Total Shoulder Replacement Program

Welcome to Doylestown Health’s Orthopedic Institute

Our surgeons, nurses, therapists, and other care providers are passionate about their work and committed to providing you with the highest quality of care.

By working as a team, our personalized approach to your orthopedic care includes specialists in joint and reconstructive surgery; sports medicine; trauma; hand, shoulder, and spine surgery; and rehabilitation. We are focused on patients with problems related to bones, tendons, ligaments, joints, and muscles. This approach to care ensures the best outcomes for our patients. 

Couple gardening | Doylestown Health

More Information

Provider discussing a chart with patient | Doylestown HealthStress, injury, and aging cause wear and tear of the joint. This can lead to osteoarthritis, also known as degenerative joint disease. When we lose the smooth gliding movement of bone over cartilage, pain, swelling, stiffness, and instability often occur.

Joint replacement — called arthroplasty — is often the best method to relieve severe osteoarthritis and helps a person regain movement and decrease pain.

Joint replacement surgery is one of the most successful surgical procedures available. Many individuals wonder why they waited so long to choose surgery and regain function. Some say it is like getting their life back. Surgery gives them back their freedom to return to normal activities.

About 53,000 shoulder replacements are performed in the United States yearly. Shoulder replacement surgery was first performed in the United States in the 1950s to treat severe shoulder fractures. Over the years, shoulder joint replacement is used for many other painful conditions of the shoulder, such as arthritis.

THE SHOULDER

X-ray view of a shoulder | Doylestown HealthThe shoulder is the most mobile joint in the body. Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball of your upper arm bone (humerus) fits into a shallow socket in your shoulder blade (glenoid). 

The surfaces of the bones where they touch are covered with articular cartilage, a smooth material that cushions the bones so that they glide smoothly. With osteoarthritis this cushioning is missing, making movement painful.

A thin, smooth lining (synovial membrane) secretes a clear liquid called synovial fluid. Synovial fluid lubricates the joint. This fluid reduces friction and allows smooth motion.

The muscles and tendons that surround the shoulder provide stability and support.

Shoulder replacement is a surgical procedure in which arthritic or damaged parts of the shoulder joint are replaced with metal and plastic parts to relieve pain and improve function.

There are different types of shoulder replacements. Your surgeon will discuss with you which type of replacement is best for you. The treatment options are:

  • Total Shoulder Replacement: Replacement of both the ball of the upper arm bone (humerus) and the socket (glenoid) with a plastic cup.
  • Hemiarthroplasty: Replacement of just the ball of the upper arm bone (humerus).
  • Reverse Total Shoulder Replacement: A metal ball is attached to the socket side (glenoid) and a plastic socket is attached to the upper arm bone where the ball (humeral head) used to be.

Total Shoulder Replacement

X-ray view of a shoulder | Doylestown Health

The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket. These parts come in

 various sizes. They may be either non-cemented (“press fit”) or cemented into the bone. If the bone is of good quality, your surgeon may choose to use a non-cemented humeral part. If the bone is soft, the

 humeral part may be implanted using bone cement. In most cases, a plastic socket (glenoid) part is implanted with bone cement. Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for total shoulder replacement.

Hemiarthroplasty

In a traditional hemiarthroplasty, the ball of the upper arm bone (humerus) is replaced with a metal ball and stem, similar to the component used in a total shoulder replacement. This technique is often used to repair severe shoulder fractures in addition to arthritis.

Reverse Total Shoulder Replacement

Elderly woman on a wheelchair with husband | Doylestown HealthThis technique is used for patients who have a complete rotator cuff tear in addition to severe arthritis. In reverse total shoulder replacement, the socket and metal ball are switched. This means a metal ball is attached to the socket side (glenoid) and a plastic socket is attached to the upper arm bone where the ball (humeral head) used to be. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.

Regardless of the type of surgery, you will wear a sling at all times, for four weeks for total shoulder replacements and two weeks for reverse shoulder replacements with the exception of when you are bathing, getting dressed, and performing your exercises. You will need to keep your arm close to your side and will not be able to reach behind your back.

THE PRE-ADMISSION PROCESS

Doylestown Health’s orthopedic care team will help prepare you both physically and emotionally for your total joint procedure.

