A Patient s Guide To Shoulder Replacement at The American Center

A Patient s Guide To Shoulder Replacement at The American Center

Getting Ready 1. Pre-surgery physical: To assure you are in good health prior to surgery you will need to have a pre-surgery physical exam within 30 days of surgery in the Orthopedic Surgery Clinic. Our scheduler will help arrange this. During this appointment, the surgery will be reviewed, you will get instructions for surgery and the provider will do a thorough history and exam. Make sure to mention to the provider if you take blood thinners or have any implanted devices such as a pacemaker. Expect this appointment to last 1-2 hours. 2. Specialists: Depending on your health history, you may also need to meet with other specialists prior to surgery such as a cardiologist, rheumatologist or lung doctor. Our scheduler will talk to you about this if necessary. 3. Dentist: Your dental health is important to prevent infection in your new joint replacement. Dental care must be up to date prior to having a shoulder replacement. Make sure you have had a dental cleaning and exam within 6 months of your surgery. If you have any new dental issues these will need to be taken care of prior to your surgery. 4. Nicotine: Nicotine is known to slow down healing and cause other negative health effects. If you use nicotine in any form (smoking, chewing tobacco, nicotine gum or patch) you will be expected to stop all nicotine at least 1 month before surgery and through the recovery time after surgery. You will have a lab test prior to surgery to assure there is no nicotine in your system. Medicines to Stop Before Surgery Do not take any nonsteroidal medicines such as aspirin, ibuprofen, Naproxen, Aleve, or Motrin for 1 week before surgery. You may take Tylenol if needed. If you are on Coumadin (warfarin) or other blood thinners, you will need to stop them before surgery with the guidance of the orthopedic provider or the healthcare provider who prescribes them. 1

If you are taking medicines for arthritis, you may need to stop these before surgery. Do not take herbal supplements 1 week prior to surgery, especially fish oil. Planning Ahead Many people who have a total joint replacement find it useful to plan ahead. Expect to be in the hospital for at least 1 night after surgery. You may need to stay longer if you have problems with nausea, pain control or balance. Have someone ready to bring you home from the hospital the day after surgery. You should arrange for someone to stay with you at least for a few days after surgery to help you out. Some people need further rehab or nursing home care. Please discuss this with the Orthopedic Provider prior to surgery. A social worker or nurse case manager can work with you to arrange for these services ahead of time. In most cases, these cares are not covered under Medicare unless there are extenuating health problems that qualify you for this type of care. To prevent falls after surgery, prepare your home in advance. Check your home for: o Loose rugs or loose carpets. Remove all of them. o Pets that may run in your path. o Water spills. o Bare slippery floors. o Long cords across floor, such as phone or fan cords. o Ice on steps and porches, etc. The Day before Surgery Because of unpredictable changes in the schedule due to emergencies, the time of your surgery will not be set until the day before. A nurse will call you at the phone number listed in your chart the day before your surgery (on the Friday before a Monday surgery). Make sure we have your correct contact numbers. You will be told when to arrive, where to go, and answer questions that you may have. Before 2

this call, please write down any remaining questions you have. If you get a call from us by 4:00 pm, please call (608) 234-6698. Try your best to have a restful night s sleep. If you are coming from out of town, you may wish to stay in Madison. The American Center Guest Services can provide you with a list of nearby motels and arrange for your stay at a discount rate. You may contact them at (608) 440-6242. The night before surgery eat a light supper. Stop eating solid food after midnight the morning of surgery. It is ok to drink clear liquids such as water or apple juice until 4 hours before surgery starts. If you are the first surgery of the day, you may not drink after midnight. Shower with Hibiclens Chlorhexidine gluconate (CHG) Soap the night before surgery and the morning of surgery according to the directions on the brochure you received. Make sure to wash all your skin from the neck down avoiding your genitals. Pay close attention to your surgical shoulder. Make sure the soap stays on your skin for at least 60 seconds. Remove nail polish, make-up, and jewelry. Plan to leave any valuables at home. The Morning of Surgery With a sip of water, take only the medicines that you have been told to take. Arrive to The American Center by. Enter the hospital at the MAIN ENTRANCE by Valet Parking. Check in on the 1 st floor. For going home, bring shoes that are easy to slip on, bottoms that are easy to pull on and a shirt that buttons up the front or any loose fitting shirt large enough to go over a bulky dressing. Bring along any inhalers or CPAP equipment, eye glasses, eye drops, hearing aids, dentures, prostheses, or other special equipment that you will need. Be sure these items are labeled and in a case, if appropriate. Please do not bring bottles of medicines with you unless you have been told to do so. If you have diabetes, you will be given special instruction about your insulin or oral medicines at your clinic visit. 3

