Total Shoulder Replacement Recovery Plan

June 13, 2018

Total shoulder replacement surgery, also known as total shoulder arthroplasty, is an effective way of treating permanent joint damage caused by arthritis. It can relieve the severe pain and stiffness in a patient’s shoulder and allow them to return to sports they enjoy such as baseball, golf, or swimming.

While the long-term benefits of a shoulder replacement cannot be overstated, patients must also consider how a replacement will affect them during the months immediately following their procedure. Recovery does not happen overnight—it’s a gradual process. Patients must be willing to limit or modify their activities as they slowly regain shoulder strength and mobility. Moreover, participating in physical therapy will not only help ease shoulder pain and help restore shoulder function in the short-term, but it will also help the patient preserve their new joint for years to come.

This article provides general recovery guidelines for shoulder replacement surgery. It is important to note, however, that there are many types of shoulder replacement surgery, including:

• Total shoulder replacement (traditional shoulder arthroplasty)
• Reverse shoulder replacement (reverse total shoulder arthroplasty)
• Partial shoulder replacement (stemmed hemiarthroplasty)
• Shoulder resurfacing (resurfacing hemiarthroplasty).

The recovery guidelines that you will be expected to follow may vary based on the type of surgery you receive. For a detailed explanation of what you can expect, talk to a shoulder specialist.

Before Surgery

The majority of your recovery period will be spent at home. At Beacon Orthopaedics and Sports Medicine, total shoulder replacement is performed in an outpatient setting so patients return home even sooner. Since you will not be able to use your arm for several weeks, making preparations at home will make the recovery process a little smoother.

Equipment and Supplies

Take note of activities in your daily routine that require the use of your arm and plan accordingly. It is highly recommended that patients of total shoulder replacement surgery have:

• Detachable showerhead. You will need to keep your incision dry so a detachable showerhead is helpful. Moreover, you may consider a large waterproof bandage or a second sling that you can leave to dry between showers.
• Many patients find it helpful to sleep in a reclined position because it puts less strain on the shoulder. This can be achieved by bolstering your lower and mid back with pillows. You may also find it comfortable to prop your injured up on a pillow while sitting.
• Packaged or frozen food. You should continue to eat fresh meals when possible; however, having packaged or frozen food provides you with convenient options.
• Clothes that button or zip. Having clothes that you can button or zip, instead of pulling over your head, will make dressing a lot easier.
• Velcro strap shoes. Tying shoelaces with only one hand is inconvenient. Consider shoes that you can easily slip on and off.

In general, you should stock up on supplies that you use regularly. Most patients cannot drive for 6 to 8 weeks after surgery, so you may need to depend on others when supplies are low.

Assistance and Monitoring

Identify several family members and friends who will assist you during your recovery. These individuals will help you around the house and drive you where you need to go for the first several weeks after surgery. Expect to need a lot of assistance on both the day of your surgery as well as the immediate days following it, and gradually need less as you return to normal shoulder function.

After Surgery

Incision Care

Keep the bandage over your wound clean and dry. Your physician may restrict you from taking a shower for the first few days after your surgery; however, you may be advised to change the bandage every day. Do not shower until your physician gives you permission. When you do, let the water run over the incision and do not scrub.

Contact your physician immediately if you experience any of the following:

• Bleeding that soaks through your bandage and does not stop with applied pressure.
• Pain that does not go away with pain medicine.
• Moving or shifting in your new shoulder joint.
• Temperature higher than 101°F (38.3°C). This is a possible sign of an infection.
• Tenderness, redness, or pain in your calf, chest pain, and/or shortness of breath. These are all signs of a possible blood clot.

Precautions and Physical Therapy

In order to ensure a fast recovery and the best possible outcome, it is imperative that you adhere to the recovery plan outlined by your physician. The plan will include precautions to help protect your new joint as well as physical therapy to restore shoulder strength and mobility.

Recovery is a gradual process. Typically, it takes at least 4 – 6 months for a patient to return to their pre-injury level of activity. In some cases, it may take as long as 9 – 12 months to make a full recovery. In either case, it is important that you maintain realistic expectations about your progress. The following is a general recovery timeline for total shoulder replacement surgery. For a more specific timeline, see Dr. Rolf’s list of physical therapy protocols.

Phase I: Immediate Post-Surgical Phase (Weeks 1 – 4)

Precaution: Prevent the arm from moving with use of a sling

Your arm will continuously be in a sling for approximately the first four weeks following surgery. Always use the sling when you are walking or standing. If you are sitting or lying down, you can use a pillow to support your arm. You will gradually use your sling less as you near the end of the phase.

Precaution: No lifting or weight-bearing on the operated arm

During this phase, you will have no active range of motion (AROM) in your shoulder. In other words, you will not be able to move your shoulder on your own. At this time, a physical therapist will also begin working with you to restore passive range of motion (PROM) in your shoulder. PROM refers to your ability to move your shoulder with assistance.

Phase II: Early Strengthening Phase (Weeks 4 – 6)

Precaution: No heavy lifting or weight-bearing on the operated arm

Precaution: No sudden jerking movements in the operated arm

Your physical therapist will also begin exercises with you to gradually restore AROM in your shoulder. Typically, patients can lift objects no heavier than a coffee cup by this point.

Phase III: Moderate Strengthening Phase (Post-6 Weeks)

Precaution: No heavy lifting in excess of 5 lbs. with the operated arm

Precaution: No sudden jerking movements in the operated arm

Your physical therapist will continue to work with you to focus on gradually increasing shoulder strength, endurance, and functional mobility.

Phase IV: Advanced Strengthening Phase (Post-12 Weeks)

Precaution: Ensure gradual progression of shoulder strength

You should continue to exercise 3 – 5 times a week. At Beacon Orthopaedics, a physical therapist can create a customized routine of sport-specific training exercises for you. This will include ways to preserve your new joint for specific sports such as baseball or golf.

Talk to an Orthopaedic Specialist

Of course, recovery from a shoulder replacement does not happen in a vacuum—nor should it. While this article provides a broad overview of the many factors that influence your recovery, perhaps the two most important factors are your individual health and your choice of orthopaedic surgeon. Only a discussion with a qualified orthopaedist can answer those questions.

Dr. Robert Rolf is a board-certified orthopaedic surgeon at Beacon Orthopaedics and Sports Medicine who provides extensive expertise in total shoulder replacements. Dr. Rolf can provide a comprehensive examination of your health and discuss what you can expect during recovery. For your convenience, Dr. Rolf meets with patients at Beacon’s Batesville, Lawrenceburg, or Northern Kentucky locations as well as Beacon West in Harrison, Ohio. Schedule an appointment online to meet with Dr. Rolf.