Total Shoulder Replacement

Ultimately, you should expect a significant reduction in pain and improvement in functionality for daily living activities.  Everyone’s situation is unique and therefore results very.  Although your shoulder will likely feel much better than it did before the surgery, the shoulder replacement is made of artificial parts and cannot be expected to function or feel like the shoulder you had when you were 16! 

Depending on your Body Mass Index (BMI), you may be told that you need to reduce your weight prior to surgery. People with a BMI score of over 40 can have a much more difficult time healing and have an increased risk of complications.
Here are some of the specific complications associated with obesity after joint replacement surgery:

• Infection
• Poor wound healing
• Difficulty breathing
• Blood clots
• Blood loss
• Pulmonary embolism (a blood clot in the lungs)
• Difficulty participating and meeting the required goals of the physical therapy program
• Falls resulting in catastrophic injury to the new and healing shoulder replacement.

 

CLICK HERE TO FIND OUT WHAT YOUR BMI SCORE IS AND MORE INFORMATION ON THE SUBJECT.

Potential risks of shoulder replacement surgery include but are not limited to:

• Blood Clots
• Blood Loss
• Infection of the Joint Replacement
• Shoulder Implant Loosening
• Fracture of the patient bone
• Numbness around the incision site
• Nerve dysfunction resulting in numbness and loss of control of the arm or hand
• Wound healing delay and/or wound separation

Your surgeon and the entire surgical team have worked diligently to put together a program that significantly reduces the risk of complications. Over the last few years the complication rates have definitely been reduced, but the potential for complications still exist and has not been completely eliminated.

Typically, patients who undergo Total Shoulder Arthroplasty can go home the day of surgery, but some may require a facility stay for observation if there are medical or social concerns. Each patient recovers differently but all must reach the following goals before being discharged home:

• Vital signs stable (Blood pressure, Heart rate, Temperature, Respirations)
• Ability to get from the bed to the bathroom and back to the bed safely.
• Ability to walk 50 feet down the hall and back.
• Ability to urinate.
• Nausea and/or vomiting controlled.
• No medication interactions or adverse side effects.
• Ability to tolerate eating and drinking.
• Pain reasonably controlled with Oral Medications.
• Diabetic patients must have their blood sugars well controlled.

• Shoulder replacements do wear and can eventually wear out. Unfortunately, an artificial shoulder is not as durable as your own natural shoulder. Because the shoulder replacement implants are made of metal and plastic, these materials do wear over time, similar to the treads on your car tires.

• Studies show that shoulder replacements can last up to and longer than 15-20 years. This is dependent on many factors. Activity level, weight, and age of the patient can affect the longevity of the joint. In general, we expect around 85% of shoulder replacements to be still functioning well after 15 years.

• Total shoulder replacement implants can often feel slightly abnormal and might make a slight snap or popping sound with certain activities or maneuvers. Typically, this is painless and does not present any problem.

• You may have relatively mild to moderate pain following the procedure, or you may have a more difficult time than others. Everyone is unique, handling and perceiving pain differently. Keep in mind that while pain management has greatly improved, a pain-free surgery is unlikely. You will want to take your pain medicines as directed by your surgeon. The instructions on the pill bottle describe the maximum dose and frequency of the prescribed pain medicine. It is preferable to reduce the number of narcotic pills taken as much as possible and minimize the amount of narcotic/opioids consumed.

• Most patients report fairly rapid relief of pre-operative pain.  However, there will be surgical pain.  Surgical pain will typically improve drastically over the first couple weeks.

• Typically, the incision will be about 5 inches long but depends on the surgical needs. Your surgeon will make the incision as small as possible, but the priority will be on being able to see everything to perform an excellent surgery.

• Severe stiffness is common in arthritis of the shoulder, many times due to the osteophytes (bone spurs) located in the joint. Correcting the deformity at the time of surgery is typical and a routine part of shoulder replacement surgery. After completion of the procedure, your shoulder should be able to recover much of the motion that was gradually lost due to your arthritis.

• Typically, regaining the ability to reach overhead after progressing with therapy is expected. Each shoulder replacement has its own set of circumstances and some may achieve a little more or a little less motion. The ability to reach the back of your head or to get a cup out of a cupboard is a reasonable expectation in most instances.

• Typically, a nerve block is used in conjunction with general anesthesia. There are other options available as well depending on what is best for each patient.

