Total Shoulder Anthroplasty
What are the Treatment Options?
Circumstances vary, but generally patients are considered for total joint replacement if:
- Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living
- Pain is not relieved by more conservative methods of treatment — such as medications (including but not limited to, cortisone or steroid injections and other anti-inflammatories) and physical therapy — and/or by restricting activities
- Stiffness in the joint is marked and, in the shoulder, significantly limits range of motion of the arm
- X-rays show advanced arthritis or other problems
Advancements in Shoulder Replacement
If you’re reading this website, chances are you’re considering or preparing for shoulder surgery. But don't worry — because shoulder replacement has been proven to relieve severe shoulder pain and restore function in the vast majority of patients.
Advancements in the design of shoulder prosthesis allow the potential for you to restore your range of motion. Developed with patient comfort in mind, the Solar® Shoulder is designed for a more natural feel throughout range of motion.
The Solar® Shoulder is designed to replicate the natural anatomy of the patient and help provide you with maximum range of motion so you can get back to the activities you enjoy.*
As you read, make a note of anything you don’t understand. Your orthopaedic surgeon will be happy to answer your questions so that you’ll feel comfortable and confident with your chosen treatment plan.
According to the American Academy of Orthopaedic Surgeons, approximately 23,000 people have shoulder replacement surgery each year. Shoulder problems may arise because of injury to the soft tissues of the shoulder, overuse or underuse of the shoulder, or even because of damage to the tissues. Shoulder problems result in pain, which may be localized to the joint or travel to areas around the shoulder or down the arm.
Risks of the Procedure
The complication rate following joint replacement surgery is very low. Serious complications, such as joint infection, occur in less than 2% of patients. Nevertheless, as with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications — many of which can be successfully avoided and/or treated.
Possible complications include:
Infection: Infection may occur in the wound or within the area around the new joint. It can occur in the hospital, after the patient returns home, or years later. Following surgery, joint replacement patients receive antibiotics to help prevent infection. Joint replacement patients may also need to take antibiotics before undergoing any medical procedures to reduce the chance of infection spreading to the artificial joint.
Blood Clots: Blood clots can result from several factors, including the patient's decreased mobility following surgery, which slows the movement of the blood. There are a number of ways to reduce the possibility of blood clots, including:
• Blood thinning medications (anticoagulants)
• Elastic support stockings that improve blood circulation in the legs
• Plastic boots that inflate with air to promote blood flow in the legs
• Elevating the feet and legs to keep blood from pooling
• Walking hourly
Lung Congestion: Pneumonia is always a risk following major surgery. To help keep the lungs clear of congestion, patients are assigned a series of deep breathing exercises.
What to Expect
1. Arrive at the hospital at the appointed time.
2. Complete the admission process.
3. Have final pre-surgery assessment of vital signs and general health.
4. Remove all personal belongings – dentures, hearing aids, hairpins, wigs, jewelry, glasses, contact lenses, nail polish, all underwear – and leave them with your family or friends during surgery. You will be dressed in a hospital gown and nothing else.
5. There will be several checks to make sure the correct joint is being replaced: your surgeon will review your X-ray and mark the area to be operated on; nursing staff will check the consent form you signed to make sure it agrees with the procedure on the operating room list.
6. Final meeting with anesthesiologist and operating room nurse.
7. Start IV (intravenous) catheter for administration of fluids and antibiotics.
8. Transportation to the operating room.
Many people will be with you in the operating room during your one to three-hour surgery, including:
• Orthopaedic surgeon(s) – your doctor(s) who will perform surgery.
• Anesthesiologist or nurse anesthetist – the doctor or nurse who gives you anesthesia.
• Scrub nurse – the nurse who hands the doctors the tools they need during surgery.
• Circulating nurse – a nurse who brings things to the surgical team.
Your surgeon and the anesthesiologist or nurse anesthetist will help you choose the best anesthesia for your situation. No matter what type of anesthesia you have, be assured you will not feel any pain during the surgery.
Every hospital has its own particular procedures, however, they often follow the basic routine outlined below. Your surgeon and hospital where the surgery will be performed will provide you with information detailing their specific procedures.
• Arrive at the hospital at the appointed time
• Complete the admission process
• Final pre-surgery assessment of vital signs and general health
• Final meeting with anesthesiologist and operating room nurse
• Start IV (intravenous) catheter for administration of fluids and antibiotics
• Transportation to the operating room
• Joint replacement surgery — generally lasts 1 to 2 hours
• Transportation to a recovery room
• Ongoing monitoring of vital signs until condition is stabilized
• Transportation to individual hospital room
• Ongoing monitoring of vital signs and surgical dressing
• Orientation to hospital routine
• Evaluation by physical therapist
• Diet of clear liquids or soft foods, as tolerated
• Begin post-op activities taught during pre-op visit
In the days following surgery, your condition and progress will continue to be closely monitored by your orthopaedic surgeon, nurses, and physical therapists. Much time will be given to exercising the new joint, as well as deep breathing exercises to prevent lung congestion. Gradually, pain medication will be reduced, the IV will be removed, diet will progress to solid food, and you will become increasingly mobile.
