Shoulder Replacement Surgery Education

You are not alone in your decision to have shoulder replacement surgery. More than 20,000 new patients undergo this surgery every year in the United States. Chances are that the reason you are having a joint replacement is to relieve your severe pain and / or so you may resume normal activities.

Your Shoulder Joint

The shoulder is a ball and socket joint made up mainly of two bones. The ball portion of the joint is part of the upper arm bone (humerus). The socket portion is part of the shoulder blade. The ball fits into the socket and the two bones rub together as the shoulder moves.

In a normal, healthy shoulder joint the surfaces of these bones where the ball and socket rub together are very smooth and covered with a tough protective tissue called cartilage. This spongy layer of tissue prevents direct contact between these bones and allows the two bones to move without creating friction or wear on the bone surfaces.

When this cartilage is damaged or worn away, the bones rub directly together causing friction, pain and, eventually deterioration of the bone surfaces. The most common causes of damage to cartilage are various types of arthritis.

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Shoulder Replacement Surgery


In shoulder replacement surgery, the parts of the bones that rub together are resurfaced with metal and plastic implants. Often, both parts of the joint are replaced; however, sometimes it may only be necessary to replace the ball portion of the joint. Your surgeon will determine what is best for you.

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Surgery with a Team Approach

With your decision to have shoulder surgery, you have taken the first step toward freedom from hip pain and return to the activities you wish to do. Joint arthroplasty (replacement) is an elective procedure and you have a lot of choices of where to have it done. The philosophy of the Cedars-Sinai Institute for Joint Replacement is geared to making your surgical experience as easy and pleasant as possible.

A multidisciplinary health care team, whose goal is to give you the best care and to help you regain the ability to care for yourself as soon as possible, will manage your care at Cedars-Sinai. The program is an aggressive one that allows you to be functional in a short time. The mindset is that "I am not really sick, I am here to have my joint replaced." Don't forget, we have a staff of trained professionals all working together for your success. We will be with you all the way. We want to educate and assist you and your family or significant other on your way to recovery.

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Preparing for Your Surgery

All shoulder replacement surgery starts with a multidisciplinary education program, to help prepare you for the surgery and the rehabilitation program required after surgery. You will learn what you should and should not do, what to expect, what is expected of you, and whom you can contact if you have any questions or problems at any time during your course of treatment. Family or significant other participation is encouraged, in order to educate everyone involved with your care.

A nurse will be working with the surgeon, operating room services, anesthesiology, and case management (for needs after hospitalization), to make the patient flow a seamless process. To exactly guide your care and treatment, a dedicated specially trained multidisciplinary staff, on a dedicated unit, utilizes clinical care pathways (maps). The unit includes a private room for each patient.

You are encouraged to get out of hospital gowns and into comfortable sports cloths as soon as possible. Families or your caregivers are asked to participate in your therapy so they can keep you on track after discharge.
Because of this pre-operative preparation, you will already have some knowledge about your hospital stay and what you will need at home even before you are admitted. So hopefully there should be less anxiety as you progress through your pathway and are discharged. The anticipated hospital stay following hip surgery is usually 3 days including the day of surgery. As you meet discharge criteria, you will be discharged with appropriate home care services or if needed transferred to a sub acute unit (rehabilitation) in the community.



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Before Your Surgery

Since shoulder surgery is usually scheduled in advance, there is a lot you can do before surgery to make your recovery in the hospital and at home go smoothly.
In your surgeon's office you will fill out forms to schedule your surgery, hospital admittance, pre-testing and pre-surgery education program.
You will receive calls from Cedars-Sinai Medical Center to confirm your surgery date, financial information and your attendance our Multidisciplinary Pre-Operative Training and Education Program. If your doctor has not completed pre-operative tests you will be scheduled for testing at the Surgery Assessment and Testing Program.

Carefully follow your healthcare team's advice about

  • Changes you should make in your diet
  • Any exercises you should start, stop, or keep doing (exercises from the Multidisciplinary Training and Pre-operative Training Program).
  • If needed, helping your recovery by losing or gaining a few pounds
  • Stopping or continuing the medicines that you regularly or occasionally take, including prescription medicines, over-the-counter medicines, natural remedies (herbal medicines) and dietary supplements
  • If you take daily insulin, heart or blood pressure medicine, ask your doctor at what time you should take your medicine the day before and/or the morning of surgery
If you are a smoker, nicotine can slow down the healing process, so you may want to quit smoking before surgery. Talk with your doctor before using nicotine replacement products such as a patch, gum or cigarette substitute.

