The following are post-operative instructions for patients who have undergone shoulder replacement. Shoulder replacement is a resurfacing of the shoulder with metal, and plastic components which are inserted through a shoulder incision to resurface the exposed bone; designed to relieve pain, and improve shoulder function. The procedure is performed on an inpatient basis (discharged the next day after surgery). You will require someone at home to assist you initially after discharge.
You will be provided with an immobilizer for your comfort. You may open the wristband (if your immobilizer has this option) only to use the hand to eat or to straighten the elbow. Do not remove the immobilizer yet and elevate the shoulder. When you are seen in the office we will let you know when it is ok to only use the immobilizer and be out of it.
The incision will be 4-6 inches in length, is sutured with absorbable suture and skin glue and covered with a gauze dressing. Schedule an office appointment for about 7-10 days from your surgery so the wound can be checked. Usually, the nurses will send you home with extra dressings. You may change the dressing every 3 days until the wound is healing well about 5-7 days. (Remove dressings carefully to avoid skin abrasions). By 5-7 days after surgery if the wound is dry without drainage you may get the incision wet and leave the wound open to air. Any wound drainage should be reported to our office. You may shower with the waterproof dressing. Some swelling, bruising and warmth are expected after surgery. If you develop increased redness, drainage, or a fever, CALL THE OFFICE. Bruising around the shoulder upper arm area is not uncommon. This may even extend down the elbow and forearm area and will resolve in over 3-4 weeks.
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
Normally we will avoid using anti-inflammatory medication (i.e. ibuprofen, Advil, Aleve, etc.) as this may interfere with bone or tendon healing. If you are intolerant to most pain medications the short term use of anti-inflammatory medication is OK. In this case, you might be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 400-600 mg 3-4 times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure. If you have kidney problems you should avoid these medications.
Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.
Again, swelling around the shoulder and down the hand region is NORMAL. Reducing the swelling as much as possible will improve comfort and mobility. Pumping the hand or straightening the elbow can help with swelling. Wear the TED stockings (white) for at least 1-2 weeks after surgery. Once you are up and about regularly you may discontinue the stockings.
An ice pack will be applied after surgery. The ice should be replaced every 2-3 hours for the first couple days. Protect the skin from direct contact with the ice pack. (Not necessary to change as often during sleep hours.) After the first few days apply refreshed ice pack on the hip, 3 or 4 times a day for 20-30 minutes. The ice and elevation may be helpful up to 2 weeks after surgery. If you feel the swelling is excessive you should call the office.
In order to reduce stiffness and obtain maximum function of your shoulder, it is important to maintain a good balance of rest and exercise. Listen to your body; too much activity will produce increased swelling and/or pain; too little activity could prolong your recovery and/or limit your mobility. The physical therapist should provide you with shoulder exercises. To promote circulation, remember to do your ankle/foot stretching exercises regularly.
Note: Walking will not harm the implants and is encouraged.
These are averages, remember that each case is individualized, depending on your general health, age, and attitude. For 3-4 weeks after surgery, your activity level is usually limited, however, you will be able to walk independently. We usually start weaning out of the immobilizer at 4 weeks. Then you may use the hand more. Good surgical wound healing takes 6-8 weeks, complete healing is over 6-9 months. During this initial 6-8 weeks time, some swelling and discomfort is normal and should be manageable with the prescribed medications. After this time the shoulder tissues begin to soften and become more natural. Some patients may notice a small area of numbness around the incision. This may or may not resolve over time.
Important Notice: You will require an antibiotic prophylaxis prior to having any dental work or invasive procedures done for the first 6 months after surgery. If you have no diabetes or other immune-suppressing medications or conditions you may discontinue these after 6 months.This includes routine cleaning. Please let your dentist know you have a shoulder implant at the time you make the appointment.
If you then still have any questions or concerns please notify me, my nurse, or physician assistant.
Bryan Bomberg, MD