GENERAL INFORMATION ABOUT UNDERGOING A SHOULDER REPLACEMENT

MINOR SURGICAL PROCEDURES OR DENTAL CARE

Do not schedule minor procedures such as urological manipulators or dental procedures such

as a teeth cleaning, cavity repairs or oral surgery within two weeks of your scheduled surgery.

SORE THROATS, COLDS AND FLU

If you develop a significant cold, sore throat or the flu within one week of your scheduled procedure, please call your surgeon. These conditions may increase the operative and anesthetic risks, and your procedure may need to be rescheduled.

URINARY TRACT INFECTIONS

If you develop a urinary tract infection within two weeks of your scheduled procedure, contact your family physician for treatment, and call your surgeon. This condition may increase the risk of a postoperative infection, and your procedure may need to be rescheduled.

DENTURES AND CONTACT LENSES

Contact lenses, dentures and plates CANNOT be worn in the operating room. Be sure to bring your container and solutions to keep these devices protected while you are in surgery.

CLOTHING

Remember to bring comfortable, loose-fitting bed clothing. A robe and slippers are recommended.

MEDICATION

If you are taking any anti-inflammatory medications especially aspirin, your surgeon will probably advise you to stop taking them one week prior to surgery. This helps to minimize bleeding during your operation. Anti-inflammatory medications include any form of aspirin, including coated or buffered aspirin, Disalcid, Indocin, Tolectin, Clinoril, Naprosyn, Nalfon, Meclomen, Motrin, Feldene, Orudis, etc.

Exception: If you are taking aspirin under the order of a physician because of a past history of stroke, heart disease or other vascular problem, you should continue to take your medication unless you have been advised it is OK to stop it. If you have any questions as to whether you should continue to take your medication, please discuss this with your specialist or family physician.

If you are taking other medications on a regular basis, you should bring them with you to the hospital. The doctors will advise you as to their continued use.

LENGTH OF STAY and WHAT TO BRING TO THE HOSPITAL

The normal length of stay varies from three to five days, although it may be longer or shorter depending on your individual case.

• A robe (long or short), slippers and toiletries.

• A loose fitting, buttoned shirt to wear home.

• Your own nightgown or pajamas to wear after surgery. Otherwise, hospital gowns will be provided for you.

• Books, magazines, stationery, hand crafts or hobbies.

• A small amount of money for stamps, etc.

• Any medications that you take on a regular basis.

• Containers and solutions for contact lenses, dentures and plates. These items CANNOT be worn in the operating room.

WHAT TO EXPECT PRIOR TO SURGERY

• Depending on when you are admitted to the hospital, you may speak to and be examined by a member of the department of anesthesia. They will ask you questions, explain the anesthetic procedure, and in some cases, allow you to choose the type of anesthetic used.

• The nursing staff will take your temperature, pulse, respiration and blood pressure.

• You will be seen by a member of the surgical team when you are in the operating theatre.

• Your family may visit you the morning of surgery in your room if you like.

• Before going to the operating room:

  • Your shoulder area will be prepared if required.

  • You may brush your teeth and rinse your mouth, but do not swallow water.

  • Elastic support hose will be applied to your legs to help with circulation while you are lying on the operating room table and help prevent DVT's.

  • You will be asked to empty your bladder.

  • To receive medications, an intravenous (IV) line will be started in the holding area of the operating suite.

  • About an hour before your surgery, the nurse may give you a pre-med injection if this is requested by the anaesthetist.

  • Shortly after you are given your preoperative medication, you will be transferred to the preoperative waiting area.

• In the operating room, you will be transferred from the stretcher to a special operating room table. The room is equipped with special overhead surgical lights and anesthesia equipment.

RECOVERY ROOM

When the procedure is completed, your surgeon will contact your family or friends to update them on the success of your surgery if this was requested before the surgery. You will awaken after surgery in the post-anesthesia recovery room, probably feeling as though you were only away from your hospital room for a few minutes. You will remain there for an hour or so, or until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. If you have pain, the nurses will administer medication. Your arm may be supported in a sling.

WHAT TO EXPECT AFTER SURGERY

Your dressing will probably be changed on the first or second postoperative day, and cold compresses may be applied for up to two days.

The IV will remain in your arm for one to two days to administer fluids and antibiotics. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. It is normal to feel pain and discomfort after surgery. Be sure to inform your nurse of your pain, and medication will be ordered. You may be able to administer your pain medication through a push button attached to your bed. This system is called "Patient Controlled Anesthesia" (PCA). The nurses will show you how to use this system, which is designed to prevent over-dosage of the pain medication. You will begin taking oral pain medications as soon as you are able.

-Your arm will be in a shoulder immobilizer, which protects and positions your shoulder, or it may be placed in a shoulder splint. Keeping a small pillow or folded blanket under your elbow while sitting or lying down will prevent the arm from falling back and straining the area of your operation.

-A trapeze bar attached to the bed will help you move about more easily. It is important that you use only your non-operated arm with the trapeze. You do not want to turn on or move your postoperative shoulder until instructed that it is alright to do so by your surgeon. The nurse will help you find comfortable positions.

-On the day after  your surgery, the physiotherapist may remove the sling and gently move your operated arm. They will give you instructions on how much you can or should move your arm.

-The nurses and physiotherapists will encourage and help you to stand, walk and do your pendulum exercises on the day after surgery. Your physician will also direct you on the use of your arm for special stretching and range of motion exercises.

-On the first or second day after surgery, you will be encouraged to use your involved arm for some gentle living activities such as feeding yourself, brushing your teeth, shaving and drinking.

