What to expect

In the weeks before surgery

• Arrange a pre-surgery visit with your doctor.
• Get lab tests that the doctor orders.
• Complete health forms.
• Prepare and freeze some meals to make it easier when you get home.
• Choose and talk to a physical therapist to learn some important activities for after surgery.
• Talk to your surgeon’s team about if or when to stop your routine medications.
• Ensure transportation to and from your surgery is discussed, as well as any mobility needs if you use a walking aid or wheelchair. Ask your doctor or hospital staff for help in making arrangements if you cant not obtain adequate help with transportation or home come following your surgery.
• Talk to your surgeon’s team about what to wear and bring to the facility on the day of your surgery to make your stay more comfortable
• Pick up any items that may be easily tripped over.
• Place frequently used items within easy-to-reach, low level locations.
• Put comfortable, loose fitting clothing in easy-to-reach location.
• Exercise under your doctor’s supervision.
• Get a physical.
• Get a dental checkup.
• Stop smoking.
• Lose weight if you’re overweight.

The night before

• Fast – nothing to eat or drink.
• Bathe the surgical area with the antiseptic solution provided to you.
• Prepare to bring all your regular medications with you to the hospital or surgery center if required by your surgeon and care team.

Day of surgery

Every hospital and surgery center has its own procedures, but you may expect to follow this basic routine:

• Arrive at the hospital at your appointment time and complete the registration and admission process.
• Your care team will assess your vital signs (like blood pressure and temperature) and your general health.
• You’ll change into a hospital gown and likely settle into a pre-surgery room.
• Your anesthesiologist and operating room nurse will come in to talk with you, and the team will start the IV (intravenous) line that will be used to administer fluids and medication.
• Your family can stay with you until the team wheels to the operating room where your orthopaedic surgeon and your surgical team will perform your shoulder surgery.
• After the surgery, you’ll be wheeled into a recovery room where your recovery team will monitor your vital signs until you’re ready for transport to your hospital room.
• From there, the hospital floor nursing team will continue to monitor your vital signs and your incision site and dressing.
• You may be surprised how quickly you’ll be evaluated by a physical therapist. The team will get you moving with special post-op activities. You’ll also be allowed to eat and drink as you can tolerate it

Talk to your doctor
Like any surgery, joint replacement surgery has serious risks. Your surgeon can explain all of the possible complications of the surgery, as well as side effects, in greater detail.

During surgery

• You will be transferred to a stretcher prior to going to the operating room.
• How long is surgery?
  Surgery time depends on the complexity of each shoulder replacement. In general, expect to spend two hours in surgery and another two to three hours in the recovery room. Every patient is different and individual surgery times will vary. In general, most patients spend two hours in surgery and another two to three hours in the recovery room.
• The operating room will be bright, loud and there will be several people in the room.
• Anesthesia will be administered.
• What type of anesthesia will I have?
  You may receive general anesthesia, a regional anesthesia (just numbing the shoulder joint), or a combination of both. Ask your anesthesiologist about the method recommended for you and any other concerns you have.
• Your shoulder will be scrubbed and sterilized.
• A small incision is made over the front part of the shoulder to expose the joint (approximately 4-8 inches long).
• The bones of your shoulder will be visible and your orthopaedic surgeon will use specialized tools to prepare the bone to accept the implants.
• Your shoulder replacement is complete and the incision is closed.
• A sterile surgical dressing is applied.

What happens after the surgery while I’m in the hospital?
You’ll be wheeled from the recovery area to your hospital room on the orthopaedic surgery floor a few hours after surgery. You may still have an IV for fluids and pain medication. The first night following surgery you may feel groggy from anesthesia and pain medication, but once you’re fully awake, you may be able to eat and drink if allowed by your doctor. Your care team will be monitoring your vital signs, urinary output, and drainage from the incision site.

