What is arthritis?
Arthritis is where the smooth gliding cartilage (articular cartilage) wears away. As the arthritis becomes more advanced, portions can wear completely away until the underlying bone is exposed. Based on the integrity of your rotator cuff, you may be a candidate for a traditional or a “reverse” total shoulder arthroplasty
What happens during surgery?
Your surgeon will use specially designed instruments to free up any scar tissue/adhesions, and carefully remove the arthritic cartilage and damaged bone from your glenoid (shoulder socket), and the humerus (upper arm bone). The end of the humerus is replaced with metal and the gliding surface of the glenoid is replaced with plastic. Then after a perfect fit is insured, you wake up in the recovery room.
What is a “reverse” total shoulder arthroplasty?
When the patient no longer has a functioning rotator cuff, your surgeon will perform a “reverse” total shoulder arthroplasty. In this setting, the traditional position of the ball and socket part of the joint is reversed in order to allow other muscles surrounding the shoulder to function more effectively in moving your shoulder.
What do I need to do prior to surgery?
- You will be scheduled a preoperative appointment at our clinic. Dr. Kevin J. Murphy will review your surgical procedure with you, your medical history, answer questions, and provide you with a physical therapy prescription. You will get your postoperative pain prescriptions at that visit.
- If you have certain medical conditions, you may require preoperative clearance from your primary care provider, cardiologist, etc. This must be completed prior to surgery.
- You will require blood work and EKG which should be completed as soon as possible so we have time to review the results prior to surgery. Abnormal results could cause your surgery to be rescheduled.
- Typically we have you stop any blood thinner, including certain over-the-counter medicines that can thin your blood, such as vitamin E, Advil (ibuprofen), and Aleve (naproxen) 2 weeks prior to surgery. If a physician has placed you on a prescription blood thinner such as Plavix, Xarelto, Coumadin, or aspirin, please discuss this with your surgeon or his PA and we can tell you when to stop these medications.
- Please notify us of any:
- Allergies to medicine, latex, tape, or adhesives.
- Personal or family history of anesthetic complications
- Personal or family history of blood clots-deep vein thrombosis or pulmonary embolism
- History of postoperative infections
- Schedule your first postoperative physical therapy appointment for about one week after surgery. Do not wait until after surgery to set this up as some PT clinics book out weeks in advance
- Starting 5 days prior to your surgery, apply over the counter topical benzoyl peroxide to the surgical site once a day for 5 days to help reduce the risk of infection. (We can show you where to apply this at your preoperative visit)
- Drink plenty of water, sports drink, or other liquid without caffeine or alcohol the day before your surgery to hydrate yourself.
- Complete any last minute grocery shopping, meal preparation or any tasks that require two arms prior to surgery since you will be in a sling for one month after surgery and will not be able to drive for one month after surgery.
- Arrange for a responsible adult to assist you the first few days after surgery
- Prepare your home for your postoperative recovery by removing objects you could easily trip over such as throw rugs, clutter in the hallways, bedrooms, bathrooms, et cetera. Most people find it much more comfortable to sleep in a more upright position after surgery, such as in a recliner, or propping yourself up on several pillows/cushions in bed so you are at a 45° angle. Keep a cellphone or wireless phone nearby in case you need assistance.
- Do not eat or drink anything (including water) 8 hours prior to your surgery! Our office or the hospital/surgery center will give you specific instructions regarding any prescription medications you may be allowed to take the morning of surgery.
What do I need to do the day of surgery?
• You may take heart or blood pressure medications with a tiny sip of water, unless you were instructed to hold those medications by our office or the hospital/surgery center. Otherwise, do not eat or drink anything 8 hours prior to surgery!
• If your surgery is scheduled for later in the day, stay near a phone in case there is a cancellation and we need you to come in earlier.
• Take a shower before coming in, preferably with antibacterial soap.
• Where a loose-fitting top, such as a button-down shirt
• Please leave all jewelry, including body piercings (metal body piercings can cause burns if left in), and valuables at home.
• Bring your identification and insurance information with you
• Bring your sling and cooling unit (if you have one) with you
• Do not wear contact lenses, wear glasses instead.
• Do not mark or draw on either shoulder. Dr. Kevin J. Murphy will mark the correct surgical site when he sees you before surgery.
How long does surgery take and how long while I be in the recovery room?
Typically, the surgery takes up to 2 hours and most people during the recovery room for about 60-90 min.
What type of anesthesia is used?
A combination of general anesthesia as well as a regional anesthetic (nerve blocks) are used. The nerve blocks typically help with pain relief for up to 24-40 hours after surgery. Your anesthesiologist will discuss all the different options with you on the day of your surgery.
How long will I be in the hospital/surgery center?
With the advances made in pain control, the majority of people go home the same day. If, based on your health/medical needs your surgery is performed at the hospital, you may still go home the same day or possibly spend the night.
Will I have to have a catheter in my bladder?
No. These are only used if you cannot urinate on your own.
Will I need a blood transfusion?
It is very rare to require a blood transfusion after the surgery.
When can I take a shower?
Most people shower one or 2 days after surgery. You will have a special waterproof dressing on your shoulder after surgery.
Do I need to change the dressing after surgery?
You will receive detailed discharge instructions when you leave the hospital. We typically use a waterproof surgical dressing that will stay on your shoulder for 2 weeks after your surgery.