Joint replacement patients are generally discharged from the hospital when they are able to achieve certain rehabilitative milestones, such as getting in and out of bed unassisted or walking 100 feet. Whether you are sent directly home or to a facility that assists in rehabilitation will depend on your physician’s assessment of your abilities.
I. What to do Before you Check In
Preparing for total joint replacement begins weeks before the actual surgery. In general, you may be told to:
1. Donate blood – While some total joint procedures do not require blood transfusion, you may need blood before or after surgery. You may use donor blood or plan ahead to make an autologous donation of your own. You may also have a family member or friend with the same blood type as you designate a donation specifically for you.
2. Exercise under your doctor’s supervision – It’s important to be in the best possible overall health to promote the best possible surgical experience. Increasing upper body strength is important to help you maneuver a walker or crutches after surgery. Strengthening the lower body to increase leg strength before surgery can reduce recovery time.
3. Have a general physical examination – You should be evaluated by your primary care physician to assess overall health and identify any medical conditions that could interfere with surgery or recovery.
4. Have a dental examination – Although infections after joint replacement are not common, an infection can occur if bacteria enter the bloodstream. Therefore, dental procedures such as extractions and periodontal work should be completed before joint replacement surgery.
5. Review medications – Your orthopaedic surgeon can tell you which over-the-counter, prescription medications and herbal supplements should not be taken before surgery.
6. Stop smoking – Breaking the habit is particularly important before major surgery to reduce the risk of post-operative lung problems and improve healing.
7. Lose weight – For patients who are overweight, losing weight helps reduce stress on a new joint.
8. Arrange a pre-operative visit – It’s important to meet with healthcare professionals at the hospital before surgery to discuss your personal hospital care plan, including anesthesia, preventing complications, pain control and diet. Bring a written list of past surgeries and medications and dosages you normally take at home.
9. Get laboratory Tests – Your surgeon may prescribe blood tests, urine tests, an EKG or cardiogram, and chest X-ray to confirm you are fit for surgery. These tests should be performed within 14 days of the scheduled surgery in order to be acceptable.
10. Complete forms – You will need to fill out a consent form for your surgeon confirming that you agree to have the operation and that you know the risks involved, as well as hospital forms about your past history, medications, previous operations, insurance and billing information.
11. Prepare meals – You may want to prepare meals in advance and freeze them so they’re ready when you return.
12. Confer with physical therapist – The physical therapist will record a baseline of information, including measurements of current pain levels, functional abilities, the presence of swelling, and available movement and strength. You will also practice post-operative exercises using either a walker or crutches.
13. Plan for post-surgery rehabilitative care – Total joint replacement recipients may need help at home for the first few weeks, including assistance bathing, dressing, preparing meals and with transportation. If you can’t arrange for someone to help you at home, you may need to stay in a rehabilitation or skilled nursing facility. A medical social worker can assist with arrangements. Home therapy visits should end when you can safely leave the house and outpatient physical therapy should begin.
14. Fast the night before – No eating or drinking after midnight before surgery; however, you may brush your teeth or have a few sips of water if you need to take medicines. Discuss the need to take medications such as insulin, heart or blood pressure pills with your doctor or nurse to make sure you don’t miss them.
15. Bathe surgical area with antiseptic solution – Use antiseptic scrub brushes supplied by your health team the night before and morning of to reduce the risk of infection. Tell the nurse if you are allergic to iodine or soap. If possible, shampoo your hair. You must remove all nail polish and make-up. Do not shave your legs within 3-4 days of surgery.
What to Expect, What to Watch For, & How to Recover Safely
When you leave the hospital, your family will need to bring extra pillows for you to sit on in the car. It will be most comfortable to sit in the front seat. Your physical therapist will show you how best to get in and out.
All of the tubes will be out. All that should remain is a bandage on your wound site. If you have been instructed to use an abduction wedge you will still need to use this at night when you are sleeping.
You’ll need to continue taking medications as prescribed by your doctor. You may be sent home with prescriptions for preventing blood clots, some of which require monitoring through blood draws two times per week. Make sure to take pain medication 30 minutes before exercises—it’s easier to prevent pain than to chase it later.
Your surgeon may recommend taking a multi-vitamin with iron daily for a month. You may also be advised to take 1-2 enteric-coated aspirin daily for 6 weeks and non-steroid anti-inflammatory medication for pain and swelling unless you are on blood thinners such as Coumadin or Lovenox. Check with your doctor about special precautions while on these bloodthinning medications.