Joint replacement surgeries can be performed as an outpatient or an inpatient procedure. The decision on whether you are admitted as an inpatient or you are sent directly home after your surgery (outpatient) is dependent upon many factors, including but not limited to your medical history and insurance. Your surgeon will determine which procedure is best for you.

Joint replacement surgeries can be performed as an outpatient or an inpatient procedure. The decision on whether you are admitted as an inpatient or you are sent directly home after your surgery (outpatient) is dependent upon many factors, including but not limited to your medical history and insurance. Your surgeon will determine which procedure is best for you.

As part of the pre-admission process, you will be contacted by the hospital staff to schedule your pre-admission testing and nurse call.

Pre-admission Testing

Provider discussing surgery with a patient | Doylestown HealthPre-admission testing will be scheduled for you. You will have lab work and an electrocardiogram (EKG). You will have a telephone conversation with a nurse to discuss your other medical issues and medicines. You will be given your pre-operative instructions.

The nurse will need to know all of the medicines you take (including vitamins/ supplements and over the counter medicine). 

You will need to schedule appointments for your surgical clearances. These include your family doctor and cardiologist (if prior history). They can occur after your pre-admission testing. Finally, you will meet with a physician assistant who will review your health, medical clearances, and blood work to ensure you are medically ready for surgery.

Pre-operative Education

Please view the online education program as soon as possible. This program is extremely valuable and will help you understand:

  • What will happen in the hospital
  • The rehabilitation process
  • How you can return to active living as you recover from surgery

More about post operative exercises on Doylestown Health's website.

Pre-operative discussion with patient and provider | Doylestown Health

You may have some questions about your surgery and care. Later in this booklet, you will find a list of frequently asked questions. There is also a list of questions you may want to ask those caring for you. 

Don’t be afraid to ask — our orthopedic care team is here to answer your questions while providing the best care available. 

 

DAY OF SURGERY

The orthopedic team will be ready for you when you arrive at Doylestown Hospital for your surgery.

Before coming to the hospital, remove all of your jewelry and leave any valuables at home. If your surgeon gave you a sling, bring it with you. 

When you arrive at the hospital, please report to the Same Day Surgery (SDS) unit on the 2nd floor above the main lobby.

Your nurse will begin to prepare you for surgery. An anesthesiologist will discuss your anesthesia options with you and you will meet a nurse anesthetist.

Anesthesia

Your anesthesia needs will be carefully matched to your medical condition and the details of the surgery. Your response to anesthesia will be closely monitored. Be sure to share with your anesthesiologist your current health history, including any reactions to medicines and past experiences with anesthesia. 

If you have specific questions about anesthesia prior to your surgery, let the pre-admission nurse know and she will set up an individual meeting for you. 

Depending on your medical history, your surgeon may require you to meet with anesthesiology prior to surgery. If this is the case, you will receive a call from anesthesiology.

There are two types of anesthesia: general and regional.

  1. General anesthesia acts on the brain and nervous system, similar to a deep sleep. It is given by intravenous (IV) followed by breathing it in.
  2. Regional anesthesia involves a nerve block to numb the shoulder and arm without acting on the brain. This nerve block will give you pain relief for up to three days after surgery. 

Getting Ready for Surgery

For your safety, your team will ask you to confirm that you are the correct patient and what surgery you are having. You will also be asked your name and date of birth several times during during your hospital stay.

All dentures, contact lenses, glasses, hearing aids, and hairpieces will be removed and safely kept for you.

An IV catheter will be placed into one of your veins, and fluids and antibiotics will be given.

Any hair on your surgical site will be clipped. An antibacterial scrub will be used.

Before you arrive for your surgery, your team of experienced anesthesia and operating room staff, who are experts in total joint surgery, will plan and prepare the operating room suite. This team will stay with you during the entire surgery, providing for your safety and privacy while you are under anesthesia.

As the time of your surgery nears, you will meet your nurse anesthetist. Your medical chart will have already been reviewed by the team to be sure that all important information is noted, including your permit for surgery, the history and physical findings, and medical reports. 

Surgery

Surgery in progress | Doylestown HealthNext, you will be taken into the operating room suite. The room will be a bit chilly; warm blankets will be given to you.

