Presentation on theme: "Joint PREP Class Shoulder Replacement T. Andrew Israel, MD Luther Midelfort Orthopaedic & Sports Medicine Center."— Presentation transcript:
Joint PREP Class Shoulder Replacement T. Andrew Israel, MD Luther Midelfort Orthopaedic & Sports Medicine Center
2 Goals for you and your family Recognize shoulder replacement is a reliable operation to improve quality of life Describe what to expect of the shoulder replacement procedure. Discuss the risks of shoulder replacement surgery.
3 Goals of Your Shoulder Replacement Improve your quality of life by: Relieve your pain Improved motion Improved strength Better function
Shoulder Joint Replacement Indications l Bone on bone osteoarthritis l Intact rotator cuff tendons
5 Shoulder Arthritis Loss of cartilage leads to narrowing of the joint space
6 Shoulder Arthritis As the cartilage wears, bone spurs form and the shoulder becomes stiff
7 Surgical Technique of Total Shoulder Replacement Replaces the worn bony surfaces with metal ball and plastic socket (glenoid) Replaces the worn bony surfaces with metal ball and plastic socket (glenoid) Restores shoulder motion and stability Restores shoulder motion and stability
8 Implant Materials A plastic socket A Metal ball attached to a stem -Non-cemented press fit into the -Non-cemented press fit into the humerus humerusor - Bone cement is used to cement - Bone cement is used to cement the stem into the humerus. the stem into the humerus.
9 Implant Materials A plastic socket is cemented into the glenoid. A plastic socket is cemented into the glenoid. A metal ball and stem goes down into the humerus. A metal ball and stem goes down into the humerus.
10 Hemiarthroplasty A metal ball and stem goes down into the humerus. A metal ball and stem goes down into the humerus. No plastic socket is placed.
Reverse Total Shoulder Indications l Completely torn rotator cuff with severe arthritis l Complex fractures l Previous failed shoulder replacement
12 REVERSE TOTAL SHOULDER Socket and ball are reversed - Humeral head (ball) - Humeral head (ball) becomes the becomes the socket socket - Glenoid (socket) - Glenoid (socket) becomes the ball becomes the ball
13 Surgical Technique Incision The incision is made in the front of the shoulder Your surgeon will make the incision long enough to see the joint area Your surgeon will use techniques to spare muscle Surgical techniques continue to improve as technology advances
14 Day of Surgery Your surgeon will meet you in SurgiCenter to initial your shoulder and answer final questions. Family can wait with you in SurgiCenter. You will go to the Operating Room (OR) Surgery lasts 2 hours. You will then go to the recovery room for 1-2 hours.
15 After Surgery in the Hospital Physical & Occupational Therapy is critical for a good outcome Therapy starts the day after surgery - Wear an arm sling immobilizer full time for 4 weeks - No forceful contraction of muscles such as pushing up out of chair or bed. - Follow the exercise program set up for you 4-5 times a day for 4-6 weeks.
16 Shoulder precautions Do not overdo it! Early overuse may result in severe limitations of motion Do not lift anything heavier than a glass of water for the first 6 weeks Do not participate in contact sports or any repetitive heavy lifting after your shoulder replacement. Avoid placing your arm in any extreme position for the first 6 weeks
17 Other Doctors in the hospital Additional Doctors take care of non-orthopedic issues (such as high blood pressure or diabetes). If you have an Internal Medicine doctor here, they will see you after surgery. If your regular doctor does not see patients in the hospital, a Hospitalist will see you after surgery. If you are not getting a medication you think you should, please ask.
18 Blood Clot Prevention Enteric coated aspirin 325 mg twice a day while in hospital to prevent blood clots. Continue at home for 3 weeks. TED hose worn for 3 weeks after surgery, you may remove these at night. SCDs (calf squeezers) are on in the hospital whenever you are in bed. Exercising your legs and being up and walking promotes blood flow.
19 Risks of Surgery Anesthetic Complications Anesthesia providers meet with you the day of surgery. They discuss anesthetic options including nerve blocks for postoperative pain relief. Nausea and vomiting are common but more serious side effects or complications may occur. Please tell the anesthesia provider of any past experience with anesthesia.
20 Risks of Surgery Blood Clots Lower risk for blood clots with total shoulder replacement Clots can go to the lungs and be fatal Your risk is reduced to <1% if treated with medication (aspirin) and TED hose Being active and walking helps to prevent blood clots
21 Risks of Surgery Infection You will get antibiotics at the time of surgery and for 24 hours after surgery. Surgeons, assistants and scrub techs wear spacesuits. Using all precautions, risk of infection is ~1%. Infection may occur months or years after surgery. Infection may mean removal of your implants.
22 Spacesuits worn during surgery
23 Risks of Surgery Blood loss Bony surfaces bleed during surgery. There may be some bleeding after surgery. Your surgeon may use a drain in the shoulder Your blood count will be checked each morning after surgery. If you have symptoms from a low blood count, you may need a blood transfusion.
