Total Shoulder Arthroplasty ERAS

In a total shoulder arthroplasty (also called shoulder replacement surgery), damaged parts of the shoulder are removed and replaced with artificial implants. It can be a treatment for osteoarthritis, fractures, severe rotator cuff injuries, and other conditions that can damage the shoulder joint.

Our total shoulder arthroplasty ERAS program is designed to help patients return to health more quickly after undergoing the procedure.

Before Surgery

• Your surgeon will meet with you to explain surgical plans and set expectations for your surgery.
  • Contact your surgeon via MyChart or call the Orthopaedic Clinic with questions: 214-645-3300.
• You will receive instructions for surgery and medications via a phone call before surgery. You may also be scheduled for an appointment in our Pre-Surgical Testing Clinic to meet with our anesthesia team and have bloodwork drawn.
  • We may request testing or records from your other physicians.
  • Call our Pre-Surgical Testing clinic with any questions: 214-645-4120.
• Lifestyle change recommendations:
  • We encourage you to stop smoking two months before surgery. We encourage you to stop consuming alcohol for one month before surgery.
  • You will receive specific instructions regarding exercises to do at home.
  • Eat a balanced, healthy diet high in protein and remain hydrated throughout the months and weeks leading up to surgery.
• Three days before surgery:
  • Apply mupirocin nasal ointment (betadine swabs if allergic to mupirocin).
  • This is done to minimize the risk of infection.
• On the night before surgery:
  • Eat no solid foods after 11 p.m.
  • Shower with Hibiclens (which you will receive at your clinic visit).
  • You can drink clear liquids (such as water, Gatorade, or black coffee) until two hours before your surgery start time.
• On the day of surgery:
  • Shower with Hibiclens.
  • Drink either a bottle of water or 20 oz. of Gatorade on the way to the hospital, at least two hours before your surgery start time.
  • In the pre-op area, you will receive non-narcotic pain medications (celecoxib and acetaminophen) to reduce your postoperative pain. If you are at high risk for nausea, you may be given medicines before surgery to decrease this risk.
  • The majority of patients receive a nerve block before surgery. The nerve block uses local anesthetic to decrease your pain after surgery.

During Surgery

• You will receive general anesthesia.
• Your anesthesia team will monitor you very closely during the surgery.
• You will receive medications during surgery to treat pain and nausea.
• There will be a specific and tailored anesthetic protocol to decrease the stress on your body, improve pain, and accelerate your recovery.

After Surgery

• You will wake up in our Post-Anesthesia Care Unit (PACU).
• The nerve block numbs the nerves that provide pain sensation from the area of the surgery and additional nerves that are located nearby. One of those nerves is a nerve that goes to the diaphragm and helps you breathe in. People with lung problems, or who are very observant, may notice some shortness of breath. This is typically not a problem and will resolve when the shoulder numbness resolves. If your oxygen levels are safe in the recovery room, you are safe to go home. If you wear a CPAP or BiPAP, please wear it when you sleep for the next three nights. If you feel short of breath when lying flat, sitting up some when sleeping can help.
• Use your incentive spirometer tool to expand your lungs.
• Avoid other local anesthetic numbing medications for the next four days.
• Home exercises and physical therapy will be an essential part of your recovery regimen. You will start the exercises when you go home.
• Unless instructed otherwise by your nurse or surgeon, you should be able to eat a normal diet a few hours after surgery.
• You will take scheduled non-opioid pain medications during your recovery and have narcotic medications available for breakthrough pain, if necessary.