Dr Mullen will schedule a preop appointment with you about a week before surgery. Please bring a current complete list of all of your medications to your preop appointment.
Some patients will be notified ahead of time and sent for blood work and an EKG before surgery. If a heart condition needed to be addressed within the prior year, a letter from your cardiologist describing your condition should be faxed to Dr Mullen.
At your office visit prior to surgery you will sign a consent form and Dr Mullen will electronically send in prescriptions for pain medications that you may prefer to use AFTER surgery. You can pick up these pain pills before surgery, but they are not to be taken until after surgery is completed.
At your office visit Dr Mullen will also provide you with the appropriate post-surgical shoulder sling, depending on the planned surgery. You will need to then bring this shoulder sling with you to surgery.
What medicines should I stop taking before surgery?
Plavix (Clopidogrel), Effient (Prasugrel), Pletal (Cilostazol) and NSAIDs (Advil, Aleve, Aspirin, Diclofenac, Ibuprofen, Motrin) need to be discontinued 10 days prior to surgery.
Over-the-counter vitamins often have ingredients that may thin the blood and must be discontinued 7 days prior to surgery.
Coumadin (Warfarin) and Brilinta (Ticagrelor) need to be discontinued 5 days prior to surgery.
Eliquis (Apixaban), Xarelto (Rivaroxaban) and Pradaxa (Dabigatran) need to be discontinued 4 days prior to surgery.
Failure to stop taking these blood thinning agents at these recommended times puts you at significant risk for excessive and potentially life-threatening bleeding, and may result in cancellation of your surgery. If you have any specific concerns with regards to your blood thinners, please address them with Dr Mullen and his office team no later than at your pre-operative appointment.
What kind of Ice Packs should I get?
While at your pharmacy before surgery you may consider obtaining two cold therapy packs that can mold to your shoulder to use after surgery. Two are nice to have so one can be in the freezer while the other is on your shoulder. Some people like one on the front and one on the back of the shoulder at the same time. There are many brands and sizes, most are inexpensive and very helpful with swelling and minimize pain. Alternatively, Polar Care Cryotherapy Units are not covered by most insurance plans but can be found and purchased on Amazon if you prefer. Regular ice packs work well too. Frozen peas are gross and disgusting.
Where will surgery take place?
Dr Mullen has operating privileges at multiple hospitals, but for many reasons he prefers to do most of his knee replacement surgeries at OASIS Hospital on 40th St and North Loop 202. However, some patients with a Banner Insurance Medicare Replacement Plans will be scheduled at Banner Baywood.
All of his patients get a private room.
OASIS Hospital is an orthopedic specialty hospital, and does not admit sick patients, making it a very clean and safer hospital environment.
All of Dr Mullen’s patients are cared for by a certified orthopedic nurse who will not concurrently have responsibilities for any patients with concomitant infections or contagions. This is very important to Dr Mullen and should be to you. Within this system, there are very few resultant infections.
The physical therapy program targets and often allows for patients to be discharged the very next day. In some cases patients can go home that very same day. Very rarely does a patient need to stay a second night. Planning for a Rehab Center or a Skilled Nursing Facility will not be necessary with his program.
What do I do the night before surgery?
Drink plenty of liquids. Stock your home with easy to prepare meals for a few days.
In order to reduce the chance of infection, we ask you to perform a pre-operative skin prep. Please shower and scrub every day the week preceding surgery and make sure you shower the morning of surgery with regular soap.
You may take your pre-approved medicines the morning of surgery with a sip of water, but may NOT eat or drink anything else the day of surgery. No mints, no gum, no tic tacs… nothing.
When do I need to get to the hospital?
Wear or bring a loose fitting shirt. A button up front is ideal. Leave valuable jewelry at home. Bring your sling. You will report to the surgery center 2-3 hours before the surgery is scheduled to start. This time is needed for administrative check in, escort to the preop area, changing into a hospital gown, have a nursing evaluation, get an IV, and get a preoperative IV antibiotic infusion through that IV. You will meet your anesthesiologist to both answer and ask questions. Anti-nausea medication can be delivered before surgery through the IV.
