This information has been designed to give you and your family some basic information about shoulder replacement surgery, and what you can expect to happen before and after the operation. This information is intended as a guideline, you may have many more questions, which the doctors, nurses, physiotherapists and occupational therapists will only be to happy to answer.

Why is the operation necessary?

Your shoulder joint is like a ball and socket and it allows you to move your arm in many directions. In a healthy shoulder joint the movement is smooth and pain free. When a joint becomes damaged the surface of the joint becomes rough and movement becomes stiff and painful. The shoulder replacement operation removes the damaged joint surfaces and replaces them with plastic and metal parts that work smoothly.

You will have been seen at the pre-assessment clinic before your admission where you will have you pre-operative tests. These are usually an examination, an x-ray and blood tests

You will usually be admitted to the ward the day before surgery. The nursing staff will meet you to show you the layout of the ward and introduce you to your named nurse. They will ask you a number of questions, so that they can cater for any individual needs you may have.

The surgeon and anaesthetist will see you before your operation to examine you and answer any questions you may have. The surgeon will discuss with you the nature of the surgery, outline the associated risks and obtain your informed consent.

The anaesthetist will discuss the type of anaesthetic best suited to you; usually the procedure is performed under general anaesthetic. A local anaesthetic block is sometimes used which means that your arm is numbed from the shoulder down for the duration of the procedure, a sedative is usually also given. The different forms of anaesthetic will be explained to you and you will be given the opportunity to ask questions.

Your physiotherapist will also come and see you before the operation to assess your current range of movement and function and discuss with you the exercises you need to do after the operation, to help you to recover.

The most important preparation is for you to understand what your operation involves and for you to feel comfortable with your decision, remember that staff are here to help you and answer any questions you may have.

You will not be able to eat and drink for a period of time before your operation. The nursing staff will advise you on admission when you should stop eating and drinking in preparation for your surgery. You will be helped into a gown and the nurses will complete a checklist in order to ensure you are safely transferred to theatre. A member of nursing staff will escort you to theatre either on a trolley or bed. Once in theatre your care will be transferred to a member of the theatre staff who will check your personal details again and who will look after you until it is time for your anaesthetic.

Once in the anaesthetic room, you will be given an injection in your hand to put you to sleep, if you are having a general anaesthetic. If the anaesthetist has advised you that you are having a local anaesthetic block. This will be explained to you fully at the time.

The first 48 hours

After a short stay in the theatre recovery area you will return to the ward. When you come back from the operation your arm will be held in position in a type of sling called a shoulder imobiliser.

You may have a ‘drip’ in your arm that ensures that you get plenty of fluids, as you are unable to take anything by mouth for a short time after the operation. Once you are able to eat and drink normally this ‘drip’ will be removed. This is usually on the first day after your operation.

Your physiotherapy will begin the day after your operation and you will continue with exercises for your new shoulder joint. The exercises are gradually progressed each day until the range of movement required for discharge is achieved.

You will also have stitches in the wound and these are usually removed 10 – 14 days after the operation by your GP’s Nurse.

Many patients worry about how painful surgery will be and all staff understand this. It is usual to experience some discomfort and the staff will give you painkillers when you need them to help keep you comfortable. Everyone feels differently and it is important that you tell the nurses or physiotherapist, if you are in pain, especially with exercises.

In some instances it is possible for you to be given a type of pain relief that enables you to control the amount of painkiller you receive yourself (Patient Controlled Analgesia). Further information about this is available on the ward, and will be explained to you if you are to be given this. You will be monitored closely by the nursing staff after your operation and they will keep you comfortable.

Getting up and about

You will be able to get up the day after surgery and you may require an x-ray. Your surgeon and physiotherapist will decide exactly which exercises are required and when they can be started. Remember to keep elevating your arm when resting to prevent swelling.

What problems can occur?

No operation is without the risk of complication. Your surgeon and therapist will explain any particular risks/complications of your operation before surgery.

Is the operation always successful?

The surgeon’s expectation of your operation will be discussed before surgery (usually when initially seen in out patients) so that you understand the likely result, and the risks/benefits of the proposed operation. This information must be taken into account when you make the decision to undergo surgery.

Your discharge from hospital

Your stay in hospital will usually vary depending on your progress. Once you have achieved the required range of movement and the physiotherapist is happy with your shoulder, you will be discharged home usually as soon as suitable arrangements can be made.

You will be required to attend for outpatient physiotherapy to continue with treatment and this will be arranged with you prior to your discharge home. Normally this will involve you returning as an outpatient to Freeman Hospital Physiotherapy department.

Planning for going home begins as soon as you arrive in hospital, if you have any fears or concerns regarding discharge please discuss these with your named nurse.

Your named nurse will ask you and your carers about your social circumstances, this is just to ensure that you will be able to manage certain tasks when you go home such as washing, dressing and meal preparation.

If your named nurse feels you and your carer will require extra support, she will discuss this with you and with your permission, arrange for you to discuss your needs with the hospital social worker and occupational therapist.

Transport home

Please discuss your transport arrangements home with your named nurse before your day of discharge. It is possible in some instances to organise hospital transport, if required.

The day of your discharge

On the day of your discharge your named nurse will give you some things to take home with you, these will include:

• A letter for your GP (in some instances this will be posted) This should be handed in to your GP by either a relative or friend on the next working day following your discharge.
• Medication Any medication you have bought into hospital will be returned to you. You will also be given a 7-day supply of any new medications. The nurse will advise you on how and when to take these.
• Outpatient Clinic Appointment You will be given an appointment to be reviewed in clinic, approximately two weeks after your surgery. If transport is required this can be done by yourself contacting your GP, providing a weeks notice where possible. If for any reason you are unable to attend your appointment please contact the outpatient department to rearrange the appointment. Your physiotherapist will arrange you outpatient physiotherapy appointment, and explain you home exercise programme to you.
• Care Plan If you have a care package arranged you would receive a copy of the care plan from the Social Worker before your discharge home. This is for your own information.
• Discharge Record This provides details about your stay and is for your own information.
• Patient information Please take home any written information given to you during your stay and please do not hesitate to use the contact numbers if you require any further advice.
• Valuables Please ensure you have all your valuables with you

General advice after discharge

• Cars and Driving It is inadvisable to drive while wearing a cast, splint or restrictive bandage. Always check with your insurance company before starting to drive again. It is not the responsibility of your consultant to make this decision. He will advise when he feels driving will cause you no harm.
• Work How soon you are able to return to work will depend on the type of job you do. You should discuss this with your surgeon when you see him in the Outpatient Department.
• Wound Care All dressings should be left undisturbed until your Consultant sees you in the outpatient clinic. Keep your wound dry until your stitches are removed.
• Exercises Continue to do your exercises as instructed by the physiotherapist.
• Pain Take your painkillers as prescribed. Do not take more than the stated dose. If you notice any increased pain, swelling or if your wound starts to ooze please contact your General Practitioner.

Follow up

You will be followed up as an outpatient at regular intervals after your discharge from hospital. Please use this opportunity to ask questions and discuss any concerns you may have. You are also this is available on the ward, and will be explained to you if you are to be given this. You will be monitored closely by the nursing staff after your operation and they will keep you comfortable.