24 Risks of Surgery Medical Complications Surgery is a stress to your body. Heart and lung problems, stroke, stomach problems, constipation - all may occur. A physical with your regular doctor and an EKG are required before surgery. Despite precautions, unforeseen medical complications may still occur.
25 Risks of Surgery Dislocation This is an artificial joint and may slip out of joint. If it does dislocate, this often requires a trip to the hospital to have the shoulder put back in place. You may be required to wear a brace if it dislocates. Multiple dislocations may require revision surgery to fix the problem.
26 Risks of Surgery Need for Revision We encourage patients to wait as long as possible before replacement. Implants wear with time.. Wear rate is about 1% a year Wear rate is about 1% a year Revision surgery may involve changing the plastic or changing one or all metal parts. Revision surgery is more challenging with a more difficult recovery.
27 Recovery time 3-4 months: normal activity 6 months: normal endurance 12 months: maximal recovery Focus on exercises for movement and then strength Getting back to work is individual- check with your surgeon
28 Summary Shoulder replacement is a reliable operation to improve quality of life with less pain, improved motion, strength and better function. As with any operation, there are associated risks. All of the precautions we take are to minimize risk and to provide for a routine operation
Joint PREP Class P atient R esource and E ducation P rogram
30 Goals for you and your family Discuss steps to take to get ready for the surgical procedure Discuss what to expect of the surgical experience Recognize why it is important for you to participate in your plan of care
31 Plan Ahead Appointments: Your regular doctor for pre-surgery; Blood work, EKG, Physical exam, discuss medications Your surgeon for final discussion and update Stop smoking – talk to your regular doctor to get help Call your surgeon if you get a fever, cold, infection or rash before your surgery date
32 Plan Ahead Plan for your return home Identify who will take care of you after surgery; Plan for about 2 weeks Identify who will assist you with shoulder exercises for 4-6 weeks Practice daily activities not using the arm affected by surgery
33 Plan Ahead (cont) Simplify meals. Plan for 2 weeks of easy or no preparation meals Pick up throw rugs and other hazards that may cause you to trip. Place frequently used items in convenient locations…not too high or not too low Any planned dental work should be finished about 2 weeks before your surgery date
34 What to bring to the hospital Loose comfortable clothing to wear home Non skid comfortable shoes Personal items: toiletries, books etc. Medication list, inhalers, C-PAP mask Prepaid long distance calling card (optional) Cell phones are not allowed to be used in the patient rooms
35 What not to bring to the hospital Valuables/Jewelry Credit cards, check book or large sums of money Your medications (except inhalers)
36 The day before surgery A SurgiCenter nurse will call you to: Review your medications Tell you what medications to take and not take the day of surgery Review eating, drinking and smoking restrictions Give hygiene instructions Tell you what time to arrive at Luther Hospital
37 Day of surgery Take medications at home as at home as instructed instructed Check in at Luther Hospital Luther Hospital Registration Desk Registration Desk
38 Day of Surgery (continued) You will be taken to the SurgiCenter You will be asked your name and date of birth by everyone who has contact with you – this is done for your safety Family and Friends are welcome. Try to limit to 2 people on day of surgery
39 SurgiCenter SurgiCenter Nursing admission in the SurgiCenter- We will ask you many questions and get you ready for your surgery Leg squeezers and TED hose applied Anesthesia visit Surgeon visit
40 Leg Squeezers – SCDs
41 Going to the Operating Room
42 Operating Room (OR) MonitorsAnesthesia Surgical scrub Foley catheter Staff will communicate to your family if the surgery is longer than 2-3 hours
43 Recovery Room/Post Anesthesia Care Unit (PACU) Your nausea and pain are managed as you awaken When you are ready, you will be transferred to a hospital room
44 Arrival in your Hospital Room You will have… Oxygen An IV Your affected arm will be in a shoulder immobilizer after surgery (May) have a foley catheter A pulse oximeter – a device that fits on your finger to measure blood oxygen level
45 Pulse Oximeter
46 Arrival in your Hospital Room (continued) We will check on you, take your vital signs You will be able to start drinking and eating when ready Activity as you tolerate Help you with control of pain and nausea.
47 Pain Management Pain Management
48 After Shoulder Surgery The nurse will check your bandage on your shoulder Report any soreness, numbness or tingling in your arm or fingers to the nurse Ice will be applied to your shoulder to reduce pain and swelling
49 Post operative day You will have…. Blood work Medication For pain control Aspirin 325 mg for blood thinning to prevent blood clots Aspirin 325 mg for blood thinning to prevent blood clots Activity – Occupational and/or Physical Therapy You are a Partner in your care!
