Most surgery is elective, including operations for shoulder arthritis, rotator cuff problems and dislocation. This gives the patient the opportunity to bring their best, most healthy and most prepared self to the operating room.
Here are some steps we recommend to our patients.
A. Get comfortable with the surgeon, the surgery and the recovery. Discuss with the surgeon
i. what procedure is planned, including the likely benefits to you and the possible risks.
ii. what surgical and non-operative options are there for treating your problem
iii. the recovery process, including what you should and should not do in the weeks and months after surgery.
iv. the need for special equipment
Hydration – drink plenty of water/clear liquids. Some surgeons encourage water, fruit juices without pulp, carbonated beverages, black coffee or a drink such as Ensure Clear up to two hours before surgery, avoiding prolonged fasting (be sure to check on this with your surgeon). See:Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures
iii. Habits
Alcohol use can complicate anesthesia and recovery. Be sure your surgeon knows how much alcohol you consume on an average week. Avoid or reduce alcohol consumption in the weeks leading up to surgery
Nicotine interferes with healing. Stop smoking and the use of any nicotine products at least a month before surgery
Reduce or eliminate use of narcotic medication a month before surgery.
iv. Fall prevention. Patients are at increased risk of falling after surgery. Remove tripping hazards. Practice balance. Optimize vision. Assure stairways are lighted with hand rails. Watch out for ice.
v. Exercise
Walk, swim or bike regularly
Use light weights with high repetitions to build strength
Optimize flexibility
vi. Manage chronic conditions
Ensure blood sugar levels (A1C) and blood pressure are well managed
Optimize lung function – manage asthma and obstructive sleep apnea (CPAP)
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
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v. the timing and frequency of postoperative visits
vi. the need for physical therapy
B. Assure that you have your team in place to provide support during your recovery
C. Make sure that the procedure has been authorized by your insurance company
D. Complete all required tests, imaging and consultations sufficiently in advance
E. Understand which of your medications need to be discontinued before surgery (and how long before surgery they should be discontinued). For some new medications, the risk and time of discontinuance is yet to be determined. See for example Glucagon-like Peptide-1 Receptor Agonist Use is Associated With Increased Risk of Perioperative Complication and Readmission Following Shoulder Arthroplasty
F. Understand when you need to stop (1) eating and (2) drinking clear liquids prior to surgery.
G. Discuss postoperative pain management - what will be prescribed and who will manage pain medications
H. Discuss your exercise tolerance and your need for cane/walker or other walking aids.
I. Optimize your health, recognizing that any surgery can a challenge to a person’s overall condition
B. Assure that you have your team in place to provide support during your recovery
C. Make sure that the procedure has been authorized by your insurance company
D. Complete all required tests, imaging and consultations sufficiently in advance
E. Understand which of your medications need to be discontinued before surgery (and how long before surgery they should be discontinued). For some new medications, the risk and time of discontinuance is yet to be determined. See for example Glucagon-like Peptide-1 Receptor Agonist Use is Associated With Increased Risk of Perioperative Complication and Readmission Following Shoulder Arthroplasty
F. Understand when you need to stop (1) eating and (2) drinking clear liquids prior to surgery.
G. Discuss postoperative pain management - what will be prescribed and who will manage pain medications
H. Discuss your exercise tolerance and your need for cane/walker or other walking aids.
I. Optimize your health, recognizing that any surgery can a challenge to a person’s overall condition
i. Weight – if you are very thin, obese or have had an unexpected weight loss, consult your primary care provider and inform your surgeon. Calculate your body mass index (BMI) . The CDC defines four categories. Both "underweight" and "obese" are associated with increased risk of complications and adverse outcomes from surgery.
