.
• A representative from the Social Service department may visit with you and your family. Planning for your discharge from the hospital begins now in earnest.

Postoperative Day #2

• The dressing over your wound will be changed.
• Discharge to our Rehabilitation hospital may be as early as postoperative day two.
• If a drain was placed in your wound, it is removed.
• If a catheter was placed in your bladder, it is usually removed on the first or - second day after surgery.

Physical therapy continues:

Shoulder, elbow and hand exercises

You should be getting into a chair at least three times a day.

You should begin walking in the hallways.

The social service representative, in discussions with you, your family, your physicians and your therapists, will finalize discharge planning. Discharge to home or rehabilitation hospital may be as early as postoperative day two.

Postoperative Day #3

• The dressing on your wound will be changed.
<>If you still need more inpatient physical therapy, you may be transferred to a rehabilitation hospital. (pain medicine may cause constipation), the nurses may offer you a suppository or an enema.

Physical therapy continues:

• You should learn to perform the shoulder elbow and hand exercises on your own and with assistance from family members
• You should practice to become independent with transfers.
• The Occupational Therapist will visit to assist you with performance of everyday living tasks.

Leaving the Hospital

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When you are medically stable, able to get in and out of bed on your own and familiar with the exercises, you may be discharged to home. Arrangements may be made for home or outpatient physical therapy. if you still need more inpatient physical therapy, you may be transferred to a rehabilitation hospital.

Here is some general information of interest to you as you plan to leave the hospital:

Before you leave the hospital, you will be given prescriptions for any medications that you need.

Otherwise, outpatient therapy will be prescribed by your physician during the postoperative phase. The social service team will assist you with these arrangements. Before you leave the hospital, you will be given prescriptions for any medications that you need, including pain medication, Usually you will resume taking all of the medications that you were taking before you came into the hospital. These medications should be reviewed with your regular doctor.

Follow-Up Visit

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Usually, your surgeon will want to see you in the outpatient clinic to remove skin staples or sutures two weeks after your surgery. If you go to a rehabilitation hospital, they may remove your staples or sutures. You will see your surgeon at the Lahey Clinic four to six weeks following surgery. An x-ray of your shoulder may be ordered during your four to six week follow-up visit.

General Care

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Wound Care:

You should keep a dressing over your wound if there is any drainage. If the wound is clean and dry, you can either leave it open to air or cover it with a dressing—whichever you wish. If you see increasing redness around your shoulder wound, drainage that persists or looks like pus, or if the wound becomes increasingly tender or warm, call your surgeon immediately.

Bathing:

You may shower after your skin staples or sutures are removed. Bathing is best done in the shower - getting in and out of a tub can be difficult and dangerous when recovering from shoulder surgery. A long-handled sponge can be helpful for bathing your lower body. Some surgery

patients find a tub seat in the shower helpful. Be cautious when walking on slippery bathroom floors.

Dressing:

Some patients will need assistive devices in order to dress independently. A stocking aid may enable you to put on your socks without bending over too far. A dressing stick or long-handled shoehorn may assist you in taking socks off. Long-handled reachers may assist you in putting on and pulling up your pants. You will be evaluated at the time of discharge for your particular needs.

Driving:

You should not drive until you can safely control your vehicle. This is your decision, not your doctor’s.

Sexual Relations:

You may resume sexual relations whenever you wish. Usually, it is best if you wait a few weeks

for your surgical discomfort to subside. A general rule for sex after surgery is to do what seems comfortable and enjoyable while keeping the arm in the sling for the first six weeks after surgery.

Dental Work:

Antibiotic prophylaxis should be considered for joint replacement patients undergoing dental procedures within two years of the time of joint replacement. Antibiotic prophylaxis is not necessary for joint replacement patients undergoing dental procedures two years or more following joint replacement surgery. If a patient has increased risk for infection, or if extensive dental work is anticipated more than 90 minutes), antibiotic prophylaxis should be considered regardless of the interval since joint replacement surgery.

Infections:

Rarely, infections from other sites of the body can travel through the blood and settle in the artificial shoulder, causing an infection. Anytime you suspect you may have an infection of any kind—of your skin, your throat, your urine, your teeth, etc., see your family doctor sooner rather than later. Let your doctor know that you have an artificial shoulder. He or she will decide whether it is appropriate to begin treating the infection with antibiotics.

Do's and Don'ts After Shoulder Replacement Surgery

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For the safety of your artificial shoulder replacement, you should adhere to the following precautions. It is especially important that you comply with these precautions during the first eight weeks after surgery.

• Follow the exercise guidelines set by your surgeon and the physical therapist
• Wear the sling for six weeks after surgery. Remove the sling for bathing, dressing and physical therapy.
• Do stay active. Walking is your most important physical therapy You should take daily walks, each time lengthening your walking distances as your strength improves.
• For the rest of your life, you should protect your artificial shoulder from undue stress by being careful about your activity. Heavy lifting should be avoided. Low-impact activities, such as walking, cycling, swimming, or golf are suitable activities for recreation and exercise after shoulder replacement. Talk to your surgeon about activities such as racquet sports and other sports you may be interested in pursuing.