Preparing for Shoulder Replacement

Preparing for Shoulder Replacement

I have put together the information contained herein with the patient undergoing shoulder replacement surgery in mind. Be advised that each patient’s situation is unique and that this information is only intended to provide a general guideline and answer commonly asked questions.

Before Surgery

Dr. Diaz's office will arrange for bloodwork and medical clearance from your internist or cardiologist prior to surgery. You will also have a pre-operative appointment with the anesthesia team at the hospital the week prior to your procedure, and an appointment with me to review CT and MRI studies of your shoulder and answer any questions. 

1. Unless otherwise instructed, stop blood thinners and arthritis medication other than Tylenol for 5 days prior to surgery. 
2. Focus on good nutrition. I may have prescribed weight loss before considering you a candidate for shoulder replacement, but starting two weeks prior to surgery, do not lose any weight and try to maintain your weight after surgery. Patients with diabetes should focus on tight blood glucose control and notify their internist or endocrinologist if they are having difficulty managing their glucose levels. 
3. Take a shower the night before surgery and scrub your operative shoulder, neck, upper back, underarm, and chest wall well with the surgical soap provided followed by wiping the same area with a cloth soaked in 3% hydrogen peroxide. 
4. No eating or drinking after midnight the night before surgery. Be sure to take any blood pressure or thyroid medication as scheduled with a tiny sip of water. 
5. You may receive the sling before surgery. If so, put it in the car that you will take to the hospital the night before surgery and bring it with you to the surgical prep area. 
6. What to pack for your overnight stay at the hospital: 
   • A loose-fitting shirt that buttons down the front for ease of putting on and taking off Pants that are easy to put on and take off (ideally with an elastic waist)
   • Comfortable, supportive shoes that don't need laces tied 
   • Basic toiletries (toothbrush, brush, face cream)
   • Healthy snacks that don't require refrigeration 
   • Your cell phone and a charger
   • Reading glasses and hearing aids 

Do not bring any jewelry or valuable items other than your cell phone and your wallet (for your ID for registration)

The Day of Surgery

When you arrive at the hospital, the preoperative team will start an IV and antibiotics. You will likely receive an arm block (regional anesthesia) that will numb and paralyze your shoulder temporarily. The effects could last anywhere from 6-24 hours after surgery. Sometimes the blocks are not 100% effective.

Depending on the severity of arthritis, patient size and overall health, and history of prior surgeries to your shoulder, most patients’ surgery will take between 1-2 hours. For the first 30 minutes before and after the actual surgery you are being placed under anesthesia and positioned for surgery, and being woken up. So to your family and friends it could be 3 hours between when they say goodbye to you and when they hear from me. Not all of that time is surgery. You will probably spend a couple of hours in the recovery area (PACU) before they take you up to your room or discharge you. 

If you aren’;t too nauseous or sleepy from the anesthesia, you should try to walk with someone’s assistance or supervision the afternoon of surgery. This will keep your lungs well aerated and the blood circulating in your veins to prevent clotting. It will also help you feel more oriented.

As soon as you regain control of your arm, you should bend and straighten your fingers into a fist to keep them from getting stiff. You can also bend your elbow to bring your hand to your face or on a table surface for eating, brushing your teeth, texting on your phone, etc. No shoulder motion until you come to the office for an appointment.

When can I go home after surgery?

Most patients will be released from the hospital the day after surgery. Some patients may be able to go home the same day. 

Will I receive medication for pain?

Yes. Discontinue the prescription medication as soon as your pain levels allow you to do so, with a goal of being off prescription pain medication by one week after surgery. 

How do I sleep after surgery? 

Most patients recovering from shoulder surgery find it easiest to sleep in a recliner chair for up to several weeks after surgery. An alternative is to sleep propped up in bed with multiple supportive pillows. The sling should be on for sleeping. 

Will I receive a cooling machine?

If you are interested in renting an ice machine that circulates ice water around your shoulder, please let my office know. Whether you use an ice machine or a reusable pack/gel pad, ice is an excellent means of reducing pain and swelling in the shoulder.

How do I take care of the incision?

The cleanest bandage your shoulder will have is the one placed in the operating room immediately after the surgery, because it is placed in a sterile environment. Furthermore, this bandage has a water resistant cover that makes it easier to keep the incision dry while showering (so long as the operative shoulder is pointed away from the showerhead or a hand held wand is used). As long as the bandage remains clean and adherent, retain it for at least 7 days until the incision is partially healed before removing it. The hospital staff will provide you with replacement bandages. Do not get the incision wet until you see Dr. Diaz at 2 weeks after surgery.

How long do I have to be in a sling?

Remain in the sling at all times except to shower or to periodically bring your hand to your face for eating, brushing teeth, shaving, etc or periodically extend your elbow. Your hand on the surgery side should remain in front of your face until instructed. Do not move your shoulder or discontinue the sling until I have instructed you to do so. When you are bathing you can bend forward at the hips and lower back and dangle your arm out of the sling to straighten out the elbow to prevent stiffness and so that you can access under your arm for bathing.

For anatomic total shoulder replacement, the sling is usually worn for 6 weeks to allow the front part of the rotator cuff (subscapularis) to heal after it is opened to expose the shoulder and then repaired. For reverse total shoulder replacement, the period of sling immobilization will last between 4-6 weeks.

How much general activity is advised?

Try to maintain light levels of activity in a climate-controlled environment. Walking around your home or in a cool environment with even footing will help prevent blood clots and constipation. Avoid sweating as this can lead to wound infection.

How soon after surgery may I drive?

Many patients want to know when they can resume driving after shoulder replacement surgery. This is contingent upon a variety of factors including duration of sling immobilization, manual or automatic transmission, etc. Generally, reaction time can be affected for up to 6 weeks following shoulder surgery, with variability from patient to patient.

You should ask Dr. Diaz before resuming driving after shoulder surgery. You should begin with short, familiar distances and have a licensed driver in the passenger seat the first time you resume driving. 

When may I return to work or resume sports?

Return to work or sports is dependent on a number of variables. Patients with sedentary jobs may be able to return as early as two weeks. Patients who have to use their arm for lifting, carrying, climbing, driving, or above eye level work will generally need 12 weeks of modified or no work. I generally allow patients to return to golf, tennis, and swimming between 4-5 months, but in select cases earlier.

Please call the office or use the Patient Messaging Portal should you have any further questions.