For some conditions, the minimally invasive procedures are not effective. For these more complex joint problems, the surgeon must use open surgery. The purpose for all of these surgeries is to relieve pain and restore function by reconstructing, replacing, or realigning the joint. There are several types of arthroplasty procedures.

• Joint resection involves removing a portion of the bone from a stiffened shoulder joint, increasing the space between the bone and the shoulder socket. The result is increased range of motion and reduced pain, but the joint may be less stable.
• Interpositional reconstruction is surgery to reshape the joint and add a prosthetic disk between the two bones forming the joint.
• Shoulder replacement surgery is used when interpositional reconstruction fails or is not appropriate. Total joint replacement removes a diseased shoulder joint and replaces it with an artificial joint, called a prosthesis. Shoulder replacement is typically used for people with severe joint damage from arthritis or an injury. Followed by rehabilitation, shoulder replacement can relieve pain, restore range of motion and mobility and in many cases lead to an overall increase in the quality of life.

Conditions helped by shoulder replacement

• Severe shoulder fractures
• Osteoarthritis (degenerative joint disease)
• Rheumatoid arthritis
• Post-traumatic arthritis
• Rotator cuff tear arthropathy (a combination of severe arthritis and a massive non-reparable rotator cuff tendon tear)
• Avascular necrosis (osteonecrosis)

What to expect

Preparing for your shoulder surgery
Because you shoulder arthroplasty is usually a scheduled surgery rather than an emergency, you’ll have time to prepare for the surgery and recovery period. Many shoulder surgeries require a hospital stay. Riverside offers surgery on the same day you are admitted, so instead of spending the night before in the hospital, you can sleep in your own bed. This section highlights our services and offers some tips to make your surgery and recovery a more positive experience.

Riverside tips
We have few tips of things you will want to take care of before your surgery to reduce worries and to make life more convenient while you are healing.

Make sure your medical insurance coverage in order. Insurance coverage is one area you don’t want to worry about. Well before the surgery, contact your insurer to make sure you understand the following:

• Need for a second opinion on your surgery.
• Hospital and health care providers’ status as “in-network” or “preferred.”
• Deductibles for hospital services.
• Limits on length of stay.
• Coverage for hospital rehabilitation services.
• After-care services for your arthroplasty surgery, such as physical or occupational therapy. (Ask whether the therapists must be from an approved list and how many visits or sessions are covered.)
• Any medical equipment and whether they must be obtained from approved vendors.
• Home health care coverage, what type, and for how long.

Get your home ready for recovery
After your surgery, your mobility and flexibility will be severely limited while you are recovering. Planning ahead can save aggravation and keep you safe.

• Go through the house and place frequently used items within arm’s reach.
• Make sure you have a sturdy chair with arms in the room where you will spend most of your time.
• Place a table, wastebasket, phone and TV remote control nearby.
• Buy or prepare and freeze meals in advance.
• Take care of important paperwork and get caught up on bills.
• Buy a long-handled grabbing device. You won’t be able to reach down or over to pick up things.
• Ask neighbors, friends and family for help in advance.

• Donate your blood. Because you may require a blood transfusion during or after your surgery, you may be asked to donate your own blood.
• Pre-operative testing. You’ll need to go for Pre-operative Assessment testing before your operation or on the day of your surgery. Call Riverside Central Scheduling at (757) 989-8830 (Option 2).
• Exercising. You’re getting your shoulder repaired or replaced, so it may sound counterintuitive to exercise and strengthen the one you’ve got now. It’s essential that the muscles surrounding your new shoulder joint are strong enough to support you as you move and use your arms.
• Nutrition. Your body needs to be in the best condition possible before the stresses of surgery. This means you should try to lose weight if you are overweight. Everyone should eat a healthy, well balanced diet and increase your intake of calcium, iron and vitamin C. Calcium is important for building and maintaining bone strength. Iron builds red blood cells, which help healing. Vitamin C improves the absorption of iron into the body.

• Calcium: 1000 to 1200 milligrams
• Iron: is 8-18 milligrams
• Vitamin C: is 75-90 milligrams

Other questions?
Your Riverside surgeon and staff will be happy to explain your particular shoulder replacement procedure, the type of device being implanted, and what you should expect in terms of pain management, your rehabilitation center stay or the type of home assistance required. Don’t hesitate to ask questions. The Riverside Nurse service is also a good resource for information about knee replacement surgery and recovery. They can be reached at (757) 595-6363 or 1-800-675-6368.