On the first day after your surgery, you may get out of bed and begin physical and occupational therapy — typically for several brief sessions a day. These are first steps on your way to getting back into the routines of your life!
In the days following surgery, your condition and progress will continue to be closely monitored by your orthopaedic specialist, nurses, and physical therapists. A good deal of time will be given to exercising the new joint, as well as deep-breathing exercises to prevent lung congestion. Gradually, pain medication will be reduced, the IV will be removed, diet will progress to solid food, and you will become increasingly mobile. Every individual is different, and insurance coverage will differ as well. Generally speaking, a total of four days (including the day of the surgery) in the hospital is typical.
Joint replacement patients are generally discharged from the hospital when they are able to achieve certain rehabilitative milestones, such as getting in and out of bed unassisted or walking 100 feet. Your physician will assess your progress and decide whether you are ready to go directly home or to a facility that will assist with your rehabilitation.
Usually a case manager is assigned to work with you as you move through your rehabilitation routines. As the days progress, expect to become more independent using two crutches or a walker.
If you need to work with a physical therapist after your joint replacement surgery, the therapist will begin an exercise program that you can perform in bed and in the therapy department. The physical therapist will work with you to help you gain confidence and increase your range of motion.
To help you gain confidence with your new joint, the physical therapist (or nurses) will also show you:
• How to get out of bed
• How to use the bathroom
• How to get dressed
Leaving the hospital will depend on when you “graduate” from physical therapy. When you leave the hospital, the physical therapist should give you a list of activities, exercises, and “do’s and don’t’s” to follow. An occupational therapist or nurse may also be assigned to help with special needs. An occupational therapist may show you how to use certain devices that assist in performing daily activities, such as putting on socks, reaching for household items, and bathing.
You shouldn’t be surprised if you feel a little shaky and uncertain for the first day or two after you’re discharged. However, you should soon get a routine going and gain confidence in your new joint — the start of a new life with less pain. (As with any surgery, expect to take pain medication for a few days while you are healing.)
If you had a hip or knee replacement, you may need a walker and/or crutches for about six weeks, then a cane for another six weeks or so. Your doctor or orthopaedic specialist as well as your case manager will be in touch with you, so use these opportunities to ask questions or discuss concerns, and keep your team up-to-date on your progress.
The decision to resume a normal daily routine is one that only you and your doctor or orthopaedic surgeon can make. However, there are some general guidelines that your doctor may give you.
• You should have no restrictions on leaving your home as long as your safety and comfort are assured. Just don’t tire yourself out; a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength.
• You may need to take antibiotics before dental work (including dental cleaning) and any surgical procedure that could allow bacteria to enter the bloodstream. Ask your healthcare provider whether you will need to take antibiotics at certain times to prevent infection.
• When to resume driving a car, going back to work, and/or participating in sports activities are all highly individualized decisions. Be sure to follow your doctor’s or orthopaedic specialist’s advice and recommendations.
The success of your joint replacement will strongly depend on how well you follow your orthopaedic surgeon’s instructions. As time passes, you will potentially experience a dramatic reduction in joint pain and a significant improvement in your ability to participate in daily activities. Remember, however, that joint replacement surgery will not allow you to do more than you could before you developed your joint problems.
It’s important to have realistic expectations. For example, artificial joints have limitations:
• Excessive joint “loading” because of the patient being overweight or strenuous activity, such as running and hiking, may injure the artificial joint.
• The artificial joint will not restore function to the same level as normal, healthy bone.
• The life span of the artificial joint is not infinite. It cannot be expected to equal that of normal, healthy bone.
• Adverse effects may result in a need for additional surgery, including revision or removal of the artificial joint.
• You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.
Shoulder Care & Bathing
• Keep your dressing, splint, cast and/or sling in place until your first post-op visit
• Dressing will be changed at your first post-op appointment
• Tegaderm dressing will be placed which will allow you to shower immediately
• No bath or swimming until the bandages are removed
• If the tegaderm dressings become loose or fall off replace with over the counter water proof bandages
• Keep incision dry until sutures are removed
Elevation and Circulation
• Elevate the extremity on pillows with fingers point toward the ceiling as much as possible for the first 3-5 days.
• After these first few days, continue to elevate as needed in order to reduce swelling.
• To encourage circulation and decrease swelling, wiggle your fingers, thumb and wrist several times each hour.
• To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling.
• To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
• It is not necessary to use ice while sleeping.
• We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.
• Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol.
• While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
• No driving while taking any narcotic pain medication!
• The pain medication may cause some nausea so take it with food.
• The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.
• Watch for temperature > 101.5F, persistent numbness and tingling, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
• If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.