For your safety, your team will ask you to confirm what surgery you are having. They will also ask you your name and date of birth.

In the room, you will notice some team members in what look like space suits. During your surgery, the surgeon, nurses, and assistants will wear these suits to protect both you and the staff from any potentially harmful bacteria or viruses.

The nurse anesthetist will place equipment on you to check your blood pressure, oxygen level, and the rate and rhythm of your heart before, during, and after surgery. 

Total shoulder replacement surgery takes approximately 90 minutes to complete.

Rehabilitation Begins When Surgery Ends

After surgery, you will be taken to the post-anesthesia care unit (PACU) to begin your recovery.

Your vital signs (temperature, blood pressure, pulse, blood oxygen level, and respirations) will be closely monitored. A sling will be placed on your arm.

An X-ray may be taken while in the PACU to check the positioning of your new shoulder in this early phase of your recovery.

After your initial recovery from anesthesia, if you are staying overnight you will continue on the orthopedic unit. If you are going home, you will return to the Same Day Surgery (SDS) unit.

Even though you are having surgery on your shoulder, keeping blood flowing to and from your legs is of utmost importance. One of the major risks for patients who have joint surgery is a problem called deep vein thrombosis (DVT). A deep vein thrombosis is when a blood clot forms within a deep vein in the thigh or calf. Surgery-related changes in circulation and activity, as well as individual risk factors, contribute to a clot’s formation.

Our team has measures in place to help prevent this from happening. These may include:

  • Anti-embolism stockings (TED stockings). These are elastic compression stockings used to help circulation. You may wake up from surgery with these on your legs.
  • Foot pump. This is a foot wrap connected to a small machine that applies pressure to the bottom of the foot, helping with blood circulation. 
  • Medicine prevention. The use of aspirin or an anitcoagulant medicine such as Lovenox or Warfarin (coumadin) may be started. (See the “Medications and Pain Management” section.)

Your incision will have dissolvable stitches with glue or staples. A sling will be given to you and must be worn at all times for four weeks for shoulder replacements and two weeks for reverse shoulder replacements, with the exception of when you are bathing, dressing, and doing your exercises. A special waterproof dressing will be over your incision to promote healing. This will stay in place for five to seven days. You will be given instructions for removal. It is common to have swelling and black and blue coloring throughout your operated arm. Ice packs may be used to help with the swelling and ease the pain. If you have staples, you will be discharged with them in. If you are receiving home care, the nurse will remove them. Otherwise, you will be instructed to make an appointment to have them removed.

If you are admitted to the hospital, you will begin your normal diet as soon as you are able. “At Your Request” is a bedside service for ordering meals of your choice. You may also order meals for family members at a cost.

While in the hospital, you will be followed by your orthopedic team. Your team includes your surgeon, physician assistants, case manager, orthopedic nurses, and occupational therapists. You may also have contact with pharmacists, physical therapists, dietary, and/or housekeeping staff.

Occupational therapy (OT) may begin the day of surgery. The therapy sessions are specific to your needs. They will focus on dressing, bathing, and exercising. The occupational therapists will help you return to your activities of daily living (ADLs), such as bathing, dressing, using the toilet and shower, and homemaking activities. You will dress in your own clothing during your stay.

You will learn how to use the special equipment recommended by your occupational therapist, so that you can do as much as possible for yourself.  

Planning for Discharge

Provider discussing discharge with a patient | Doylestown HealthYour plan for discharge will be based on how you progress with therapy. The majority of our patients stay only one night.

After discharge from the hospital, home care may be ordered for you if your personal needs and insurance permit. This will include home visits by a nurse and an occupational therapist (OT). This can be anywhere from two to four weeks depending on your status.

Outpatient physical therapy will begin when you are out of your sling and can be anywhere from four to eight weeks depending on when you regain function and range of motion.

If choosing to have therapy at Doylestown Hospital’s Clark Outpatient Rehabilitation Center, located on the hospital’s campus, please call 215.345.2894 to schedule your appointment.

ANTICOAGULANTS (BLOOD THINNERS)

An important part of your recovery is anticoagulation medicine to thin the blood and help prevent blood clots. Aspirin and Warfarin (Coumadin) are our most common medicines used to prevent blood clots.

