What is shoulder replacement surgery?

In shoulder replacement surgery, a doctor removes the end of the upper arm bone. Often they also take out the end of the shoulder bone. The ends are replaced with plastic or metal pieces.

Your doctor will let you know if you will stay in the hospital or if you can go home the day of surgery. Some people stay in the hospital 1 or 2 days. Your rehabilitation program (rehab) starts when you are in the hospital. You will do this rehab for about 3 months or longer.

After surgery and rehab, you probably will have much less pain than before. And you should be able to return to your usual activities. But your doctor may advise you not to do activities that put stress on that shoulder, such as weight lifting or tennis.

Doctors recommend joint replacement surgery when shoulder pain and loss of function become severe and when medicines and other treatments no longer relieve pain. Your doctor will use X-rays to look at the bones and cartilage in your shoulder to see whether they are damaged and to make sure that the pain isn't coming from somewhere else.

Shoulder replacement may not be recommended for people who:

• Have poor general health and may not tolerate anesthesia and surgery well.
• Have an active infection or are at risk for infection.
• Have osteoporosis (significant thinning of the bones).
• Have severe weakness of or damage to the muscles around the shoulder.

Some doctors will recommend other types of surgery if possible for younger people and especially for those who do strenuous work. A younger or more active person is more likely than an older or less active person to have an artificial shoulder joint wear out.

Doctors usually do not recommend shoulder replacement surgery for people who have very high expectations for how much they will be able to do with the artificial joint (for example, people who expect to be able to play competitive tennis, paint ceilings, or do other activities that stress the shoulder joint). The artificial shoulder allows a person to do ordinary daily activities with less pain. It does not restore the same level of function that the person had before the damage to the shoulder joint began.

Most people have much less pain after shoulder replacement surgery and are able to do many of their daily activities more easily.

• The shoulder will not move as far as it did before you started having shoulder problems. But the surgery will allow you to do more of your normal activities without pain.
• After surgery, you may be allowed to resume activities such as golfing, riding a bike, swimming, walking for exercise, dancing, or cross-country skiing (if you did these activities before).
• Your doctor may discourage you from doing things that put a lot of stress on the joint.

The younger you are when you have the surgery, and the more stress you put on the joint, the more likely it is that you will eventually need a second surgery to replace the first artificial joint. Over time, the components wear down or may loosen and need to be replaced.

Your artificial joint should last longer if you do not do hard physical work or play sports that stress the joint. Shoulder replacements usually last for about 10 to 20 years.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure to have extra help at home. This is most important if you live alone or care for another person.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. You may take a nap, but don't stay in bed all day.
• Work with your physical therapist to learn the best way to exercise.
• You will have a sling to wear at night. And it's a good idea to also put a small stack of folded sheets or towels under your upper arm while you are in bed to keep your arm from dropping too far back.
• Your arm should stay next to your body or in front of it for several weeks, both while you are up and during sleep.
• You can move your fingers, wrist, and elbow. But don't lift anything with the affected arm for 6 weeks.
• Ask your doctor when you can drive again.
• Ask your doctor when it is okay for you to have sex.
• Your doctor may advise you to give up activities that put stress on that shoulder. This includes sports such as weight lifting or tennis, unless your tennis arm was not the one affected.

Diet

• By the time you leave the hospital, you will probably be eating your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Your doctor may recommend that you take iron and vitamin supplements.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Don't stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you take a blood thinner, be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

Incision care

• If your doctor told you how to care for your cut (incision), follow your doctor's instructions. You will have a dressing over the cut. A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.
• If you did not get instructions, follow this general advice:
  • If you have strips of tape on the cut the doctor made, leave the tape on for a week or until it falls off.
  • If you have stitches or staples, your doctor will tell you when to come back to have them removed.
  • If you have skin glue on the cut, leave it on until it falls off. Skin glue is also called skin adhesive or liquid stitches.
  • Change the bandage every day.
  • Wash the area daily with warm water, and pat it dry. Don't use hydrogen peroxide or alcohol. They can slow healing.
  • You may cover the area with a gauze bandage if it oozes fluid or rubs against clothing.
  • You may shower 24 to 48 hours after surgery. Pat the incision dry. Don't swim or take a bath for the first 2 weeks, or until your doctor tells you it is okay.

Exercise

• Shoulder rehabilitation is a series of exercises you do after your surgery. This helps you get back your shoulder's range of motion and strength. You will work with your doctor and physical therapist to plan this exercise program. To get the best results, you need to do the exercises correctly and as often and as long as your doctor tells you.

Ice

• For pain, put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. If your doctor recommended cold therapy using a portable machine, follow the instructions that came with the machine.