Some of your Questions:

Q. How long does the surgery take?

The actual shoulder replacement procedure takes 60 to 90 minutes. However, pre-operative preparation and postoperative recovery require additional time. A member of the care team will keep your family members informed of your progress and let them know when they can visit you in the recovery room.

Q. Will I need blood?

In some cases, patients may need blood after surgery. For some types of shoulder replacement procedures, you may need to get a blood type and cross-match as part of your presurgical testing. This will ensure that any donor blood you receive is compatible with your blood type. Patients do not need to donate their own blood before surgery.

Q. Do I need to be put to sleep for this surgery?

You will probably have general anesthesia, which most people call “being put to sleep.” In addition, you may have regional anesthesia, which is sometimes called a nerve block. Anesthetic medication is injected around the nerve and blocks pain during and immediately following surgery. It causes numbness and may last 12 to 18 hours. In some instances, your surgeon may also inject a local anesthetic at the operative site to ease postoperative pain. It is important to discuss all of these options with your surgeon and the anesthesiologist before your procedure.

Q. How long will I be in the hospital?

The typical stay is somewhere between 24-48 hours: 50% stay one day while 50% stay two days. Rarely do patients stay longer than two days. There are several goals that must be achieved before discharge. Your surgeon will discuss these with you in advance.

Q. Will there be pain after surgery?

You will have pain around the incision following surgery, but you will be kept as comfortable as possible with appropriate medication. If you do feel pain after your procedure, alert a member of your healthcare team. Some patients control their pain with a special pump called a PCA that delivers medication directly into their intravenous (IV) tube. You may have a catheter in your arm to support the administration of IV fluids or pain medication. Ask your surgeon or anesthesiologist for more information.

Q. When should I expect to feel relief from my shoulder pain after my shoulder replacement?

There is some immediate change in regard to the movement of the shoulder being much smoother; however, for a few weeks after surgery it is more painful than before surgery. At about two weeks post-surgery people start to get over the “hump” and it is less painful than prior to surgery. The pain will continue to gradually decrease. At two months the average patient is very happy they had their shoulder replaced.

Q. What should I expect to be the hardest part of my recovery following my shoulder replacement?

The first couple of days the pain will be significant, but it can also be controlled with the appropriate medications. Regaining range of motion takes time, patience and persistence… it only improves at a certain rate each month.

Q. When do I start rehabilitation?

Your rehabilitation therapist will see you the day after surgery. Remember that pain control is very important. Your nurse will give you pain medicine about 30 minutes before your rehabilitation sessions start so that you can do as many exercises with your physical therapist as possible. You should continue these exercises once you return home.

Q. Will I be prescribed physical therapy? How long will therapy last?

Yes we will prescribe physical therapy. Typically, therapy will last two months following the operation; however, sometimes patients require more.

Q. What kind of medical equipment will I need?

Typically you go home from the hospital with a sling (shoulder immobilizer).

Q. How long will I wear the sling?

In most cases, you will be wearing your shoulder immobilizer for a total of six weeks. Normally, unless you have had a reverse total shoulder arthroplasty, you will remove your shoulder immobilizer at least twice a day for physical therapy or your home exercises. You will also be able to do your personal hygiene and change your clothes at the same time, although you will need to wait until after your first post-surgical office visit to shower. Your physical therapist will instruct you on how to change a button-front shirt while you are in the hospital after your surgery.

Q. What precautions should I take when I first get home?

You may need to use a cane if you feel unsteady.

  • DO NOT swim, use hot tubs or take tub baths until your surgeon gives you the go-ahead.
  • DO NOT USE ointments, lotions, oils or vitamin preparations on your incision until after your first follow-up appointment.
  • Apply an ice pack or cooling system to your shoulder dressing for a minimum of twenty minutes, at least four times daily to decrease pain and swelling.
  • Be sure to take your pain medication with food to avoid nausea.
  • To help your wound heal faster, continue your healthy eating habits, give up smoking (if you haven’t already), and, if you are diabetic, maintain control of your blood glucose level.
  • Do not allow pets to share the space where you are sleeping and resting; they can infect your incision.

  • To reduce the chance of getting an infection, make sure you and your caregiver wash your hands throughly

    • when they are visibly soiled
    • before and after care of your incision
    • before eating
    • after going to the bathroom
    • after handling or caring for pets

    Q. How to use the shower?

    • You will be able to shower after your first post-operative visit.
    • If you are unsteady on your feet, it is safest to sit while taking a shower.
    • Pat your incision dry after showering.