Underweight: BMI less than 18.5
Normal weight: BMI 18.5–24.9
Overweight: BMI 25–29.9
Obesity: BMI 30 or higher
ii Diet – It turns out that some patients coming for shoulder surgery are malnourished with increased rates of complications, including wound healing problems and infection. (Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty.)( A retrospective study evaluating the association between hypoalbuminemia and postoperative outcomes for patients receiving open rotator cuff repair)(Albumin and surgical site infection risk in orthopaedics: a meta-analysis)( Malnutrition in Orthopaedic Sports Medicine: A Review of the Current Literature.) (Serum albumin and total lymphocyte count as predictors of outcome in hip fractures).
Normal weight: BMI 18.5–24.9
Overweight: BMI 25–29.9
Obesity: BMI 30 or higher
ii Diet – It turns out that some patients coming for shoulder surgery are malnourished with increased rates of complications, including wound healing problems and infection. (Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty.)( A retrospective study evaluating the association between hypoalbuminemia and postoperative outcomes for patients receiving open rotator cuff repair)(Albumin and surgical site infection risk in orthopaedics: a meta-analysis)( Malnutrition in Orthopaedic Sports Medicine: A Review of the Current Literature.) (Serum albumin and total lymphocyte count as predictors of outcome in hip fractures).
Healing and general recovery after surgery requires energy, protein, and vitamins. Check with your primary care provider to see if the below is right for you.
Protein – a general recommendation is one half gram of lean protein per pound of body weight per day. For example, a person weighing 150 pounds could meet this target by eating the equivalent of 8 ounces of lean turkey per day.
Plenty of fruits and vetables
Supplements: vitamin D and vitamin C are thought to boost the healing response. There is evidence that at least 1 billion people worldwide are vitamin D deficient with resulting healing problems. Vitamin D Deficiency Leads to Poorer Health Outcomes and Greater Length of Stay After Total Knee Arthroplasty and Supplementation Improves Outcomes: A Systematic Review and Meta-Analysis
Protein – a general recommendation is one half gram of lean protein per pound of body weight per day. For example, a person weighing 150 pounds could meet this target by eating the equivalent of 8 ounces of lean turkey per day.
Plenty of fruits and vetables
Supplements: vitamin D and vitamin C are thought to boost the healing response. There is evidence that at least 1 billion people worldwide are vitamin D deficient with resulting healing problems. Vitamin D Deficiency Leads to Poorer Health Outcomes and Greater Length of Stay After Total Knee Arthroplasty and Supplementation Improves Outcomes: A Systematic Review and Meta-Analysis
Hydration – drink plenty of water/clear liquids. Some surgeons encourage water, fruit juices without pulp, carbonated beverages, black coffee or a drink such as Ensure Clear up to two hours before surgery, avoiding prolonged fasting (be sure to check on this with your surgeon). See:Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures
iii. Habits
Alcohol use can complicate anesthesia and recovery. Be sure your surgeon knows how much alcohol you consume on an average week. Avoid or reduce alcohol consumption in the weeks leading up to surgery
Nicotine interferes with healing. Stop smoking and the use of any nicotine products at least a month before surgery
Reduce or eliminate use of narcotic medication a month before surgery.
iv. Fall prevention. Patients are at increased risk of falling after surgery. Remove tripping hazards. Practice balance. Optimize vision. Assure stairways are lighted with hand rails. Watch out for ice.
v. Exercise
Walk, swim or bike regularly
Use light weights with high repetitions to build strength
Optimize flexibility
vi. Manage chronic conditions
Ensure blood sugar levels (A1C) and blood pressure are well managed
Optimize lung function – manage asthma and obstructive sleep apnea (CPAP)
Optimize bone health Anti-Osteoporotic Treatment Reduces Risk of Revision Following Total Shoulder Arthroplasty in Patients with Osteoporosis
vii. Take regular medications until the time to stop before surgery
vii. Take regular medications until the time to stop before surgery
viii. Rest up
ix. Make sure there are no issues with your skin anywhere on your body
ix. Make sure there are no issues with your skin anywhere on your body
x. Prospectively manage dental conditions.
Comment: While we want to do everything we can to assure a great recovery from surgery, these are steps that only the patient can carry out. Do your part!
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link
Follow on twitter/X: https://x.com/RickMatsenFollow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
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