Orthopedic Services
Total Shoulder Replacement
Patient Guide
2 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
2
Table of Contents
Welcome ............................................................... 3
How the Normal Shoulder Works
............................................ 4
Causes of Shoulder Pain / Loss of Function
.................................... 4
Types of Total Shoulder Replacements
....................................... 5
The Orthopedic Evaluation
................................................. 6
Possible Complications Aer Surgery
......................................... 6
Preparing for Surgery
..................................................... 7
Day of Surgery
........................................................... 9
Preopereative Skin Preparation Instrutions
...................................10
Surgery Day
............................................................11
Incentive Spirometer
.....................................................13
Leg Exercises Aer Surgery
................................................14
Aer Your Surgery
........................................................ 15
Recovering at Home
.....................................................16
Post-Operative Guide
....................................................18
Daily Activities Aer Surgery
...............................................20
TOTAL HIP/KNEE REPLACEMENT • 3
Total Shoulder Replacement Patient Guide
3
Welcome to Saint Joseph Mercy Health System
Our physicians are all board certied and fellowship-trained
in the various orthopedic specialties and subspecialties.
We’re number one for knee surgeries in the state, a leader
in total joint replacements and have the largest group of
hand specialists in the area. We also oer a full complement
of non-surgical treatments and procedures that have earned
us some of the highest patient-satisfaction ratings in the state.
We’ve formed specialized teams of physicians, nurses,
therapists and other sta to identify and implement pain management protocols that
bring post-surgical patients the most relief. In addition, we work with manufacturers to
identify the best functioning, longest lasting replacement joints to oer patients the
most satisfactory outcomes. Through research, we are able to identify and share the
best procedures, prosthetics and protocols not only within our own group but with
physicians and hospitals across the country and around the world.
From comprehensive pre-op education through nal discharge, we are committed
to oering our patients the nest care backed by the most promising science. We are
dedicated to continuous improvement through a vigorous patient follow-up process.
Our ultimate goal is to help patients re-discover their freedom. We accomplish this by
working closely with referring physicians and patients, using the latest treatments and
proven best practices.
Thank you for choosing St. Joe’s and please don’t hesitate with any questions or
concerns throughout your experience as you begin to re-discover your freedom!
Michael Masini, MD
Medical Director, Total Joint Program
Saint Joseph Mercy Health System
4 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
4
How the Normal Shoulder Works
The shoulder joint is the most exible of all the body’s
joints. When it is functioning normally, this exibility allows
movement of the arm in almost every direction through a
full range of motion. When there is damage to any of the
structures in the shoulder, movement is dicult and painful.
The shoulder is a ball and socket joint. The ball portion is
found at the top of the arm bone, which is called the head
of the humerus. This ts into the socket, which is called the
glenoid. This ball and socket makes up the glenohumeral
joint. The glenoid composes part of the shoulder blade,
which is called the scapula. This area is a common
site for arthritis to form. Arthritis results in narrowing of
the joint space and causes stiness and pain. Shoulder
replacement may be an option for pain management
and improving movement.
Common Causes of Shoulder Pain and Loss of Function
Severe arthritis in combination with large rotator cu tears that cannot be repaired
Various types of arthritis: degenerative joint disease (osteoarthritis), rheumatoid or post-traumatic
Disruption of the blood supply to the head of the humerus (avascular necrosis)
Severe fractures
Clavicle
Acromion
Cartilage
Glenoid
Cavity
Scapula
Humerus
Shoulder Anatomy
Healthy Shoulder and Types of Arthritis Eecting the Shoulder Function
Extensive
Osteophyte
Formation
Osteophyte
Formation
Scapula
Humeral
Head
Humerus
Acromion
Coracoid Process
Healthy Shoulder
Moderate Osteoarthritis
Advanced osteoarthritis
Numeral
Head Flattening
Erosion of
Cartilage
Erosion of
Cartilage
TOTAL HIP/KNEE REPLACEMENT • 5
Total Shoulder Replacement Patient Guide
5
Types of Total Shoulder Replacements
The type of shoulder replacement your surgeon performs depends upon the extent of the abnormality
aecting the shoulder.
Anatomical Total Shoulder Replacement
Conventional total shoulder replacement is generally performed when cartilage is totally worn away, yet the
rotator cu tendons are in good condition. This type of shoulder replacement also relies on the rotator cu
muscles to move the arm. The system is modular, which allows the best t possible. The arthritic head of the
humerus bone is replaced using a metal stem and highly polished metal ball. The socket is replaced with a
plastic durable material.
