You may need shoulder replacement surgery if you experience loss of shoulder motion, pain, and difficulty with the daily activities of life. These symptoms occur when cartilage on your shoulder joint have worn out from wear-and-tear or injury.
Total shoulder replacement replaces both the ball and socket of the shoulder joint. This surgery involves the doctor making an incision approximately 4-6 inches long along the front of your shoulder. The operation takes 1 ½-2 hrs and is performed under general anesthesia with a nerve block to reduce pain after surgery.
The top end of your arm is shaped like a ball. Muscles and ligaments then hold this ball against a cup-shaped part of the shoulder bone. During surgery the doctor will replace the top of the upper arm bone with a long metal implant that is inserted into your arm bone which has a rounded head. The cup-shaped surface of your joint is also replaced with a plastic and metal implant. These new shoulder surfaces will allow you improved motion.
You will awake from surgery in the recovery room with an I.V., bulky shoulder dressing, and a shoulder immobilizer/sling. Once your vital signs are stable and you are fully awake you will be transferred to your hospital room.
You should be examined by your family doctor to ensure you are healthy enough for the planned surgery. You are encouraged to stop smoking before surgery to prevent lung complications or delayed healing. Pre-admission testing (lab work, EKG, chest x-ray) will be scheduled prior to your surgery. Medications such as anti-inflammatory medications, aspirin, and blood thinning medications should be stopped one week before surgery unless otherwise specified by your family doctor.
Most people are able to get out of bed with help the day of surgery. Hospital stay is usually 1-2 days. You may be discharged home with nursing services and a therapist to help with your home exercises.
Once home you are encouraged to be up and walking several times per day for short periods to restore your physical strength. You may be more comfortable resting or sleeping in a recliner type chair.
Home exercises are to be done 6 times per day to prevent shoulder stiffness. Formal physical therapy will begin when instructed by your surgeon usually 1-2 weeks after surgery.
Blood clots: Symptoms of a blood clot include pain, swelling, or redness of your arm, calf or thigh. Call the office immediately if you develop any of these symptoms or go to the emergency room. If you develop sudden shortness of breath go to the emergency room or call 911.
Infection: Infection is rare but can occur following surgery. You are at higher risk if you have diabetes, rheumatoid arthritis, chronic liver disease, or are taking steroids. Symptoms include: drainage, redness, fever, foul smell or increased pain of surgical site.
Blood loss: It is possible you may need a blood transfusion following surgery. Your doctor will evaluate you daily to determine if this is necessary.
Nerve damage: Damage to your surrounding shoulder nerves is rare but can occur. Notify your doctor if numbness or tingling around the shoulder is prolonged or worsens following surgery.
Anesthesia complications: Risk of respiratory failure, shock, cardiac arrest, and death are always possible. Patients with long-term liver, kidney, heart or lung disease are at a higher risk. Nausea and vomiting from the anesthesia are common. Coughing and deep breathing as well as drinking fluids will help flush out the anesthesia gases.
Bone fracture: Although it is rare, a fracture could occur during surgery while fixating the implant.
Pneumonia: Lung congestion is possible following surgery when you are not as active. Coughing and deep breathing is encouraged to help you expand your lungs and clear any congestion.
Constipation: Bowel movements are slowed down with less activity and use of pain medications. Stool softeners will be encouraged after discharge to promote regular bowel movements and prevent constipation.
Dislocation of shoulder: Rarely happens but occurs when soft tissues around the shoulder joint are stretched too soon after surgery.
The average recovery period for shoulder replacement surgery is 4-6 months. Lower impact activities such as walking, biking and swimming are good forms of exercises after your recovery period.
Notify your family doctor if you develop any suspected infections so you can be placed on an antibiotic to prevent the spread of infection to your shoulder joint. Infections such as ear infections, ingrown toenails, bladder infections, sinus infections, and sore throats should be reported immediately. Make sure all of your doctors know you have had a joint replacement so you can be pre-medicated with an antibiotic before any dental work, bladder, bowel or vaginal surgeries or a colonoscopy.
Your sling must stay on at all times (even during sleep) and worn for 4 weeks following surgery. The chest strap wrapped around your body must stay on for the first 2 weeks. Ice to the surgery area (20min on and 20 min off) will help decrease your pain and swelling.
72 hours following surgery you may remove the dressing and shower but do not submerse your shoulder in water. You are allowed to remove your sling for showering only but keep your surgical arm at the side of your body during the shower. Soapy water may rinse over your surgical site but do not scrub this area. Pat dry the surgical site with a clean towel and leave the incision site open to the air. Do not apply any lotions, ointments, or Neosporin over the incision area.
Please perform the following exercises 6 times/day for 2 minutes each.
Stir the paint: Remove your sling and stand at a counter or table top. Bend forward and let your surgical arm dangle. Slowly move your arm in a circular motion as if you were stirring a can of paint. Repeat exercise going the opposite direction.
Handshake: Remove your sling and keep your elbow tucked in at your side. Move your surgical arm outward until you reach 90 degrees or a handshake position. Do not go over 90 degrees or move your elbow away from the side of your body.