    Q. What Do's and Dont's should I follow?

    The success of your surgery will depend largely on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery. Here are some common do's and don'ts for when you return home:

    • Don't use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.
    • Do follow the program of home exercises prescribed for you. You may need to do the exercises 2 to 3 times a day for a month or more.
    • Don't overdo it! If your shoulder pain was severe before the surgery, the experience of pain-free motion may lull you into thinking that you can do more than is prescribed. Early overuse of the shoulder may result in severe limitations in motion.
    • Don't lift anything heavier than a glass of water for the first 2 to 4 weeks after surgery.
    • Do ask for assistance. Your physician may be able to recommend an agency or facility if you do not have home support.
    • Don't participate in contact sports or do any repetitive heavy lifting after your shoulder replacement.
    • Do avoid placing your arm in any extreme position, such as straight out to the side or behind your body for the first 6 weeks after surgery.

    Q. When should I call Dr. Arora's office?

    You should call Dr. Arora's office immediately when you notice the following conditions:

    • experience any unusual or increased shoulder pain, redness or swelling.
    • have a fever (temperature above 100.3) lasting longer than 24 hours. Note that mild temperature elevations are normal in the afternoons and evenings.
    • experience increasing redness, swelling, warmth, unpleasant odor or milky liquid coming from the wound.
    • have a sudden shortness of breath or chest pain.
    • have trouble re-establishing normal bowel habits despite the use of stool softeners and increased fluids.
    • have other symptoms you are concerned about.

    Q. Is it very often that patients need both shoulders replaced?

    Most people who develop arthritis on one side develop it on the other side as well. Most often one side hurts worse than the other and so many patients opt for both shoulders to be replaced but it is usually a couple years between the two operations.

    Q. What is the replacement made of?

    The replacement is made of titanium, stainless steel and high density plastic in the socket. I have an example of the replacement I can show you when you come for an office visit.

    Q. How long will my shoulder replacement last?

    The estimate is around 15 years, but that estimate is variable and we see them last longer in some patients. It is difficult to predict how long each patient’s shoulder replacement will last, specifically because the materials we use now are improved from those 7-8 years ago.

    Typically if you need a shoulder redone, you redo the whole thing (not just parts), but it is rare that we have to do that. For most people, their shoulder will last for as long as they need it; however, that depends on the age that the patient received their replacement.

    Q. What are the possible complications of total shoulder replacement surgery?

    Typically if you need a shoulder redone, you redo the whole thing (not just parts), but it is rare that we have to do that. For most people, their shoulder will last for as long as they need it; however, that depends on the age that the patient received their replacement.

    Q. When will I be able to drive?

    Most patients resume driving two to four weeks after surgery. The precise timeline depends on your progress and your surgeon’s advice. You should not drive if you are taking narcotics for pain relief or while your arm is in a sling.

    Q. When will I be able to return to work?

    Time off from work depends on your surgery and recovery, as well as your job and responsibilities. Your surgeon will advise you on the specifics. An occupational therapist can help you with body mechanics and alignment to protect your new joint and conserve energy on the job.

    Q. When can I have sexual intercourse?

    Your orthopedic surgeon will advise you on when it is safe to resume sexual intercourse.

    Q. I’ve heard there is a shoulder replacement that you put in backwards… why backwards?

    It is called a Reverse Ball and Socket Shoulder Replacement. It is not better than a standard shoulder replacement, it is just necessary in certain circumstances. The circumstances we use it in are when you have had a very complicated fracture or when your rotator cuff is non-functional.

    Q. Is there anything else I should pre-plan for?

    Almost everyone has a thorough physical exam with their primary care physician to make sure they are healthy enough to handle the stress of replacement surgery. In addition, the biggest thing to plan for is to have help at home. We also don’t recommend you drive for at least a couple of weeks following surgery.

    Q. When do I follow up with Dr. Arora and his team?

    Dr. Arora's team will schedule regular follow-up visits each time you come to see us. These appointments will be with Dr. Arora or his associate. These associate providers know your medical history and individual situation as well as Dr. Arora, so please feel confident that they will provide you with excellent care.

    You can expect to come back for follow-up visits at these intervals post-surgery:

    • 2 weeks
    • 6 weeks
    • 12 weeks
    • 6 months

    For ongoing care:

    • every one to two years, for life

    It is important to attend the ongoing care appointments every one to two years to be sure your joint replacement is performing properly. By conducting a regular physical exam and a review of x-rays, your care team can identify any problems that may be developing even though you may not have any physical symptoms.

    Patients can always contact the Dr. Arora's clinic between visits for questions or concerns.