What type of pain medicine will like be on after surgery?
We used several different medications to help control pain after surgery. This way we are controlling pain through several different pathways. Each medicine works on a different part of your brain/spinal cord to decrease pain. As your pain is improving over the days/weeks after surgery, you will decrease the amount and frequency of your pain medicines. The following is a list of several different medications you may be on:
- Narcotics-you are typically on a short acting narcotic such as oxycodone (Percocet), or hydrocodone (Vicodin or Norco). The doses vary based on factors such as your age, weight, etc.
- Acetaminophen (Tylenol)- this is also used as a pain reliever after surgery, unless it is already mixed in with your narcotic in medicines such as Vicodin or Norco.
- Over-the-counter anti-inflammatory medicines- such as advil or aleve
- Stool softener-You will need to get Colace over the counter and you need to take this twice a day to help prevent constipation. If it is not effective, you may also take MiraLax in addition to this. If this is not effective, you may ultimately need an over-the-counter suppository, or even enema to help have a bowel movement. The best way to treat constipation is by preventing it in the first place by taking the smallest amount of narcotic pain medicine possible and by including fiber in your diet after surgery and drinking additional water.
What other medicines will be sent home on?
- Antinausea medicine-typically a prescription for promethazine (Phenergan) or ondansetron (Zofran) is given for convenience. We recommend you fill it but you only need to take it if you are having nausea. Taking your pain medicine with food will help prevent nausea.
When can I stop my pain medicine? How do I taper off of it?
You can stop your pain medicine as soon as to feel comfortable doing so. Your narcotic pain medicine will likely say to “take 1 or 2 pills every 4 hours as needed for pain”. If you are taking 2 pills, as your pain is decreasing you can switch to 1 pill, or increase the amount of time between doses to 5 hours, etc. based on your comfort level. Eventually, you will wean completely off of the medicine. As for gabapentin which is every 12 hours, people typically stop the daytime dose first, then take it only at night for a couple of days. You may also wean off of your anti-inflammatory medicine and/or Tylenol as needed.
Will I need a blood thinner after surgery?
Fortunately, the risk of blood clots following a shoulder replacement is relatively low. If you do not have a previous history of blood clots (deep vein thrombosis) then we typically just use aspirin (81mg) twice a day for 2 weeks, or resume your regular aspirin dose if you normally take aspirin. If you have a history of blood clots, please let your surgical team know.
What other methods are used to prevent blood clots after surgery?
- Early ambulation-we want you up and walking at least 3 times a day.
- TED hose-these are tight white compression socks, typically knee-high, that we have you wear 23 hours a day to prevent blood clots. These are used for a week after surgery.
When will I start physical therapy?
You will normally start outpatient physical therapy about 1 week after your surgery. If you are not strong enough, or your support system cannot get you to an outpatient physical therapist easily within the first 2 weeks after surgery, home health physical therapy can be arranged. However, our preference is to start outpatient physical therapy. Patients seem to see much more improvement with outpatient physical therapy than with home health therapy.
How long likely be in a sling?
Most people are in a sling for 4 weeks after surgery. You may remove your sling a couple of times a day to work on elbow, wrist and finger range of motion. Do not actively try to move your shoulder away from your body. You may remove your sling for showering. Otherwise, wear your sling at all times, including sleep.
How soon can I drive after surgery?
Most people are in a sling for 4 weeks after surgery and you are not allowed to drive until you are out of your sling and off of your narcotic pain medicine.
When can I return to work?
This depends on your profession. If you have a sedentary desk job, you should be able to return in 2-4 weeks. If you have a more physical job, it could be as long as 6-12 weeks before you could return.
How often will I follow up visits with the Doctor or physician assistant?
We typically see you at 2 weeks after surgery, 6 weeks after surgery and at 12 weeks after surgery. If everything is going well, then we typically don’t see you back until your one year anniversary from surgery. Obviously if there are any concerns, we will see you more frequently.
What type of exercise can I expect to return to after surgery?
Generally speaking, people are able to return to low impact activities such as golf, and doubles tennis.
Do I need to let my dentist know I had a shoulder replacement?
Yes! Typically, after a joint replacement surgery, patients need to be on antibiotics before they have any dental procedure, including a routine cleaning for the first two years after surgery. Call our office or your dentist several days before your dental appointment and we can call in a prescription for antibiotics that you will take 1 hour prior to your appointment.
What up out when I go through the security checkpoint at the airport? Will I set off the metal detector?
Yes. You will likely set off the metal detector. I typically tell patients to get there 5 min. earlier than you would normally arrive to allow for additional time.
At times my shoulder is achy after surgery, this is normal?
Yes, occasional achy pain and swelling can be experienced for up to 12 months after surgery.
What signs or symptoms should I call the office about?
Persistent nausea or vomiting, new onset of numbness or tingling, uncontrolled pain or extreme swelling, excessive drainage or bleeding from the incision, tenderness/pain/cramping in the calf area of either leg, itching despite taking Benadryl or other over-the-counter antihistamine, fever over 101.5°, difficulty breathing/unusual shortness of breath, numbness in hand or arm longer than 24 hours after surgery, severe redness at the incisions or white/yellowish drainage from the incisions, if your hand turns blue or purple and feels colder than the other hand.