A Note to Families You can wait in the Surgical Waiting Area on the 1 st floor near the Main Entrance. If you have other family calling the hospital, please have them call (608) 440-6400. After Surgery and Going Home Occupational Therapy On the day after surgery, an Occupational Therapist will visit with you in your hospital room. The therapist will review precautions (see below) for your shoulder, how to use the sling and get out of bed safely. If your surgeon feels you are ready to start therapy, you will learn exercises. These exercises are designed to improve the strength and flexibility of your arm without harming the surgical repair. Precautions Do not raise your surgical arm. Do not rotate your arm outward or away from your body. Wear the sling at all times except when doing your exercises, performing hygiene or unless your doctor or therapist tells you otherwise. Keep the surgical dressing in place until it is removed at your post-operative clinic visit. Pain Relief We want you to feel comfortable and able to do your exercises. Your doctor will prescribe pain medicine for you. It may upset your stomach or cause constipation. Eating something first will help. Or you may wish to take only half of the pill or use over-the-counter drugs like Extra Strength Tylenol. Please avoid ibuprofen or other NSAID type drugs. Antibiotics You also need to be extra careful not to get an infection in the joint. Taking antibiotics before and after certain procedures can reduce your risk. Let your doctor or dentist know that you have had a joint replacement. Plan to take antibiotics before: Dental care, even routine cleaning Diagnostic procedures that could cause trauma to body tissues (colonoscopy, endoscopy, some rectal exams or bladder exams) 4

Incision Care Keep the dressing clean, dry and in place until you come back for your followup visit. Cover the dressing with plastic and tape when you shower to keep it dry. If swelling occurs, use an ice pack for 10-15 minutes until the area is numb. After the dressing is removed in the clinic and the steri-strips fall off, it will be alright to massage the scar, if it is no longer tender. Activity Short term: Common sense will tell you when you are over doing it. Too much activity can cause pain and interfere with healing. Moderate activity helps in your recovery. Too little activity can delay the return of your strength and stamina. Keep doing the exercises you have been taught. They are important to your recovery. Long term: There will be long term restrictions for most shoulder replacements. For instance, the recoil from a firearm can dislocate the new shoulder joint; and therefore, using rifles and shotguns will be restricted forever. Bench pressing weights as well as heavy, repetitive lifting over head is not allowed. Sling You will be wearing a sling to support your arm for 4-6 weeks. It may be removed only when doing exercises and for bathing, when allowed. Sleeping You must sleep with your arm in the sling for 4-6 weeks. Most people feel more comfortable sleeping more upright propped with pillows or in a recliner. Bathing You may bathe or shower as long as the incision bandage stays dry. Use plastic and tape to cover it. At your first clinic visit, the dressing is removed, and you will be allowed to get the incision wet. Dental Care People who have had a joint replacement are at high risk for infections. Infection of a joint implant can occur when bacteria enters the bloodstream. Before having 5

any dental, medical or surgical procedure, tell your doctor or dentist of your joint replacement or metal implant. To prevent infection, you may need an antibiotic before the procedure. If you have further questions, please call our office or your primary care doctor. Activity Restrictions Driving: Do not drive when taking any prescribed pain pills. Your surgeon will let you know when you can drive. Lifting: No lifting with your operative arm for 6-8 weeks. Housework: Any activity you can do with one hand is allowed. Sports: No sports for 3-6 months or per your doctor s instructions. Clinic Visits You will be scheduled for a clinic visit 7-10 days after surgery. After the first visit you will return again in 4-6 weeks. Other visits are based on your progress. Therapy You will start formal therapy soon after your surgery through UW Health. If you have a therapist you trust closer to home or your insurance requires a certain therapy group, you may have therapy with that therapist. Ask for a copy of the Therapy Protocol your doctor uses to give to your local therapist. You will be responsible for making therapy appointments outside of UW Health. Below are some of the first exercises you might be taught. Please note that some of them might not be right for you. Your doctor and Occupational Therapist will talk with you about the best exercise program for you. Upper Extremity Perform pendulum exercises while standing and bending at the waist. Support your uninvolved arm on a table or chair and allow your involved arm to hang freely. 6

Pendulum Exercise 1 1. Keep your elbow straight throughout the exercise. 2. Use your body to make clockwise circles with your arm for one minute. 3. Reverse the direction and make counterclockwise circles for one minute. 4. Gradually increase the size of the circles. Repeat times. Pendulum Exercise 2 1. Keep your elbow straight throughout the exercise. 2. Use your body to swing your arm up toward your head, and then back along the side of your body. 3. Repeat for one minute. Repeat times Pendulum Exercise 3 1. Keep your elbow straight throughout the exercise. 2. Use your body to bring your arm across your chest, and then out to the side of your body, in a side-to-side motion. 3. Repeat for one minute. Repeat times. Special instructions 7

Important Phone Numbers Before Surgery & After Surgery Unit... (608) 234-6698 Guest Services... (608) 440-6242 Hospital Paging Operator... (608) 262-0486 Patient Information (for room number)... (608) 440-6400 The American Center Pharmacy... (608) 240-4265 Registration To speak with a financial counselor or verify insurance... (608) 261-1600 Toll-Free... 1-800-323-8942 Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person s health needs are different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright 8/2017. University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7792. 8

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