What kind of anesthesia will I get?
The anesthesiologist will likely give you an Interscalene Block immediately before surgery. The ‘block’ will numb your entire arm, leaving it temporarily flaccid but painless. You won’t be able to use your hand. The block wears off within 12-20 hours.
With the nerves of the arm “blocked”, the anesthesiologist can use a lighter general anesthesia. This allows for less nausea and a fewer side effects than with a deeper general anesthetic. Not all patients are ideal candidates for a nerve block. Before surgery, the anesthesiologist will discuss your options with you to make an informed and consensual plan. Regardless of the type of anesthesia, you will not be alert during nor remember the surgery.
How long does the surgery take?
You will arrive at the facility 2 to 3 hours before the surgical start. Once family and friends are eventually shown to the waiting area, you will get some intravenous sedation, be transported to the operating room table and then be safely anesthetized and put to sleep. You will then be comfortably positioned for your surgery, your skin sterilized, and sterile drapes applied. This all takes under an hour. Dr Mullen institutes a series of safety checks and then will perform your surgery. The actual surgery takes about another hour. You then will spend about 90 minutes in the Recovery Room. Your guests will visit with you only after you leave the Recovery Room and are brought to your private room.
How will my pain be controlled?
Your anesthesiologist will give you medicines while you are in surgery to keep you comfortable. So will the nurse in the Recovery Room. The nerve block lasts many hours. Once home, oral narcotic pain pills are initially appropriate, but you should transition to Tylenol or an NSAID as soon as possible. That is ideally within a few days and almost always can be done within a few short weeks.
Let Dr Mullen know at the pre-operative appointment if you have a preference for any particular pain medicine that works best for you. ALL narcotic pain medicine can result in nausea. This is an undesired adverse side effect, but is not an allergy. This can ideally be combatted by finding and using a narcotic that sits well in your particular stomach. If you are someone who gets nauseated with many different narcotic pain meds, we can use and anti-nausea medicine with your pain pill or just use over the counter pain analgesics like Tylenol instead. This may be a wise strategy if the nausea of a pain pill is more distasteful than the pain itself.
When will I go home?
Most patients will stay one night and go home the next day. Some patients may be allowed to go home the same day as surgery. This is a discharge plan reserved for younger patients with an insurance that allows outpatient total shoulder surgery. Nobody needs to go to a Rehab Center or a Skilled Nursing Center after shoulder replacement surgery. The hospitals are lovely, but remember, you are not sick. When you are mobile enough to get in and out of bed, up from and back into a chair, and recovered from anesthesia, you will go home.
Wouldn’t it be safer to stay longer or go into Rehab?
Not necessarily. Studies have shown an increase rate of infections and medical complications in patients who stayed in the hospital longer or went to a Rehab center before going home. The best plan is to go home.
When will I be seen after surgery?
Your next appointment in the office is usually scheduled at about 15 days after surgery.
Where and when will I do my Physical Therapy?
Most shoulder surgeries are painful. For the first week or two, it is best just to wear the sling and rest. During these first 2 weeks in your sling you can pump your fists, roll your wrists, flex your forearm muscles, and shrug your shoulders and your upper back. The Physical Therapist at the hospital can also give you pointers before you are discharged to home.
When you are home and you remove your sling for showers, you can also slowly but fully flex and extend your elbow. You can also lean over and allow your shoulder to hang and gently swing like a pendulum. Then go back into the sling.
At your first post op appointment, Dr Mullen will go over the particulars of your shoulder surgery and discuss beginning Outpatient Physical Therapy. Some patients begin Outpatient PT 2 weeks after surgery, many others wait to see if they can do it on their own and reassess the potential need for Outpatient PT with Dr Mullen 6 weeks after surgery. Some patients do all of their own rehab and never go to PT.