There are various types of implants available. Your surgeon will determine the appropriate type for you with
the goal of eliminating shoulder pain, improving movement, and allowing a return to normal activities.
Reverse Total Shoulder Replacement
Reverse Total Shoulder Replacement is performed when there is damage to the rotator cu, resulting in
inability of these muscles to help move the arm properly. The positions of the components of the reverse
total shoulder prosthesis are switched, in relation to how they are implanted in the conventional total
shoulder procedure. The pieces include a durable plastic socket that is connected to the upper part of the
arm bone and a metal ball that is attached to the shoulder bone. The goal of this surgery is to alleviate pain
and to improve the ability to li the arm up. The reverse total shoulder replacement relies on the deltoid
muscle to provide movement to the arm, rather than the torn rotator cu muscles.
Anatomical Shoulder Replacement Reverse Total Shoulder Replacement
6 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
6
The Orthopedic Evaluation
Most patients who undergo total shoulder replacement are age 60 to 80, but orthopedic surgeons evaluate
patients individually. Recommendations for surgery are based on a patient’s pain and disability, not age.
The orthopedic evaluation consists of several components:
Medical History. Your orthopedic surgeon will gather information about your general health
and ask about the extent of your knee pain and your ability to function.
Physical Examination. This will assess your shoulder motion, stability and strength.
X-rays. These images help to determine the extent of damage and deformity in your shoulder.
Other Tests. Occasionally blood tests, a magnetic resonance imaging (MRI) scan, or a bone scan may
be needed to determine the condition of the bone and so tissues of your shoulder.
Your orthopedic surgeon will review the results of your evaluation with you and discuss whether total shoulder
replacement would be the best method to relieve your pain and improve your function. Other treatment
options including medications, injections, physical therapy, or other types of surgery also will be discussed and
considered. Your orthopedic surgeon also will explain the potential risks and complications of total shoulder
replacement, including those related to the surgery itself and those that can occur over time aer your surgery.
Possible complications after surgery
The complication rate following shoulder replacement is low. Serious complications occur in less than
two percent of patients. Major medical complications, such as heart attack or stroke, occur even less
frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when
these complications occur, they can prolong or limit your full recovery.
Blood clots. Your orthopedic surgeon will outline a prevention program, which may include lower leg
exercises to increase circulation and medication to thin your blood.
Dislocation. Your new shoulder may dislocate from the new socket or glenoid. This risk decreases as the
muscles around the shoulder joint are strangthened through physical therapy.
Implant problems. Although implant designs and materials, as well as surgical techniques, have been
optimized, wear of the bearing surfaces or loosening of the components may occur.
Infection. Infection may occur in the wound or deep around the prosthesis. Minor infections in the wound
area are generally treated with antibiotics. Major or deep infections may require more surgery and removal
of the prosthesis.
Nerve injury. While rare, injury to the nerves or blood vessels around the shoulder can occur during surgery.
TOTAL HIP/KNEE REPLACEMENT • 7
Total Shoulder Replacement Patient Guide
7
Preparing for Surgery
Tests. Several tests such as blood samples, an electrocardiogram, chest X-rays and urine samples may be
needed to help plan your surgery.
Medications. Tell your orthopedic surgeon about the medications you are taking. Your orthopedist or your
primary care doctor will advise you about which medications you should stop or can continue taking
before surgery.
Additional strategies to help reduce your risk of complications, include:
Dental evaluation. Although infections aer shoulder replacement are not common, an infection can
occur if bacteria enters your bloodstream. Because bacteria can enter the bloodstream during dental
procedures, you should consider getting any dental work completed prior to one week before your
shoulder replacement surgery. Dental work should be delayed for three months aer surgery. Your surgeon
may want you to take antibiotics prior to any dental work aer your surgery. Please discuss with your surgeon.
De-stress. Research has shown a daily practice of 10 minutes
of a relaxing activity can improve your healing and help
you recover more quickly. Choose whatever calms you. For
some, this could be listening to soothing music or reading
a book. Be sure to bring something with you on the day of
surgery to help you relax during your hospital stay.
Diabetes. If you have diabetes, be sure that your blood
sugar is well controlled. Talk with your primary care doctor,
endocrinologist or surgeon if you have concerns.
