Shoulder Replacement Surgery

Realistic Expectations

Most people who undergo shoulder replacement surgery experience a dramatic reduction of shoulder pain and a significant improvement in their ability to perform daily activities.   

Following surgery, your operated arm will be immobilized at your side with the use of a specialized sling, known as an ultrasling, which has a supportive pillow. You may also be asked to avoid specific positions of the joint that could lead to dislocation. 

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Preparing for Surgery

This Pre-Surgery Checklist is typical. Ask your CJRI physician about any special preparations you might need to make.

  • Weight Loss  
  • If you are overweight, your doctor may ask you to lose some weight before surgery to potentially decrease the risks of surgery.
  • Medical Evaluation  
  • If you decide to have total shoulder replacement surgery, you may be asked to have a complete physical by your family physician several weeks before surgery to assess your health, and to rule out any conditions that could interfere with your surgery.
  • Dental Evaluation  
  • Although the incidence of infection after shoulder replacement is very low, an infection can occur if bacteria enter the bloodstream. Treatment of significant dental diseases (including tooth extractions and periodontal work) should be considered before your surgery.
  • Urological Evaluation 
  • A preoperative urological evaluation should be considered for individuals with a history of recent or frequent urinary infections. For older men with prostate disease, treatment should be considered prior to surgery.
  • Tests  
  • Several tests, such as blood tests, a urine test, and a cardiogram, may be needed to help your orthopedic surgeon plan your surgery.
  • Preparing Your Skin and Shoulder 
  • Your shoulder should not have any skin infections or irritation. Your arm should not have any chronic swelling. Contact your orthopedic surgeon prior to surgery if either of these conditions is present, for a program to best prepare your skin for surgery.
  • Medications  
  • Tell your orthopedic surgeon about the medications you are taking. You may be instructed to discontinue use of certain ones before surgery.
  • Social Planning  
  • You will need help for the first several weeks with such tasks as cooking, shopping, bathing, and transportation. If you live alone, case management at the hospital can help you make advance arrangements to have someone assist you at home.
  • Home Planning -- Make your home life easier during your recovery:
    • Stock up on nutritious ready-made and microwavable meals
    • Place items that you regularly use at arm level, so you don't have to reach up or bend down
    • Remove all loose carpets and electrical cords from the areas where you walk in your home
    • Reduce and/or eliminate clutter, which can be a safety hazard
    • Set up a "recovery center" in  your home in which phone, television remote control, facial tissues, wastebasket, pitcher and glass, reading materials, and medications are all within reach
    • Place a shower hose in your bath or shower 
    • Organize your clothes closets and drawers for easier access of clothing you plan to wear after surgery
    • Wear loose-fitting, stretchable clothing with minimal or no fasteners
    • Consider shirts that button in the front, or that have large neck openings 

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Upon Arrival at the Connecticut Joint Replacement Institute

The Surgical Procedure

You will be admitted to the hospital on the day of your surgery. After admission, you will be evaluated to determine what type of anesthesia is best for you. The most common type of anesthesia is general anesthesia. 

Your orthopedic surgeon will remove the damaged joint and replace it with biocompatible devices that provide a smooth and painless range of motion. The complication rate following total shoulder replacement is low.  Serious complications occur in less than 2 percent of patients.  Medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit your full recovery. Blood clots and infection are rare complications of this type of surgery. Your orthopedic surgeon will outline a prevention program. 

Hospital Stay

After surgery, you will be moved to the recovery room, where you will remain while your recovery from anesthesia is monitored. After you awaken, you will be taken to your inpatient, private room.

Call, Don't Fall

One of the highest risks for complications associated with joint replacement surgery is the danger of patients falling after surgery.

"Patients who have joint replacement surgery have typically experienced significant pain for prolonged periods of time. When they wake up post-operatively, they are suddenly pain-free due to the anesthesia and pain medication used in their operations and post-operatively,” said Kim Beekmann, R.N., CJRI’s executive director. “When they first try to stand, they often find themselves very unsteady.”

From pre-surgery classes through surgical preparations, CJRI staff stress to patients that regardless of their age or condition, they are at risk to fall following surgery.

“When patients come in for their surgery, we partner with them and family members by asking them to sign a pledge stating that they are aware that they are at risk of falling and that they will promise to give us a call anytime they need to mobilize — getting in or out of bed, a chair or the bathroom, so we can assist them,” Ms. Beekmann said. Patients are reminded of this pledge by staff at eight-hour intervals following surgery and through a message on the communication boards in their rooms that reads: Call — Don’t Fall.

In a further step to prevent patient falls, the beds on CJRI’s post-operative units are equipped with special monitors. "The beds are weight-activated so that if a certain percentage of the patient’s weight is lifted off the bed, it will trigger an alarm at the nursing station so that staff can come to make sure they have the assistance they need,” Ms. Beekmann said.

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At Home

When you leave the hospital your arm will be in a sling.  You will need the sling to support and protect your shoulder for the first two to four weeks after surgery.  The success of your surgery also will depend on how well you follow your orthopedic surgeon's instructions at home during the first few weeks after surgery.

Wound Care

You will have stitches or staples running along your wound or a suture beneath your skin along your wound. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal. Avoid soaking the wound in water until the wound has thoroughly sealed and dried. The wound may be bandaged to prevent irritation from clothing.

Diet

Some loss of appetite is common up to several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength.

Activity

Exercise is a critical component of home care, particularly during the first few weeks after surgery, and your active participation will affect the long-term results. You should be able to perform simple activities such as eating, dressing and grooming within two weeks following surgery. Driving is not allowed for two to four weeks after surgery.  Some pain with activity and at night is common for several weeks after surgery.

Your activity program should strictly adhere to these guidelines: 

  • Follow the program of home exercises prescribed for you.  You may need to do the exercises two to three times a day for a month or more. A physical therapist can help you at home or in a therapy center the first few weeks after surgery
  • Avoid placing your arm in any extreme position, such as straight out to the side or behind your body, for the first six weeks after surgery.
  • Avoid use of your arm to push yourself up in bed, or up from a chair.
  • Avoid lifting anything heavier than a glass of water for the first two to four weeks after surgery.

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Avoiding Complications

Preventing Blood Clots

Follow your orthopedic surgeon's instructions carefully to minimize the potential of blood clots that can occur during the first several weeks of your recovery. Warning signs of possible blood clots in your shoulder include:  

  • Increasing pain in your arm
  • Tenderness
  • Increasing swelling in your shoulder or arm

If you are experiencing any of the above symptoms, go to the emergency room immediately.

Warning signs that a blood clot has traveled to your lung include:  

  • Sudden increased shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

If you are experiencing any of the above symptoms, go to the emergency room immediately.

Preventing Infection

The most common causes of infection following total shoulder replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your shoulder replacement surgical site and cause infection.

For the first two years after your shoulder replacement, you must take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream. After two years, talk to your orthopedist and your dentist or urologist to see if you still need preventive antibiotics before any scheduled procedures.

Warning signs of a possible shoulder replacement infection are: 

  • Persistent fever (higher than 100 degrees)
  • Chills
  • Increasing redness, tenderness or swelling of the wound
  • Drainage from the wound
  • Increasing pain with both activity and rest

If you are experiencing any of these symptoms, call your CJRI surgeon.

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Joint Replacement to Restore Motion and Renew Vitality

Total knee, hip, and shoulder replacement surgery, as well as other surgical and non-surgical treatment for rheumatoid arthritis and osteoarthritis of the joints.

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