Dr Mullen knows many clinics and therapists and can help you choose a PT clinic that does good work, is near your home, and takes your insurance. If you already have a PT clinic in mind, and you know you want to go, you can preemptively schedule your first PT appointment for the day after your first post op follow up visit.
How do I keep from getting a DVT, or a ‘blood clot’?
If you already take a daily blood thinner as part of your typical medical regimen, please discuss this with Dr Mullen before surgery. These medicines have to be stopped before going into surgery but typically can be restarted 24 hours after surgery. Other patients with medical conditions that put them at particular risk for clotting may be recommended to take Aspirin after surgery. In patients who have no other medical comorbidities that put them at risk for clotting, blood thinners may not be necessary. Ask Dr Mullen and his office team at the pre-operative appointment if you have any questions regarding blood thinners.
When may I shower and change my bandage?
Dr Mullen will apply an Aquacel or Mepilex antimicrobial foam adhesive bandage to your shoulder after surgery. You may shower with the adhesive bandage on, dabbing it dry afterwards. However, under no circumstances should the shoulder be dunked or submerged under water for 6 weeks.
7 days after surgery you will peel off the adhesive bandage. You will then see your wound. Dr Mullen closed your incision with dissolvable stitches. They take about 6 weeks to dissolve. The stitches do not need to be removed. You may still shower and now get the incision wet, but only let soapy water run along the incision briefly before patting it dry. Keeping your incision clean this way is a good idea and can help prevent infection. Your shower should be brief. Don’t linger. After showering you should cover the wound with a piece of gauze and tape.
Do not apply any ointments or creams to your incision. You are still not allowed to dunk or submerge your incision under water for 6 weeks. Water exposure in this manner can seep into the incision and cause a terrible infection. That means no bathtubs, hot tubs, Jacuzzis, swimming pools, or water therapy for 6 weeks.
When may I drive?
It is illegal to drive under the influence of narcotics. Once you do not need narcotics, and only after you feel physically able to accept the responsibilities that come with driving a car may you return to driving. That turns out to be an answer that changes patient to patient. It is not illegal to drive while wearing a sling, but it may not be a wise decision to do so.
How long will I be out of work?
Your return to work is dependent on the type of occupation you have. Patients with sedentary jobs may be able to return 1-2 weeks after surgery. Patients with a physically demanding occupation may be able to return 8-10 weeks after surgery. Full recovery however may take much longer.
Do I need to take antibiotics before dental cleanings forever now?
Conflicting evidence exists regarding their necessity; however, most doctors agree that anyone with any medical condition that increases any risk of infection should use pre-dental care antibiotics. Dental infections or bad teeth can be a source of infection for a total shoulder even after the surgery is completed. For this reason it is wise to advise your dentist that you have had a total shoulder replacement surgery. For any dental procedures, including cleaning of your teeth, you should consider antibiotic prophylaxis. This is generally a single oral dose of either Amoxicillin 2 grams or Cleocin 600 mg one hour before dental procedures. Other infections in the body, such as boils or bacterial infection, could also represent a source of problems for a person with total shoulder replacement. For this reason, if you have any infection you should consult your family doctor promptly so that proper treatment can be carried out.
Are my expectations realistic?
Total shoulder replacement surgery is major surgery and should not be undertaken lightly. It is wise to keep in mind when considering this surgery that even the best total shoulder replacement is not as good as your shoulder was when it was healthy. The goal of the surgery is to relieve your pain, if not totally, then at least somewhat. It is also the goal with this surgery that you will maintain reasonable stability and flexibility as well.
Even when you feel much better you must keep in mind that this new shoulder is a mechanical device. Just like any mechanical device, including your automobile, there can be problems or failures. In general, total shoulder replacements can last many years. As with any medical procedure, there is no guarantee.
Even if you feel much better following your surgery it is wise that you avoid activities which require high impact to the shoulder or hard contusions to the shoulder. While permitted, they may break or shorten the lifespan of the shoulder.