Improve nutritional status. Many times people have poor nutrition going in to surgery. If you can improve
your nutrition even a small amount. It will help with recovery aer surgery. We encourage increasing your
lean protein intake before surgery. Examples of lean protein are Greek yogurt, chicken, sh, eggs and lean
beef. You may also drink high protein supplements such as Ensure or Boost.
Ensure pre-surgery is a supplement that you can purchase before your surgery to drink on the morning of
your surgery. It can be purchased from the pharmacy in the Reichert Health Center, St Joe’s Ann Arbor. Do not
purchase this if you take insulin for diabetes (see page 11 for further instructions).
- continued on page 8
Patient nancial services (registration, scheduling and billing)
Registration information, including medical insurance information, will be obtained by phone before your
surgery. If a patient nancial services representative is unable to reach you by pone, please call 877-791-2051
or toll-free 800-676-0437 prior to your surgery.
8 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
8
Preparing for Surgery - continued
Weight loss. If you are overweight, your doctor may ask you to lose some weight before surgery to
minimize the stress on your new shoulder and possibly decrease the risks of surgery.
Exercise/Activity. Continue any particular exercise or activity you have been doing. Working out, golng,
walking, stationary bike, swimming, etc., are all valuable. Even just a few simple exercises can make your
recovery better.
 Keep as active as you can. Continue getting out, shopping, social activities as you are able. Both the
physical activity and the social connections help you adjust to post-op recovery. Interrupt your sedentary
activities! (Long periods of sitting or lying down increases your health risks.) When sitting, take a short
walking break every hour or so.
Skin preparation. You will be given specic instructions in how to care for your skin prior to surgery. This
is important to reduce your risk of an infection. Aer showering and using the skin prep, it is important that
you lie on clean sheets, clean nightclothes and not with your pets. Please take the time to plan for that.
It is also important that you wear clean clothing to come to the hospital the following day.
(see page 10, “Preoperative Skin Preparation Instructions”)
Stop smoking.
This is one of the most important steps you can take to improve your post-op recovery.
Numerous studies have shown that smokers have a signicantly higher risk of complications and poor
outcomes. Talk to your primary care doctor about starting nicotine patches. We can order the patches
while you are in the hospital.
Home Planning
Home modications can make your return home easier during your recovery.
You will need some help for several weeks with tasks such as cooking, shopping, bathing and laundry.
You will also need someone to drive for you for a few weeks.
Make sure you have a phone available in case you need to contact anyone.
Plan in advance, make sure you have enough groceries or ready made meals for aer surgery.
Clean up clutter around your home to help prevent falls aer surgery.
Arrange your home so you can get around safely without navigating stairs, if possible.
Think about how you would be most comfortable sleeping. A recliner or wedge for your bed may be
helpful. Which side is your chair recliner lever on? You may not be able to use aer your surgery.
Gather extra pillows to support your arm in a chair or bed.
Have a night light in your bathroom or hallway.
Place things you use oen on a surface that is easy to reach.
Install grab bars in the shower and have a non slip bath mat available.
Practice these daily tasks before your surgery without using the arm you will be having surgery on - getting
in and out of bed, getting up and down from a chair, getting dressed, going to the bathroom and bathing.
TOTAL HIP/KNEE REPLACEMENT • 9
Total Shoulder Replacement Patient Guide
9
Items to BRING with you:
This book
CPAP machine (if you have one)
Copy of your advance directive/living will
(if you have one)
Drivers license/photo identication
Insurance information/card
Home medication list
List of all allergies to medications
List of important phone numbers
(family or close friends)
Toiletries
Loose and comfortable clothing
Good tting slippers/shoes
Day of Surgery
Anesthesia. The most common types of anesthesia are general anesthesia and local nerve blocks. The
anesthesia team, with your input, will determine which type of anesthesia will be best for you.
Procedure. The procedure itself takes one to two hours. Your orthopedic surgeon will remove the damaged
cartilage and bone, and then position the new metal and plastic joint surfaces to restore the alignment and
function of your shoulder.