EXCERCISES/PHYSIOTHERAPY

The postoperative rehabilitation program depends on the type of procedure performed. It normally begins the day after surgery. It consists of stretching exercises and normal, gentle daily activities. The postoperative rehabilitation program is critical, and it is important that you cooperate, follow your surgeon's instructions and work hard.

Pain medication may be taken prior to your therapy as you request. A physiotherapist will gently move your arm and shoulder through various positions while you relax. These early movements and exercises will help prevent stiffness and will help you regain shoulder motion. You will also work on tightening the muscles of your hand and arm by flexing your hand, wrist and elbow.

Your therapist will teach you the safest methods for getting in and out of bed or a chair, and on and off the toilet. You will be allowed to go to the bathroom and sit in a chair on the first day after surgery. Your therapist will check your progress daily and will keep your surgeon informed.

Click here for more details on the postoperative rehabilitation program

PROGRESS

Depending on your progress, you will gain independence about one week after surgery. You will continue strengthening yourself in preparation of your return home. It is important for you to adhere to precautions and proper positioning techniques throughout your rehabilitation. Your stitches will be removed seven to ten days after surgery. It is not uncommon to still experience pain at the surgical site. Your recovery period may last three to six months.

PREPARING TO GO HOME

Just before your discharge, you will receive instructions for your at-home recovery, including how and when to wear your shoulder sling, changing your bandage and bathing and showering. The staff will also give you directions and the necessary equipment to continue your rehabilitation program at home, any prescriptions for medication and a date for your return appointment.

AT HOME

Until you see your surgeon for your follow-up visit, you must take certain activity precautions. Look for any changes around your incision. Contact your surgeon if you develop any of the following:

• Drainage and/or foul odor from the incision.

• Fever ( 38 degrees C) for two days.

• Increased swelling, tenderness, redness and/or pain.

• Take time to adjust to your home environment - it is okay to take it easy. You may need help with your daily activities, so it is a good idea to have family and friends prepare to help you. It is normal to feel frustrated, but these frustrations

RESUMING ACTIVITIES

• Walk as much as you like, but do not tire yourself.

• With the help of family or friends, you will need to do the exercises you learned in the hospital four to six times daily. These exercises will gradually increase the movement in your joint, so it is important to do them as scheduled. Do not skip your stretching exercises.

• As necessary, rest in bed. But be sure to get out of bed and walk a bit at least every hour during the day to prevent blood clots forming in your legs (DVTs). Be sure to rest on your back.

• For bathing, wash your armpit with warm water and dry the area thoroughly. Four days after surgery, you may take a shower. To do this, you should remove the bandage, but leave the sutures in place. After the shower, you may apply a clean bandage. It is OK to leave the wound uncovered. Use only roll-on or stick deodorants. Avoid spray deodorants because they may irritate your incision.

• Your surgeon will tell you when you can begin driving a car.

• You may return to work when authorized by your surgeon.

You are encouraged to return to your normal eating and sleeping patterns as soon as possible, and to be as active as possible in order to control your weight and muscle tone. But remember to increase your activity level or exercises only as your surgeon has directed. Increasing activity too quickly may cause injury and damage to the healing tissue. Avoid activities that could cause stress on your shoulder, especially those that may result in a collision or fall such as contact sports or skiing. During your follow-up visits, your surgeon will discuss your progress with you.

Special Instructions

CONTACT YOUR FAMILY DOCTOR IF:

You develop colds; fever, sore throat, or other general physical difficulties that cause you concern.

CONTACT YOUR SURGEON IF:

You develop an increase in shoulder pain, drainage, swelling, elevated temperature or have questions about your rehabilitation program.

MEDICATION/PAIN CONTROL

It is normal for you to have some discomfort. You will receive a prescription for pain medication before you leave the hospital. If a refill is needed, please call your local doctor. Remember to call your surgeon if you have an increase in discomfort or pain.

FOLLOW-UP

You may be seen six weeks, six months and twelve months after your surgery. You may also see your surgeon once a year after the first year, even if you are not having any problems.

Note for the future: You should always tell your dentist or physician that you have an artificial joint. If you are having dental work performed, please notify your dentist or physician so that they can give you antibiotics for the day before and day of your dental care. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life.

Any infection must be promptly treated with proper antibiotics because infection can spread from one area to another through the blood stream. Every effort must be made to prevent infection in your artificial joint. Your surgeon can give you instructions on the use of special antibiotics. If you have any questions about the use of antibiotics

RISKS OF SURGERY

Joint replacement in general is highly successful and has a low rate of complications. However, it is important for patients to be well informed about the possible risks. The risks of this procedure include but are not limited to the following: infection, injury to nerves and blood vessels blood clots, bleeding, fracture, stiffness or instability of the joint and dislocation of the new joint, loosening of the artificial parts, failure of the rotator cuff, pain, and the need for additional surgeries. There are also risks of anesthesia, which you should discuss with the Anesthesia Team. Blood transfusions are occasionally necessary.

 In the post-surgical period blood clots may form in the calf or thigh. To reduce the number of clots and the chance that they will migrate to the lungs, surgeons employ medications to reduce clotting and mechanical devices that encourage blood flow in the legs. Bleeding during surgery may result in the need for a transfusion.   Patients may donate their own blood ahead of time in case this is becomes necessary. However transfusions are only very rarely required.

Infection may occur anytime after the surgery and may require removal of the prosthesis. Antibiotics are employed to help prevent infections during the surgery and for the first day following the surgery. Dislocation may occur and require revision surgery.

Finally, the new joint might fail or become loose. Most joint replacements are expected to last 10 to 20 years but some fail sooner and may require revision surgery.

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