50 Discharge Planning You will be discharged home from the hospital when: Your medical condition is stable You are able to manage safely at home with assistance You are able to do your exercises safely Your pain is under acceptable control
51 Post operative day/Discharge day The person who will be taking care of you after you go home needs to come to the hospital to learn about: Safety Exercises – Therapy When and how to use shoulder immobilizer, sling Lifting restrictions
52 Day of Discharge cont Prepare for discharge to home or transitional care Receive discharge instructions for: Incision care/bathing instructions to keep incision clean and dry Icing and how to keep swelling down How to take pain medications correctly Continuing aspirin 325 mg at home for blood thinning for 3 weeks Wearing TED hose for 3 weeks When to contact your Surgeon
53 To control swelling and pain at home l Apply ice to your shoulder after exercises (do not apply heating pad) for 4-6 weeks as directed l Pain medication as directed especially before exercises l Physical therapy/exercises as directed l Elevate and support your hand and arm on pillows above the level of the heart when at rest
54 After Discharge A person to care for you will need to be available 24 hours a day to: assist you at home the first two weeks drive you to appointments encourage you in your home exercise program Change your incision dressing every day Wear the immobilizer sling for 4 weeks, according to your surgeons directions
55 Bathing 1. You may shower when your incision is dry (no drainage) Support your arm as directed by therapy 2. Place a plastic barrier over the incision, taped in place, prior to showering 3. Wash under arm, dry thoroughly and place dry padding to absorb moisture 4. Place a new dressing on the incision after shower
56 Driving No driving. Talk with your surgeon about when you will be allowed to drive again After permission you must : Be off narcotic pain medicines to drive Be off narcotic pain medicines to drive Able to sit in car comfortably Able to sit in car comfortably Drive in a safe area Drive in a safe area
57 A Follow-Up Appointment with your surgeon will be made days after surgery At your appointment: - X-ray will be done of your shoulder - Your stitches will be removed - We will give you care instructions about your: incision, bathing, exercises, and a handout titled Joint Replacement- Dental Procedures and Antibiotics - You will see an Occupational or Physical Therapist
Total Shoulder Replacement Therapy Services: Focusing on Function
59 Purpose To discuss what to expect in therapy the first days after surgery To identify Total Shoulder motion precautions To discuss home exercise program To identify what you need to do to achieve the best outcome
60 After Surgery You will wear a sling except when performing self-cares and exercises You can move your elbow, wrist and fingers You should not move your shoulder until you have assistance from nursing or a therapist
61 After Surgery Therapy is important for a good outcome! Therapy starts the day after surgery You will learn motion precautions for your healing shoulder You will learn how to move your arm safely when: Taking care of yourself Taking sling on/off Walking/moving about
62 Therapy After Surgery Therapy Goals: l PASSIVE range of motion of surgical shoulder (Maximum: degrees flexion, 40 degrees external rotation) l Control pain and swelling l Be independent in taking care of yourself and moving your shoulder l Prepare for a safe return to home
63 Activity limitations Limit shoulder elevation to 140 degrees flexion Limit shoulder external rotation to 40 degrees
64 Therapy for home You will learn a home exercise program that includes: Passive range of motion for your shoulder (no muscle flexing) Active range of motion for your elbow, wrist and fingers (moving them on your own) Techniques to control swelling and pain It is recommended that a person be available at home to assist you
65 At home you will: Continue with range of motion exercises Wear immobilizer/sling Practice your total shoulder precautions Call the therapy department with questions or concerns
66 You are a Partner in Your Care! Make your plans… Start getting ready for surgery!
Social Services and Case Management
68 Roles of Social Services and Case Management in Your Care Social Workers and Nurse Case Managers work in teams to assist with: l Insurance l Counseling/support l Transition planning l Advance Directives for Healthcare
69 Insurance Before surgery, you will need to notify your insurance company of your surgery plans Once you are in the hospital, your Nurse Case Manager will monitor your approved stay days and be a contact person for your insurance company for any questions or concerns
70 Counseling and Support Surgery and hospitalization are stressful Meeting your emotional needs is important to all staff at Luther- Midelfort If you have any concerns about your care or are feeling out-of-sorts, please feel free to discuss these things our Social Services staff
71 Discharge Planning A Social Worker or RN Case Manager will meet with you to discuss your transition plan to home or a transition facility. You, your family, your doctor and your therapist all will help determine what transition plan is best for you.
72 Options at Discharge Home with family to care for you Home with outpatient services Home with or Home Care Skilled Nursing Facilities Transitional Care Units or Swing Beds
73 Advance Directives for Healthcare What are Advance Directives? What are the 2 types of Advanced Directives?
74 Declaration to Physicians or Living Wills Describes the kind of life-sustaining care you would want only if you had a terminal condition or were in a persistent vegetative state Living Wills direct your physician regarding life-sustaining treatment or a feeding tube Living Wills do not give authority to anyone to make health care decisions on your behalf
75 Power of Attorney for Health Care Your agent can tell your physician what kind of care you would want in all types of health decisions, not just concerning life-sustaining treatment You appoint an agent to make all health care decisions for you in collaboration with your physician In most cases, going to court to appoint guardianship can be avoided
76 Who Can Help you Complete an Advance Directive? Luther Hospital Social Services-no cost Luther Hospital Chaplaincy-no cost Your personal attorney-attorney fee
77 Safekeeping of Advance Directives Store the original document in a safe place Give a copy of the document to family members Give a copy of the document to your Physician so that it can be kept in your medical record
78 To complete an Advance Directive or for any questions Call Social Services Department at , or , or Ask for a Social Worker or Chaplain when you are admitted to Surgi Center the day of your surgery.