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 orthopedic navigator 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.
- 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.
- 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
Next, 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, an orthopedic navigator, 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
Your plan for discharge will be based on how you progress with therapy. The majority of our patients stay only one night.
If you have concerns about your discharge plans, please talk to the orthopedic navigator.
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, the orthopedic navigator will help you arrange your visits.
Stress, 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.
The 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). 
This 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.
Pre-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.
It 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. 
Your 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.
Your 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.
Check 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. 
The 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.
From 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.
For 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. 