Outpatient Shoulder Replacement

What is Outpatient Shoulder Replacement?

Outpatient shoulder replacement is a surgery that does not require an overnight hospital stay. Shoulder replacement is a surgical procedure in which the damaged or worn out articulating surfaces of the shoulder joint (surfaces of the humeral head and glenoid socket) are removed and replaced with artificial prostheses made of metal or plastic.

Traditionally, shoulder replacement has been an inpatient surgical procedure. With the introduction of minimally invasive techniques, modern pain protocols, blood loss control, improved anesthetic techniques, and rapid rehabilitation protocols, surgeons are able to perform shoulder replacement procedures on an outpatient basis. Outpatient shoulder replacement is exactly the same as traditional shoulder replacement, but the patient is allowed to go home in the first 24 hours after the surgery. This allows patients to recover at home instead of overnight in a hospital. A nurse in the patient’s home closely monitors the patient’s condition and checks vital signs, the same as what is generally performed at the hospital. Physical therapists are also available for in-home patient visits for several days to work with the patient on range of motion and flexibility exercises.

Benefits of Outpatient Shoulder Replacement

The benefits of outpatient shoulder replacement over traditional inpatient shoulder replacement include the following:

• Decreased hospital stay
• Improved pain management protocols
• Advanced blood loss control techniques
• Advanced anesthesia techniques
• Early mobilization
• Rapid recovery
• Careful home monitoring
• Fewer complications
• Improved outcomes
• Increased patient satisfaction
• Cost-effective

Anatomy of the Shoulder

The shoulder joint (glenohumeral joint) is a ball and socket joint where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered by a smooth tissue called articular cartilage, which allows the bones to slide over each other without friction, enabling smooth movement. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

Indications for Outpatient Shoulder Replacement

Not everyone qualifies for outpatient joint replacement. To be considered for an outpatient shoulder replacement, a person should be in good health (free of any diseases), a high level of motivation during the rehabilitation process, and good family support.

Outpatient shoulder replacement is commonly indicated for the treatment of shoulder conditions such as arthritis when medications, injections, physical therapy, or other treatments have been unsuccessful. Arthritis is a degenerative joint condition in which the cartilage that allows smooth movement in the joints wears away causing the adjacent bones to rub against each other resulting in pain and stiffness. In such a condition, replacement of the damaged portion of the shoulder joint with a shoulder prosthesis (artificial joint) helps relieve symptoms and restore normal function of your shoulder joint.

Preparation for Outpatient Shoulder Replacement

Preoperative preparation for outpatient shoulder replacement generally involves the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least a week before surgery.
• You should not consume solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Outpatient Shoulder Replacement

Outpatient shoulder replacement is usually performed under advanced anesthetic technique as a minimally invasive procedure. The procedure generally involves the following steps:

• You will lie in a beach chair position with the operated arm held by an arm positioner.
• A 5-cm incision is made over the shoulder joint.
• The muscle overlying the shoulder bones are cut just enough to expose the head of the humerus. 
• The humeral head is dislocated and released from the capsule. 
• The arthritic or damaged humeral head is cut at the neck and removed. 
• The humeral component is matched in diameter and thickness to the natural humeral head.
• A bone tunnel is made in the humerus to take the humeral stem.
• The humeral stem is then inserted into the humerus. This may be press-fit, relying on the bone to grow into it or cemented, depending on several factors such as bone quality and your surgeon’s preference.
• If the glenoid also needs to be replaced, your surgeon then proceeds to the preparation of the glenoid component.
• The glenoid is sized for the appropriate implant.
• Next, the glenoid is prepared to take the artificial component by drilling holes in the glenoid to fix the plastic glenoid component.
• Bone cement is placed in the holes and the glenoid implant is inserted.
• Once the glenoid is replaced with the plastic component, your surgeon works on the humeral component.
• The correct-sized metallic humeral component is then fixed to the humeral stem.
• The soft tissue covering the joint is sutured back together and the incision closed with absorbable sutures.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after outpatient shoulder replacement may involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• Once you are medically stable, you will be discharged home on the same day of the surgery with instructions on home care and rehabilitation protocols.
• Home rehabilitation program includes physical therapy, which is started soon after the surgery to help strengthen shoulder muscles and optimize shoulder function.
• You may notice some pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications, as well as, application of ice packs, are recommended as needed.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Refrain from strenuous activities and lifting heavy weights for the first few months. Gradual increase in activities over a period of time is recommended.
• You will be able to resume your normal activities in a month or two after surgery; however, return to sports may take at least 6 months or longer.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Outpatient shoulder replacement is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Postoperative pain
• Damage to nerves and vessels
• Stiffness/restricted motion
• Thromboembolism/blood clots
• Anesthetic/allergic reactions