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, however with the advancement of technology and the change in insurance regulations, these procedures can be performed on a same-day basis now.  Additionally, 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.  

Based on your insurance coverage, or self-pay arrangement, Dr. Southard can help to provide you with a nurse in your home to closely monitor your recovery, including checking vital signs, functional ability and overall recovery.  Physical therapists may also be available for in-home patient visits for several days to work with the patient on range of motion and flexibility exercises, however this is approved sparingly and on a case-by-case basis.  Most shoulder replacement patients, including those that stay overnight in the hospital quickly transition to outpatient therapy, thus making at home visits challenging and often coming at the patient’s own expense. 

Benefits of Outpatient Shoulder Replacement

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

• Decreased hospital stay
• Early mobilization
• Rapid recovery
• Careful home monitoring
• Fewer complications
• 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), possess a high level of motivation for home recovery, have solid support from friends or family, and of course, be approved for outpatient treatment by their insurance company. 

Indications for outpatient shoulder replacement are essentially identical to standard inpatient treatment, however special attention is paid to the patient’s pre-operative medical condition.  As with standard inpatient treatment, surgery is indicated for arthritic conditions of the shoulder 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.
• As with in-patient shoulder replacement, Dr. Southard will review in-detail with you pre-operative expectations, post-operative expectations, as well as a surgical accountability checklist to ensure your 100% cooperation and commitment to the procedure
• 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.
• Attention is then drawn to the
• glenoid, and Dr. Southard 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.
• 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.
• Maintain your commitment to refrain from smoking.
• Follow-up appointments to be scheduled based on the powerpoint presentation provided to you at your pre-op appointment.

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