Before your surgery

• Do not have anything to eat or drink after midnight before your surgery. (This includes mints, chewing gum, coffee, tea or water.) Since you’ll be using anesthesia, it’s essential that your stomach is empty during surgery.
• If you smoke, cut down or quit as soon as possible. Smoking changes blood flow patterns, delays healing and slows recovery. If you haven’t stopped yet, it is very important that you do not smoke after midnight before your surgery or the first 24 hours after. Please be advised that Riverside hospitals have all adopted no-smoking policies.
• Do not consume any alcohol for at least 48 hours before surgery.
• If you use any type of controlled substances, tell your doctor. Narcotics and other drugs can have an impact on your surgery.
• Take a shower or bath the night before your surgery to help reduce the risk of infection.
• Do not shave the area of your surgery.
• Do not wear any make-up, lipstick or nail polish.

Day of your surgery

What to bring

• Low heeled walking shoes with non-skid soles or tennis shoes. No open heel shoes or clogs.
• Pajamas and a short bathrobe.
• Loose fitting, comfortable clothing for when you get up and move after surgery.
• Toilet articles and any other needed personal items.
• Eyeglasses.
• If you use an inhaler, please bring it.
• Bring any orders given to you by your doctor and give them to the person who admits you.
• Insurance card, driver’s license or other government issued-issued ID.
• A list of your home medications including nonprescription or herbal items that includes:
• • What you take them for
  • How often you take them (unless on the medication packaging)
  • Dosage
• Leave all your valuables at home — money, jewelry and credit cards.

Admission
At the hospital, you’ll take care of some hospital admission paperwork. Don’t forget to bring your insurance card and a driver’s license or other government-issued ID.

In the pre-surgery unit, a nurse will speak with you and verify your health history and allergies. You’ll put on a gown and lay on a stretcher. From here on out, you’ll be wheeled to the various areas for your surgery and recovery.

Intravenous fluids will be started to provide you with medication and fluid during surgery and for a day or two after your operation.

You may receive medication to help you relax and dry out your mouth.

You’ll be given general, spinal, or epidural anesthesia.

Surgery for joint replacement
During a total shoulder joint replacement, an incision is first made in the shoulder and upper arm. The head of the humerus is removed with a bone saw. The shaft of the humerus is reamed with a bone rasp to ready it for the prosthesis. After the shoulder joint, or glenoid cavity, is similarly prepared, bone cement is applied to areas to receive prostheses. The ball and socket prostheses are put in place, and the incision is closed.

Surgery for shoulder fracture
Surgical treatment depends on your age, condition and the type of fracture you have. Once the bones are repositioned, your surgeon is likely to use surgical screws or metallic devices to hold bones in place while they heal.

After the surgery
Regardless of the type of open surgery procedure was performed on your shoulder or arm, your recovery and rehabilitation will follow along these general lines.

• Recovery room. After the operation is over, you’ll be moved to the recovery room where specially trained nurses will continue to monitor your vital signs.
• Hospital room or orthopedic unit stay. Once your condition is stabilized, you’ll be moved to a hospital room where you’ll be given pain medication. Your family will be notified as soon as your operation is over. In your hospital room, nurses will continue to monitor your vital signs and wound dressing. During your time in the hospital, your orthopaedic surgeon, nurses and physical therapists will monitor your condition and progress closely.
• You may be surprised how quickly after your surgery the nurses have you up and moving around.
• It’s important after surgery to cough and breathe deeply to help your lungs remain clear.
• You’ll also need to change positions with the help of a nurse about every 2-4 hours to help keep your skin and blood flow healthy.

Pain relief
Postoperative pain management enables you to do the required physical therapy and to minimize pain and stress. If a general or spinal anesthesia was used, postoperative pain relief may be delivered intravenously. You will be able to control the flow of medication, within preset limits as you feel the need for additional relief. Gradually the pain medication will be reduced and you’ll be given solid food.

• Pain relief after surgery

Usually, you’ll be discharged once you meet rehabilitative milestones such as getting in and out of bed unassisted and walking a short distance.

Related:

• Preparing for Surgery at Riverside Regional Medical Center