The next day, your care team may begin getting you out of bed and you’ll likely have both physical and occupational therapy working with you to get you moving safely and feel more confident when you move. The physical therapist focuses on teaching you exercises and stretches that encourage recovery. The occupational therapist will help you manage your day-to-day routine, like dressing, bathing, and reaching for things, while you’re recovering.

Will the surgeon speak to my family right after the surgery?
Typically, your doctor or one of the assisting surgeons will come out to the waiting area to talk with your family as soon as you’ve been taken into the recovery room. If your family misses seeing the surgeon, they should contact the surgeon’s office. Your doctor’s office will arrange a time for your surgeon to discuss your surgery with your family.

Will I see my doctor after the surgery while I’m in the hospital?
Doctors make rounds daily to see their patients whenever possible. Twice a day, the orthopaedic residents or physician assistants will likely monitor your progress and make any changes to your care schedule to help ensure you’re comfortable. In addition to your doctor and a resident or physician assistant, your case manager will meet with you (and family members, if necessary) in order to ensure the most appropriate discharge plan for you.

When will I be discharged from the hospital?
It all depends on you, your recovery process, and your doctor’s recommendation. Most people go home one to three days after surgery.

Recovery at home

What should I expect the first days after discharge from the hospital?
You will be sent home with your arm in a sling. You will play a large role in how well you recover. Follow your orthopaedic surgeon’s instructions for at home care. Be patient. If you have any concerns at all – call your doctor. Your case manager will check up on you in the first few days to ask you a few questions and see how you’re doing. If you have questions or concerns, tell your case manager.

What can I do when I get home after surgery?
Your doctor will likely give you a list of dos and don’ts. Follow them.

Caring for your incision
The incision along your shoulder may have been closed with staples on top of the skin or sutures underneath the skin. Staples are typically removed in your doctor’s office during your follow-up visit. Sutures may dissolve overtime as your shoulder heals. Avoid getting the area wet and follow your doctor’s instructions for changing the bandage, if necessary.

What can I expect with physical therapy?

• Your rehabilitation program will be determined by your orthopaedic surgeon and usually begins the day of your surgery and continues at home over the next few months.
• The total recovery period generally ranges from 3-6 months.
• Physical therapists are trained professionals in rehabilitation. With direction from your surgeon, they will determine an exercise program for you.

Ice or heat?

• Follow your care team’s instructions on how often and for how long you may use ice or heat during your recovery.

Driving

• Your orthopaedic surgeon will let you know when it is safe to drive.
• You should not drive until your new shoulder is strong enough to hold the arm in the horizontal position straight out in front of you.

Follow-up appointments

• Your orthopaedic surgeon will have you return for a follow-up examination to be sure your shoulder is healing properly. The first check-in may be within 2-weeks of your surgery.
• At the post-op appointment, x-rays may be obtained.
• The orthopedic surgeon and care team will determine the most appropriate follow-up appointment schedule for you as each patient’s needs vary. This may range from weeks, to months, to years depending on your individual needs.

Infection prevention

• It’s important to protect this new part of your body from infection, this may include taking an antibiotic before and after any invasive procedures you have in the future.
• Always notify your physicians and dentists that you have a shoulder replacement.

Returning to activities

• Your orthopaedic surgeon will let you know when it’s okay to return to activities and work, as this can vary depending on the physical activity involved with your work.
• Recovery varies and is unique to the individual.
• Keep in mind that you may have permanent activity restrictions, such as heavy lifting or impact loading sports.

When to call the surgeon
Call your orthoapedic surgeon immediately if you notice any of the following:

• Drainage or odor from the incision.
• Fever for more than one day.
• Increased pain unrelieved by pain medications.
• Sudden, severe shoulder pain.
• Increased redness around the incision.
• Increased swelling at the incision.
• A bulge that can be felt at the shoulder.
• Arm or shoulder pain, tenderness or swelling.
• Numbness or tingling of the arm.
• Change in arm length.
• Changes in color and temperature of the arm.
• Change in motion ability.
• A urinary tract infection, bronchitis or any other type of infection.