• It varies. Most patients will go home the same day, while some may need to stay overnight for observation. This is highly dependent upon your condition before surgery, your age, and medical problems which can influence your recovery. A safe discharge plan will be arranged for you by our orthopaedic team.

• The majority of people who undergo total shoulder replacement are able to participate in a majority of their daily activities by 6 weeks. By 3 months, most people have regained much the endurance and strength lost around the time of surgery, and can participate in daily activities without restriction. While daily activities have resumed, it is important to avoid high impact activities to give you the best long-term outcome with your shoulder.

• You can expect the majority of your recovery to occur within the first 12-16 weeks following shoulder replacement surgery however you can also expect the new shoulder to continue to slowly improve with respect to swelling, strength, and function for up to a year following the shoulder replacement procedure.

• Yes. In contrast to hip replacement surgery, almost all shoulder replacement patients require formal physical therapy in order to maximize the results of the shoulder replacement surgery. Ideally, this is performed at an outpatient physical therapy facility close to your home following your discharge from the hospital. Number of days per week and number of total weeks will vary from person to person. The goal is to keep making progress.

• We used advanced water proof bandages so you typically can take a shower 3 days postoperatively.

• You will need to wear the sling for most of the time for the first 4-6 weeks. You may come out of your sling when you are AWAKE and IN CONTROL of the shoulder to rest your shoulder, stretch your elbow, and move your wrist. When you are NOT in control of the shoulder (crowds, sleep, etc.) please use your sling to protect the shoulder. The sling is there to remind you to avoid reaching out to the side or reaching behind your back while your shoulder is healing.

• It depends. You may NOT drive if you are still taking narcotics. Depending on your insurance, there may be a policy for proximity to surgery or use of a sling. In general though, if you have an automatic transmission, driving with one arm is achievable. Around 6 weeks postoperatively, both arms should be able to be used to maneuver a car.

• Returning to work is highly dependent on your general health, activity level and the physical demands of your job. If you have a sedentary job, such as computer work, you can expect to return to work in two to three weeks. If you have a more demanding job that requires lifting or travel, you may need up to three months for full recovery.

• Very few. We advise against any extremes – no extreme positions or activities. Heavy weight lifting or heavy overhead lifting will put your new shoulder at risk of failing. However, most activities of daily living and most recreational activities should be well tolerated.

• Usually patients with joint replacements will set off metal detectors. This should not be of great concern. It is reasonable for you to inform the TSA screening agent at the airport that you have had a joint replacement; however, you will still require screening and will need to follow the directions of the screening agent. There are millions of individuals with joint replacements, and screening protocols recognize that people who have had joint replacements may set off detectors. Joint replacement documentation is not required.

Click Here To Watch A Video and Learn More About Metal Detectors and Your New New Joint!

• The American Academy of Orthopedic Surgery (AAOS) and American Dental Association (ADA) have generally recommended short-term antibiotics prior to dental procedures (one dose one hour prior to dental procedure) for patients who have had joint replacements. This recommendation continues for up to two years after your joint replacement.

• Two or more years after the replacement, continued use of antibiotics prior to dental procedures is based on the discretion of the treating surgeon and the patient. Your surgeon will consider many factors including whether or not you are at increased risk of infection due to immune suppression (i.e. diabetic, transplant patients, and rheumatoid arthritis).

• The use of prophylactic antibiotics prior to dental cleanings and other invasive procedures remains controversial. Most orthopaedic surgeons now recommend lifetime prophylaxis. Patients should discuss whether or not they need antibiotics prior to dental or other invasive procedures with their treating orthopedic surgeon.

• It is important to follow up with your surgeon after your joint replacement. In most cases, joint replacements last for many years.

• The frequency of required follow up visits is dependent on many factors including the age of the patient, the demand levels placed on the joint, and the type of replacement. We will consider all these factors and tailor a follow-up schedule to meet your needs.

• In general, seeing your surgeon every three to five years is recommended.

Yes. We have prepared a two-page document with instructions for your specific care after a total shoulder replacement.
These instructions cover very important subjects such as:

• WOUND CARE
• ACTIVITY
• MEDICATIONS
• RETURNING TO WORK
• SURGERY FOLLOW-UP
• YOUR DIET WHILE YOU HEAL
• WHEN TO CALL YOUR DOCTOR.

Click here to download these specific instructions.