Items to REMOVE BEFORE SURGERY
Dentures or any removable dental work
Glasses and contact lensses
Hairclips, hairpins
Jewelry, including all piercings
Make-up
Nail polish
Tampons
Wigs
Items NOT to bring
Large sums of money
Jewelry
Home medications
Opioid prescriptions
The hospital is not responsible for lost items
10 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
10
Preoperative Skin Preparation Instructions
Morning of surgery
DO NOT shower, bathe or shampoo hair
Wash face and private areas
Brush teeth and rinse mouth
Wear loose comfortable clothing to hospital
Night before surgery
Shower or bathe with antibacterial soap
(example: Dial
®
)
Wash hair with any shampoo
Towel dry with a clean towel
DO NOT apply any makeup, lotions, oil,
powders or deodorant on your skin
Dress in clean clothes/sleepwear
Place clean sheets on bed
Wait two hours, until skin is cool and dry
Note: Do not use chlorhexidine wipes on your face or private areas.
Wipe your neck and chest.
Wipe both arms, starting each with the shoulder and ending at
ngertips. Be sure to thoroughly wipe the arm pit areas.
Wipe your abdomen and right and le hip including thigh creases.
Wipe both legs, starting at the thigh and ending at the toes.
Be sure to thoroughly wipe behind your knees.
Wipe your back starting at the base of your neck and ending
at your waist line. Cover as much area as possible. Assistance
may be required.
Wipe the buttocks.
FRONT BACK
Proceed with using Chlorhexidine Gluconate cloths
Wash and dry hands prior to use. Open the packages and remove the cellophane lm and discard.
Using scissors cut o the end seal of all three packages.
Use one clean cloth to prep each area of the body in order as shown below.
Wipe each area in a back-and-forth motion and thoroughly. Assistance may be required.
Use all cloths in the packages and discard in trash.
Allow your skin to air dry. Skin will feel sticky/tacky – DO NOT WIPE OFF
Cloths will not stain fabrics
Keep pets out of bed
Relax or sleep
TOTAL HIP/KNEE REPLACEMENT • 11
Total Shoulder Replacement Patient Guide
11
Surgery Day
Arriving at the hospital
 Illness. Notify your surgeon’s oce immediately if you develop any kind of illness the morning of your
surgery or within ten days before surgery (cold, u, fever, herpes outbreak, skin rash or infection, or “are-
up” of a health problem). Sometimes, even minor health problems can be quite serious when combined
with the stress of surgery.
 Eating. Do not eat anything aer midnight the night before your surgery.
Drinking. On the day of surgery, you will arrive at the hospital two hours before your scheduled
surgery. You will drink a bottle of Ensure
®
Pre-Surgery Clear Nutrition Drink (10 ounce bottle)
on your drive to the hospital. It needs to be nished two hours before your surgery which is your
arrival time.
Ensure Pre-Surgery is a carbohydrate rich beverage, with added supplements that you will
drink the day of your surgery - no substitutions. It improves your comfort, hydration, hunger
and thirst and provides nutrients to aide in your post-op recovery. You may purchase this
drink at the Reichert Heath Center Pharmacy on the St Joe’s Ann Arbor Campus.
Patients with Diabetes
Ensure
®
Pre-Surgery Clear Nutrition Drink is not for patients who take insulin.
If you take insulin, you may drink 16 ounces of clear uid up to four hours before surgery.
EMERGENCY
E
L
L
I
O
T
T
D
R
I
V
E
MICHIGAN
ORTHOPEDIC CENTER
5315 Elliott Drive
REICHERT
HEALTH CENTER
5333 McAuley Drive
M
C
AU
L
EY
D
RI
V
E
Outpatient
Surgery Center
5360 McAuley Drive
Parking Lot OSC
Hospital Parking
If your surgery is scheduled at the Main
Operating Department, go to the Patient
Towers Area (parking lot B) and check in
at the front desk in the lobby of the main
hospital. Once you are checked in, you
will be given directions to the Preoperative
Holding Area (Main Surgery Center).
If your surgery is scheduled in the Outpatient
Surgery Center, go to the Outpatient Surgery
Center parking lot OSC and check in at the
front desk. Once you are checked in, you
will be given directions to the Preoperative
Holding Area (Surgery Waiting Area).
Shuttle Service | 734-712-3344
Main Hospital:
7 a.m. - 6 p.m.
Reichert Health Center: 7 a.m. - 5 p.m.
Main Surgery
Center
5301 McAuley Drive
FLOOR 2
Main Hospital
Entrance
Patient Towers
Parking Lot B
12 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
12
Surgery Day - continued
Preoperative Holding
In the preoperative holding area, you will meet your surgical team and complete mandatory surgical and
anesthesia consent authorization forms. A family member or companion may be invited to stay with you in this
area until it is time to go to the operating room. Family or companions are limited to two at any given time.
