This video is designed to give you all the information you need about your upcoming surgery.
We hope it will be able to increase your knowledge about the operation and what it entails, and
reduce any concerns you may have about what happens on the day. It will also provide you
with more information about what to expect during your recovery and rehabilitation.
Our aim is to provide you with a shoulder joint that is better than the one you currently
have in a safe, clean and efficient environment. This DVD is designed to keep you informed
about your operation and what to expect after surgery, so that appropriate plans can be
put in to place to optimise your recovery. We want to provide a package of measures to
help you in your recovery, and to speed up the process of getting better. You should
have been sent a form to complete asking about your home circumstances. This will be reviewed
and if necessary the occupational therapists may contact you to plan for any equipment
or support that may be required to aid your transition back to home. We will also teach
you some of the exercises you will need to know after your surgery. Practising these
before your surgery, may help to maintain muscle strength and aid in quicker recovery
post-surgery. You will meet some of the team who will help you with this; the physiotherapists,
occupational therapists and nursing team, depending on your needs. You will have already
met your surgeon or one of their team in the outpatient clinic, and will see them again
at the preoperative clinic or on the morning of surgery. It is often worthwhile noting
down any questions you may have for them, as we know that often minds go blank when
there was a burning question you wanted answered!
A normal shoulder is a complex joint that
relies on both smooth articular cartilage and functioning muscles in order to work properly.
You will have been offered a joint replacement because one or both of these factors have
worn out, which causes pain, stiffness, interrupts sleep, and stops you from doing the things
you want to do. The replacement removes the diseased parts of the joint, replacing it
with metal and plastic so that it can glide freely.
This is a replacement where the ball and socket are replaced in a standard fashion. The ball
is metal, and the socket is plastic. There are numerous different versions of this replacement,
with or without a stem down the arm bone. They are either cemented into your bone or
held using a tight press fit. This is what we call a reverse shoulder replacement.
It is reversed as we swap the pieces around, putting the ball on the socket and the socket
where the ball was. This means that the big muscle of your shoulder, the deltoid, can
move your arm more effectively, and is used when the small muscles in your shoulder, the
rotator cuff, no longer work properly or are torn.
After the operation you will wear a sling for 4 to 6 weeks for comfort, but be able
to take your arm out of the sling for exercises and will normally be able to use your arm
in a safe zone. You will have a scar at the top of your arm, running from near the end
of your collar bone down towards the armpit. The vast majority of shoulder replacements
are successful, safe, with a low complication rate and high patient satisfaction.
You will be invited to a preoperative clinic a few weeks before your surgery date. Here,
your health and fitness for an operation will be assessed, and routine tests such as an
ECG heart trace, blood and urine tests will be undertaken. You should bring any medications
you usually take to this appointment. If you think you may need extra help after the operation,
or are already receiving assistance from social services care or district nurse visits, then
let us know so that we can make plans to help you after your discharge from hospital.
The surgical team will see you and ask you to sign a consent form. All operations have
risks, although most are rare. We will discuss these with you. This is a great opportunity
to have any questions you may have answered. You may be seen by the occupational therapist
or physiotherapist depending on your needs. They will discuss exercises you can do prior
to your operation to help with your recovery and precautions in terms of movement after
surgery, as well as assessing any needs for equipment you may have.
It is often a good idea to stock up the freezer and cupboards, or organise support for shopping
for when you come home from hospital. You will be given a course of tablets to take
in the 5 days before your operation. These improve pain after the surgery, but may make
you feel lightheaded or sleepy.
On the morning of your surgery shower at home before coming to hospital as per your admission
letter. This is usually Ward 207. Please remove and keep safe any rings or jewellery from
the arm you are having operated on. You will be seen by the nursing team who will check
your observations, and then get changed into a surgical gown. The surgical team will see
you, draw an arrow on the arm you are having an operation on, and answer any final questions.
The anaesthetic team will see you and discuss options here. The majority of patients have
a nerve block that numbs their arm combined with either sedation or a general anaesthetic.
A porter will collect you about twenty minutes before your operation, and take you to our
theatre receiving room. Here, you will be checked in, making sure you are the right
person for the right operation. These checks will be repeated in the anaesthetic and theatre
rooms. You will then be taken through to the anaesthetic room, where routine monitoring
equipment will be used to keep you safe, and a drip placed in the back of your hand. The
anaesthetist will then numb your arm by placing local anaesthetic around the nerves coming
out of your neck, and then you will be given a general anaesthetic or sedation. You will
be placed into the position required for the operation, much like you are sitting on a
deck chair, and then will be taken through to the theatre.
After the operation you will be taken to the recovery room. Here, you will be observed
whilst the anaesthetic wears off, and given any further painkillers or anti-sickness medications
you may need. You will then be taken back to the ward where
further observations will be performed. Your arm will remain numb from the block for 8-12
hours, but it is important to have regular painkillers for when the block starts to wear
off. Usually this is simple tablet analgesia, but other stronger medications are available
if required. Drink a mixture of drinks, tea coffee and juice, not just water. When your
arm wakes back up continue to take the painkillers to allow you to perform your exercises. You
will be seen by the physiotherapy team on the ward on the day of surgery or the next
morning, who will check over your exercises. These exercises are described in your preoperative
information booklet, and it is worth practising these before surgery.
Usually patients stay in hospital for one to two days after a shoulder replacement,
to ensure that they are safe to go home and the pain is under control. We will inform
your GP that you have had your operation, and give you a supply of painkillers to take
home with you. It is important to continue to take these to allow you to do your exercises.
Aim to do these at least three times a day. It is normal to experience some swelling and
bruising following your surgery and this will vary from patient to patient. Keeping your
hand elevated above the level of your elbow will help to prevent swelling in the hand.
Regularly performing the hand exercises shown to you will also help to keep swelling to
a minimum. You have had a major operation, so it is common to feel tired, and it often
takes several weeks to fully recuperate. Your stitches will dissolve, and do not need to
removed. You will either be seen by your practice nurse or in the outpatient department to have
your wound checked at about two weeks. If the dressing remains clean and dry then it
is best to leave it on until this time. You can shower as the dressing is splash proof,
but do not soak the dressing directly under the water flow or in the bath.
Following the operation you will be seen within 3 months by the surgical team. You then will
be followed up on a yearly basis to ensure your new joint is still functioning well.
You will also be referred for outpatient physiotherapy to guide you through your rehabilitation.
You will normally be seen once whilst in the sling to check on your basic exercises. When you
come out of your sling at 4 to 6 weeks, you will be gradually progressed through movement,
strength and functional exercises over the following weeks. It is really important
to persevere with exercises to get the best result from your surgery. Progress may feel
slow initially, but do stick with it, and with time you will feel the benefits. We hope
you will find your new shoulder gives you less pain, improved function, makes doing
your usual daily activities easier, and hopefully gets you back to work or leisure activities
that your shoulder was previously stopping you from doing. You should notice definite
improvements in pain and function over the first 3-4 months, but we expect your shoulder
will continue to steadily improve for up 12-18 months following surgery.