Insurance Coverage

To avoid surprises later, learn about your insurance coverage. Talk with your benefits manager at work or call your insurance company and find out what will be paid for by the insurance and what must be paid for by you. The following are some examples:

  • Home Health for physical and/or occupational therapy
  • Cedars-Sinai Institute for Joint Replacement Physical Therapy
  • Equipment such as: Commode or raised toilet seat -- walker or crutches or cane.
  • Medication on discharge: Pain medication such as Vicodan and a blood thinner such as Fragmin.
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Planning for Returning Home

Even before you have surgery, think about going home! You will be discharge from the hospital by your surgeon when your medical condition is stable. If you are going home alone then you need to be able to walk safely, including stairs if needed. If you cannot do this by the time of discharge, then the social worker will have been working with you for placement to a community Rehab facility. The average length of stay in the hospital is 3 days. Since this surgery is planned for, please think about your home care needs and if discharge home is the right option? Once home, it's normal to have "good" and "bad" days. But if you continue exercising, there will be more good days and your general condition is likely to improve.

Planning Your Discharge

You will be evaluated everyday after surgery by a multidisciplinary team including; nurses, therapists, social worker, case manager, your doctors and yourself. The goal is to get you home safely. If you are medically stable, but not yet mobile enough to be discharged home safely, then a social worker will help make arrangements to a lower level of care facility in the community. If you need to be transferred to another facility for rehab, the social worker will help you in making that move, including determining insurance coverage.

The physical and occupational therapist will determine any special equipment and therapies that you might need and work with you and the social worker or case manager to order the appropriate items and service.

*If you live alone or have limited support system, and you know that you will need short term care or assistance please inform the health care team at the Multidisciplinary Training and Pre-operative Education program or you can call the Social Service department to start working on arrangements before you come into the hospital.

Preparing Your Home: Helpful Hints

Becoming aware and removing hazards in your home can help make your recovery easier and safer. If necessary, get help rearranging the rooms in your home to make it easier to walk around safely. Think about maneuvering a walker or crutches. Remove throw rugs and objects on the floor. Keep items you use often within easy reach. Move items, so you are not reaching up high or bending down low. Move electrical cords out of the way. Make sure your house is well stocked with groceries and food.

Check out your usual sitting areas. If you have any hip precautions, following them will affect where and how you sit, and how you should get up from a sitting position. A good rule to remember when sitting is ¿always sit with your hips higher than your knees¿. Sit in your favorite chair; are your hips higher then your knees? If not, you can raise the level of your hips by placing a firm pillow in the seat.

Once Home: Helpful Hints

Avoid uneven floors or wet floors in the bathroom and kitchen. Watch for pets that may jump on you or run in your path. Wear rubber soled and low, closed heeled shoes to prevent slipping. Use your walker and crutches and hold onto handrails when using cane. Keep rooms well lit even at night.

Transportation Home

Patients go home as a passenger in a car. You are taught how to get in and out of a car before you leave. There is a wheelchair van service for a nominal fee, which can be arranged for you. Ambulance service is used only in specific cases, as set up for you by the social worker.

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Family and Friends: An Important Role in Your Recovery

Your family and friends are especially important while you recover and adjust. They can assist you at this time and help make your home safer so you can go about your activities without hurting yourself. They can also help you with grocery shopping and help with preparing food. They can also cheer you on and celebrate when you walk a little farther, or accomplish a new task.
Most insurance policies will not pay for 24-hour care, however, if you feel you need help with daily activities (bathing, shopping) the social worker has a list of agencies which can be given to you, so that arrangements can be made to hire someone to help you.

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Arrangements for Surgery

  • When you come in for surgery or even when you are going for pre-admission, it's a good idea to have someone with you. They can listen and take notes for you.
  • Make a list of all medicines you are taking and any allergies to medicine or food that you have. Bring this list with you and give it to the admitting nurse.
  • You will be told about your rights for advanced directives, which are your written directions for your care, should you become unable to make decisions. If you have a living will and or health care power-of-attorney or advanced directive, bring a copy of these with you. If you have questions about advanced directives, call the Social Service department.
  • Report any health changes since your pre-surgery physical exam to your surgeon. Tell your surgeon if you get any cuts scrapes or sores on the affected leg. Tell your surgeon if you have any signs of infection, such as chills, fever, and coughing or runny nose within a week of your scheduled surgery.
  • You must stop eating and drinking by midnight the night before surgery. This keeps the stomach empty, which will reduce nausea and vomiting.
    In the morning, the day of your surgery, you can shower or bath, brush your teeth, and shave. Do not eat or drink anything.
  • However, follow your instructions from your primary physician about taking any of your daily medicine or any pre-surgery medicine ordered by your surgeons or physicians.
  • Be sure to arrive at the hospital the day of your surgery, at the time told to you my your surgeon's office.


