To prepare for shoulder replacement surgery, find out whether you are having a total or a reverse replacement, because the precautions afterward differ. Set up your home for about 6 weeks in a sling, arrange help with driving and household jobs for at least 6 to 8 weeks, and practice one-handed tasks now. Ask about any health checks your surgeon needs before the operation. Your surgeon’s protocol comes first, and timings vary with the type of replacement and with each surgeon.
Shoulder replacement usually means a hospital stay of 1 to 2 nights and several weeks of needing help during recovery. The more you set up beforehand, the easier those weeks are.
Key takeaways
- Know your type: total and reverse replacements have different movement precautions for the first 6 to 12 weeks.
- Sling time: plan for about 6 weeks.
- Help: arrange rides and help with heavier household jobs for at least 6 to 8 weeks.
- Health checks: your surgeon may ask for dental, skin or medical checks first to lower the risk of infection.
- Practice: sling handling, one-handed dressing and getting out of bed without pushing through the operated arm.
What the operation does
In a total (anatomic) replacement, the worn ball at the top of the arm bone is replaced with a metal ball and the socket is lined with a plastic cup. A tendon at the front of the shoulder (subscapularis) is usually detached and repaired, and it needs protecting for about 6 weeks.
In a reverse replacement, the ball and cup are swapped: the ball goes on the socket side and the cup on the arm bone. The deltoid muscle then does most of the lifting. It is usually chosen when the rotator cuff is badly torn or not working. Certain positions, especially reaching behind your back, are avoided for several weeks to protect the joint from coming out of place.
What to set up at home
- Clothing: loose, front-opening tops a size larger, elastic-waist pants, slip-on shoes and a front-fastening bra. Avoid anything you would need to reach behind your back to fasten, especially after a reverse replacement.
- Sleeping position: most people sleep propped up for 4 to 6 weeks. Set up a reclining chair or a firm stack of pillows, with a small pillow for the forearm.
- Kitchen: move daily items to between waist and chest height on your other side. Freeze 1 to 2 weeks of meals. Have a light kettle or a jug you can fill partway.
- Bathroom: pump bottles, a long-handled sponge, a non-slip mat and toilet paper on the non-operated side. Reaching behind for hygiene with the operated arm is often restricted after a reverse replacement.
- Getting up: a chair with firm arms helps you stand by pushing through your other arm. A raised toilet seat helps some people.
- Driving and help: arrange rides for at least 6 to 8 weeks. Plan for someone to help with shopping, laundry, bedding and pets.
What to practice before surgery
- Sling on and off: practice with a helper, using the sling or instructions from your team.
- One-handed tasks: dress the operated arm first and undress it last. Practice eating, hair care and toilet hygiene with the other hand.
- Getting out of bed: roll to the non-operated side if your surgeon allows, and push up with that arm, not the operated one.
- Gentle movements your surgeon allows: a shoulder that moves comfortably before surgery is often easier to rehab. Ask which movements suit your shoulder.
- Leg and general fitness: keep walking. You will rely on your legs to stand without pushing through the arm.
Questions to ask your surgeon
- Am I having a total or a reverse replacement, and why that type for me?
- What positions must I avoid, and for how long?
- How long will I wear the sling, and can I take it off to wash or sleep?
- What is the lifting limit now and in the long term?
- Will I have a nerve block, and how long will the numbness last?
- Do I need dental, skin or medical checks before surgery?
- When does physical therapy start, and how often?
- Who do I call after hours if I am worried?
The first 48 hours
Most people stay in the hospital for 1 to 2 nights. If you had a nerve block, the arm is usually numb and heavy for about 12 to 24 hours. Keep it supported in the sling. Your team may advise taking pain medicine before the block wears off.
A block at the side of the neck can briefly cause a hoarse voice, a drooping eyelid or a feeling of not getting a full breath. These usually fade as it wears off.
Your physical therapist (PT) will usually check how you get in and out of bed, dress and use the sling before you go home. Sleep propped up. Keep the dressing dry. Move the elbow, wrist and hand gently several times a day. Have an adult with you for the first few days at home.
Find out which replacement you are having before you set up your home, because the rules differ.
Call your surgeon or emergency number if
- Breathing gets harder: sudden breathlessness or chest pain. Call your local emergency number.
- The shoulder suddenly changes shape: with severe pain and the arm unable to move. Call your local emergency number.
- Calf swelling or pain: in one leg. Call your local emergency number if you are also breathless.
- Fever: 100.4°F (38°C) or higher, or shaking chills.
- Wound changes: spreading redness, warmth, pus, a bad smell or a wound that opens.
- Numbness that does not wear off: past the time your team gave you, or a hand that is cold, pale or blue.
More on this area: surgery recovery guides.
Set your home up for the replacement you are having, and the first six weeks become far more manageable.
Written by Louise Yow, Neck & Shoulder Physio.