Shoulder Replacement

What is a shoulder replacement/reverse shoulder replacement

In a normal shoulder, the ball at the top of the arm bone rotates smoothly inside the socket or cavity. Arthritis of the shoulder develops when the normally smooth, gliding surfaces of the ball and socket are damaged.

In a shoulder replacement surgery, a metal ball is placed on top of the arm bone and
a plastic socket on the shoulder blade. This is similar to how our body is designed
with a ball-and-socket joint.

Where a patient suffers from both shoulder arthritis and a rotator cuff tear the
‘Reverse total shoulder replacement’ surgery is considered. In this surgery the
socket is placed on top of the arm bone and the ball is placed on the shoulder blade.
This is the reverse of our normal anatomy therefore giving the name of this surgery.

Your surgeon will make every effort to restore your shoulder to a condition that
resembles its previous healthy state, however, this would be dependent on the
condition the shoulder is in prior to surgery.

What things do I need to do to be ready for surgery?

You will have received instructions from your doctor and the pre-admission clinic.
The Clinical Nurse Consultant will call you three days from before your surgery to ensure you are on track with your preparations for surgery.
Please follow those instructions and complete the 'My checklist to be ready for surgery'.
Having your home prepared before you have your operation will make things easier when you return home after your operation.
Preparing meals in advance and freezing them, or buying frozen dinners will help make meal preparation easier when you return home. You will need to organise family, friends or neighbours to help with the housework, shopping, driving or providing light assistance with showering dressing and putting on and taking off the stockings required to be worn for six weeks after your operation.

What can I expect after my operation?

Operation and recovery - Your operation will usually take between two to three hours. You will then remain in the recovery area until you are awake enough to return to the ward. This may take up to three hours.

Lines and drains - When you return to your ward you may still need oxygen, will have IV lines for fluid and pain medication.

Diet - If you eat and drink normally straight after your operation it may cause you to feel sick. Eating and drinking small amounts slowly will help to prevent this. You should be eating and drinking normally by Day 1 following your operation.

Pain - It is normal to have some pain and discomfort after your surgery.
However, it is important that your pain is controlled so you are able to cough, breathe deeply and do your exercises. Please let someone know about your pain so it can be treated and
managed.

Infection control - Every effort will be made to prevent infection in your artificial joint. Hand hygiene is essential when recovering from this surgery. Please wash your hands regularly. Some doctors choose to prescribe antibiotics to help prevent infections.

Blood clot prevention - To help prevent blood clots forming in your legs (thromboembolism) your doctor may request that you wear a pair of white compression stockings as well as compression pumps after your surgery. If your doctor has ordered stockings they can be removed for your shower and put back on afterwards. You will need to wear the stockings for six weeks after your operation.
Non-slip socks will also be provided.
You may have blood-thinning medication which may continue when you go home. If your doctor orders this, your nurse will provide education for you or your carer to manage this when
you go home.

Mobilising and exercising - Exercising is crucial for proper rehabilitation and your
physiotherapy will begin on the day of your operation. Keeping your arm in a sling when you are mobile or placing a pillow under your operated arm, while resting in bed, will help keep your arm from being dislocated.

Bowels - Bowel function can be affected by surgery and medication. To help your bowels return to normal function you may require bowel medication. Increasing your water intake and eating food high in fibre will also help your bowel function to return to normal. Include prunes and pear juice in your diet.

Going home - Depending on your recovery, it is anticipated you will be discharged from the second day after your surgery. We aim for discharge from the ward to be 10 am. Make sure the people helping you are aware of your discharge.

What complications could occur?

As with other operations, shoulder replacement surgery involves risks. The following
are possible complications which require your attention:

• Dislocation of the joint where the replacement can pop out of place. This is one complication that you can do something about. Most doctors suggest wearing a sling to protect the shoulder. Keeping your operated arm in front of you or by your side. Dislocation can occur if your arm is brought backwards.
• Implant loosening and wear: The typical shoulder replacement has over 90% – 95% probability of lasting more than 10 years. Over time the replacement can wear out. Slow down the wear of your shoulder replacement by avoiding strenuous or repetitive overhead activities.
• Infection: this is relatively rare but it is a serious complication that requires immediate treatment.
• Nerve and blood vessel injury: although this is an extremely low risk, similar to other surgeries there is a risk of damage to nerves or blood vessels around the surgical area during surgery.

What can I expect from my physiotherapist?

You can contribute greatly to the success of your operation by following the instructions of your health team. It is important to consider yourself as part of the team.

Physiotherapist: While you are in hospital your physiotherapist will give
information on:

• deep breathing and circulation
• getting in and out of bed, positioning in sitting and lying, and walking
• taking precautions with your new shoulder as advised by your doctor
• commencing your exercise program.

What will it be like down the track—getting back into life!

Proper rehabilitation under your doctor’s and physiotherapist’s guidance will result in
a more successful recovery.

Most patients are able to resume waist level activities—actions such as typing, writing
that do not required you to raise your arm—in the first week following surgery.

Driving is restricted for at least six weeks after the surgery depending on your
condition. You will need to check with your insurance company to see what you are
covered for after surgery. Consult your doctor prior to returning to driving. Activities
such as golf can usually be eventually resumed, but not until after a thorough
evaluation by your doctor. It is important to remember that recovery time varies for
each patient.

Having prepared yourself well and participated actively in your treatment, you will be
able to return quickly to a more active independent lifestyle.

Acknowledgments

Staff of Mater Adult Hospital, South Brisbane
Allied Health and Mater at Home

For more information about Mater Hospital Brisbane—South Brisbane, please
call Reception on 07 3163 8111.

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