An anticoagulation medicine is prescribed for several weeks after surgery unless you have health reasons not to take it, such as stomach ulcers, blood disorders, or allergies. If you are on a medicine other than aspirin, blood work will be done daily while in the hospital to help your doctor know how the medicine is working. The dose of medicine may change based upon your blood work results.

Medication bottles on a shelf | Doylestown HealthIt is normal for you to have swelling in your operative arm. If you have increased arm or calf pain, swelling, redness, or feelings of warmth, notify your nurse/surgeon immediately while in the hospital or at home. These could be signs of a blood clot.  

If you get short of breath, have chest pain or extreme fatigue, tell the staff while in the hospital or get to the nearest emergency room if you are at home. In either case, these could be signs of a blood clot in the lungs that needs emergency testing and treatment.

After you leave the hospital, if you are on medicine that requires monitoring, your doctor will manage your anticoagulation dosage, testing, and results.

While you are taking these medicines, you may be more prone to bruising and bleeding. If you have any of the following symptoms, call your doctor right away:

  •  A nosebleed
  • Change in the color of your urine or bowel movements
  • Bleeding in your gums
  • A cut that won’t stop bleeding
  • New bruises that get larger

Certain foods, especially green, leafy vegetables, can affect your anticoagulation medicine levels.

You do not need to drastically change your normal diet. It is most important to keep a similar amount of green leafy vegetables in your daily diet. Talk with your surgeon about taking over-the-counter medicines or drinking alcohol.

PAIN MANAGEMENT

Medication, pills in the palm of a hand | Doylestown HealthYour doctors use a multimodal pain management plan to control your pain and help keep you comfortable. They use small doses of several medicines that all work in different ways to decrease side effects and control pain. You will get pain medicines before, during, and after your surgery.

Every person’s level of tolerance for pain is different. We use a pain scale of 0 to 10 to measure and treat pain. A “0” means no pain and a “10” means the most severe pain you have ever had.

No matter what type of pain control is ordered, it is normal to have some pain while healing. Your doctor will help choose which medicine is best for you based on your past experience. 

Side Effects

Side effects of pain medicines can include nausea, dizziness, dry mouth, itching, drowsiness, trouble focusing, constipation, and/ or diarrhea. Most side effects can be treated and are not a reason to stop your pain medicine. At the hospital, stool softeners and laxatives will be given to prevent constipation and should be continued even after you leave the hospital.

Your Part in Management

Provider discussing pain management with a patiet | Doylestown HealthYour health care team wants and needs to know about your pain. Pain medicine is usually ordered on an “as needed” basis, every four to six hours. So, if you need it, ask for it.

  • Take or ask for pain medicine when pain first starts.
  • Take pain medicine before activity. Ask for pain medicine at least 30 to 60 minutes before therapy
  • Try relaxation techniques to help with pain control.
  • Tell your needs to your healthcare team.
  • Use ice – 20 minutes on, 20 minutes off. 

Pain medicines are not usually needed for a long period of time. As you heal, your need for pain medicine will change. Narcotics (strong medicines) will be ordered right after surgery and then will be changed to nonnarcotic and over-the-counter medicines. Anti-inflammatory medicines may be added.

If at anytime in your recovery your pain is not manageable, you need to contact your surgeon. If you run out of narcotic medication and you feel you need additional medicine, you will need to call the surgeon’s office.

 

TIPS FOR YOUR RECOVERY

Mother and daughter folding laundry | Doylestown Health

  • Schedule and keep your follow-up appointments with your surgeon, primary care doctor, and therapists.
  • To help strengthen your operative arm, do your exercises and keep a routine. As previously stated, if you return home the day of your surgery, your exercise program can be found on the education website, DoylestownHealth.org/OrthoEducation.
  • Conserve your energy. Pace activities. Rest in between.
  • Avoid low chairs and beds.
  • Resume physical activities gradually.
  • Resume household activities.
  • You must sleep with your sling on.
  • At first, sleeping in a recliner chair may be the most comfortable position.
  • Talk with your surgeon about when you may drive. You are not permitted to drive with a sling.
  • You may return to work and volunteer activities when released by your surgeon.
  • If you plan to travel by plane, you may have to go through extra security. Your prosthesis may cause sensitive metal detectors to alarm.
  • Following your surgery, you may need to take antibiotics before any dental or invasive procedure. Your surgeon will let you know if this is the case.
  • Follow all of your instructions until told otherwise by your surgeon.