Be sure to bring:

  • Your insurance card and a picture ID
  • A blank check or your credit card number & its expiration date (for any equipment & discharge medication not covered)
  • Your glasses, dentures or hearing aide, if you use them
  • Shoes with nonskid soles and a closed heel (not too tight, as your foot may be a bit swollen after surgery)
  • A knee-length robe
  • Clothing that will be easy to put on and comfortable to wear home
  • Any items you were asked to bring during the Multidisciplinary Training and Pre-operative Education Program
  • Cedars-Sinai Medical Center does not have shampoo, shaving cream, deodorant or hand-held mirrors
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Your Surgery: Day 1

Before Surgery

At the hospital, check in at the front desk of the Cedars-Sinai North Tower entrance. Someone will bring you to the 7th floor lobby to wait until the nurse from surgery comes to take you to the pre-surgery holding room. In the holding room, a nurse will help you get ready for surgery and go over any last minute questions. An anesthesiologist will talk to you and explain the type of anesthesia that will be used during surgery. An intravenous tube (IV) is placed in your arm or back of your hand. This tube supplies your body with necessary medicines and fluids. You may be given medicine to make you drowsy and relax you just before you go into the operating room.

When you go to the surgery holding room, your family or significant other and friends can wait for you in the 7th floor lobby waiting area. Surgery usually lasts 1 to 3 hours. You will be in the recovery room for another 2 to 3 hours. Someone will update your family or significant other or friends, as your surgery and recovery progress.

Surgery

There are wires and tubes attached to or placed in your body. These help monitor your body's functions, remove excess fluid, and help you breathe during surgery. Your shoulder area is scrubbed with a germ killing soap. When everything is ready, your surgeon makes an incision over your shoulder that will expose the joint. When the bones are fully visible to the surgeon, special precision guides and instruments will be used to remove the damaged parts of the bones and shape the bones to accept the implants. The implants are then secured to the bones either by using special bone cement, or by fitting the implants very tightly into the bone so they are held in place by friction. When the surgeon is satisfied with the fit and function of the implants, the incision will be closed and dressed with bandages and your arm will be placed in a sling. Then you will be placed in your bed and taken to the recovery room.

Recovery Room

You will gradually wake up during this time. You may feel groggy from the anesthesia and will still have tubes and monitors attached. When you wake up you will notice:

  • Special sequential compression selves (stockings) will be on both legs to help blood circulation and prevent blood clots
  • A triangle-shaped pillow (abduction pillow) or regular pillow between your legs to keep your legs and hip in the best position for healing
  • The intravenous tube (IV) for continued fluids, antibiotics and possible blood transfusions
  • A drain (hemovac) that will remove the excess blood till it clots
  • A drain (foley catheter) in your bladder that will remove urine, so that you do not need to move to get on a bedpan right after surgery
The nurses will keep a close watch on your recovery and help to make you comfortable. If you need pain medicine, don't wait too long to ask for it. It is easier to prevent pain than to stop pain or catch up with it once it starts. The nurses will be asking you to "pedal" your feet up and down and if you have feeling in your legs and feet -- especially in the leg with the new hip replacement. It is important to tell your nurse if you feel numbness, tingling or pain in your feet and legs.

When you are fully responsive and your blood pressure, pulse and respiration are stable, the recovery room nurses will transport you to the Orthopedic Unit for the next phase of your recovery.

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Recovery Expectations

Everyone's recovery rate is different and how quickly you recover depends in part on your physical health and level of activity before surgery and how complex your hip surgery was. Your participation in the recovery program is very important. The hospital staff will monitor your medical condition and do the things you cannot do for yourself. As you become more active, you need to become more involved in your recovery. The Cedars-Sinai Institute for Joint Replacement has developed a guide or pathway (flow or map) of the usual recovery program from the first day, right through to your discharge from the Orthopaedic Unit. It is important to us to make your hospital stay and experience informative for a faster and easier recovery.

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Recovery: Days 2 and 3

Soon after surgery you will begin a gentle exercise program that will you regain strength and range of movement in your shoulder. This program will be designed specifically for you. It may begin with simple movements of your fingers, wrist, and elbow. Eventually, the exercises will include movement of your shoulder. Your physical therapist will teach you to perform the appropriate exercises will in the hospital and also the ones you will continue to do at home

The hospital team will help arrange for any physical therapy, home care and any equipment your physician will order or you might need.

Even after you have fully recovered from your surgery, you may still have some restrictions. Normal daily activities for shoulder replacement patients do not include contact sports or activities that put excessive strain on your shoulder.

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