What should I do in the weeks before my surgery?

Couple with bicycles | Doylestown HealthCheck your pre-admission checklist in your folder and make sure you complete all of the tasks. Medical check-ups are required for joint replacement. You must make sure you see the doctors before your surgery. 

Your surgery may need to be rescheduled if these are not done in a timely manner.

Practice getting in and out of the chair/recliner and managing in the bathroom without using your surgical arm. 

Get plenty of rest and eat balanced meals.

If you are taking medicines that thin the blood, your doctor will tell you if/when you should stop the medicine prior to surgery. This will also be reviewed with you at your pre-operative physician assistant’s visit prior to surgery.

For 24 hours before surgery, do not smoke or drink alcohol.

Prepare for a safe return home by safeguarding your house:

  • Make sure that your furniture and railings are sturdy.
  • Remove any throw rugs and secure loose edges of carpet.
  • Clear walking paths of any electrical cords or other objects.
  • Keep a light at your bedside.
  • Consider light-sensitive automatic nightlights to place in rooms/hallways/ bathrooms.
  • Consider grab bars in your tub or shower.
  • Three days prior to surgery, follow your shower and nose medicine guidelines.
  • Organize your kitchen by storing cooking utensils and food in areas that are easy to reach.
  • Stock easily prepared foods, such as canned, frozen, or microwavable meals.
  • Obtain safety devices in the bathroom such as slip-proof mats and grab bars for the bath and or toilet.
  • Buy the equipment that you will need before your surgery. 
  • Think ahead about care of your pets. You may need help with them even after your surgery.
  • Ask someone to help you for a few days after your surgery.

What should I do the day before my surgery?

  • Patient reading a newspaper | Doylestown HealthThe hospital will call you after 2 pm the day before your surgery to tell you what time to arrive. If your surgery is on Monday, they will call on Friday.
  • Follow the eating/drinking guidelines that you were given.
  • Remove all nail polish for circulation checks.
  • Follow the shower guidelines in your folder.
  • Follow the nose medicine guidelines in your folder.

What should I bring to the hospital?

  • Bring a current list of all your prescription and over-the-counter medicines and supplements (including dosages).
  • You may bring any personal items, including any toiletries or cosmetics. You should not bring valuables to the hospital.
  • Pack comfortable, loose clothing to wear while in the hospital.
  • Bring supportive shoes with non-slip soles. Shoes without ties are easier for most patients.

How long will my surgery take?

Patient in bed with wife and provider | Doylestown HealthFrom the time you you arrive to the Same Day Surgery (SDS) unit, have surgery, and recover in the Post-Anesthesia Care Unit (PACU) and be settled in your room, or ready to go home, it may be up to four hours.

How do you ensure my safety? 

Doylestown Health is committed to patient safety. To provide a safe environment for all of our patients, we follow these safety guidelines:

  • We ask you your name and date of birth many times during your stay.
  • We use a “Time-Out” in the operating room, a process that confirms the right patient, procedure, and site. 
  • We follow strict infection control procedures.
  • We have specially trained orthopedic staff that care for you in the operating room and on the orthopedic unit.
  • The operating room staff wears sterile attire.
  • We have a special air-flow design in the surgical suites.
  • We give antibiotics before, during, and after surgery.
  • We adhere to required hand washing and sterilization by staff.
  • We screen for infections before surgery.
  • We use special wipes before surgery

Where should my family or friends wait during my surgery?

The waiting area is located on the 2nd floor of the hospital’s Main Lobby atrium, outside of the Same Day Surgery unit.

After my surgery, if I have questions related to my surgery who should I call? 

Elderly woman with daughter and granddaughter | Doylestown HealthFor any issues, call the surgeon’s office; they answer calls 24 hours a day. In the case of a medical emergency, you should call 911 if necessary or go to the closest hospital. If you receive care at another hospital, please let the surgeon know when you are able.