Surgery Family Room
Your family or companions will be asked to provide a cell phone number so they can be to notied when
to return to the surgery family room. Aer surgery, your doctor will talk to your family or companions in the
surgery family room. Your family will be informed when you are assigned a hospital room. They can meet
you in your hospital room aer you come out of recovery.
The Operating Room
The lights will be bright and the room temperature will seem cool. Small sticky pads will be placed on your
chest to a monitor your heart throughout the procedure. A blood pressure cu will be placed on your arm
to check your blood pressure every few minutes. A probe will be placed on your nger to check how much
oxygen is in your blood. You will be given extra oxygen to breathe through a mask. The anesthesiologist will
give you medicine through your IV that will make you go into a deep sleep. Your nurse will be near you as
you go to sleep. Warm blankets are available for your comfort.
TOTAL HIP/KNEE REPLACEMENT • 13
Total Shoulder Replacement Patient Guide
13
Incentive Spirometer
Read these instructions before your surgery so that you will be prepared to start these exercises as soon as
possible aer your surgery. Take at least 10 breaths every hour, resting aer each breath. Continue using the
Incentive Spirometer for one to two weeks aer your surgery.
Incentive Spirometer
Deep breathing is very important aer surgery. It expands the lungs, helps circulation and helps prevent
pneumonia. Your surgeon wants you to perform deep breathing exercises aer surgery. You will also use
an incentive spirometer to help you meet goals for deep breathing.
The incentive spirometer is a plastic device that helps you to breathe deeply. It encourages you to take
deep breaths and gives you instant feedback on how well you are doing.
How Do I Use the Incentive Spirometer? Sit up as straight as possible so that your lungs can fully expand.
Hold the spirometer’s mouthpiece with one hand and the spirometer’s handle with your other hand. Keep
the spirometer level with your mouth.
• Exhale normally, and then place your lips tightly around the spirometer’s mouthpiece.
• Slowly inhale through the mouthpiece as much air as you can. Give this your best eort! Watch the blue
disc in the spirometer rise to see how deeply you inhaled. The deeper you breathe, the higher the blue
disc rises. Hold your breath and count to ve. Try to keep the disc elevated in the spirometer if you can.
• Finally, remove the mouthpiece from your mouth and exhale normally. Rest for a moment and the
repeat the exercise. Rest in between each deep breath. As you fully expand your lungs you will see the
disc rise higher. You can track your progress on the spirometer with the sliding arrows. As you master one
level, aim to move the disc higher with the next set of deep breaths.
Blue Disc
Handal
Sliding Arrow
Mouthpiece
14 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
14
Leg Exercises After Surgery
These exercises will help return blood from your legs to your heart. This improves circulation and helps
prevent blood clots. You should do these exercises when you are in bed aer your operation. You can
practice these at home as well.
Doing the Leg Exercises
Push toes of both feet toward the end of the bed. Relax both feet. Pull toes of
both feet toward your chin. Relax both feet.
Point your toes and draw a circle with them, rst to the right and then to the le.
It is important that you exercise your legs every hour while you are awake.
Walking
Walking involves all your systems, promotes normal body functions,
helps you take deep breaths, improves your circulation and helps relieve
any gas pains or muscle spasms you might have. Ask for help getting
out of your bed until your nurse tells you it is safe for you to do this alone
or with a family member.
You should take a short walk with help on day of surgery.
Starting the day aer surgery you should take a walk out in
the hall at least ve times each day. Try to walk a little farther
each time you walk.
Leg Exercises
|
It is important that you exercise your legs every hour while you are awake.
Push toes of both feet toward the end of the bed.
Relax both feet. Pull toes of both feet toward your
chin. Relax both feet.
Point your toes and draw a circle with them,
rst to the right and then to the le.
TOTAL HIP/KNEE REPLACEMENT • 15
Total Shoulder Replacement Patient Guide
15
After Your Surgery
You may expect the following:
Diet. You may eat your normal diet aer surgery. It may take several days before your appetite returns
to normal. Some patients will experience nausea, and medications will be used to prevent this. You will
receive uids intravenously to prevent dehydration.
Medications. Your doctor and nurses will review your home medications and start these if needed.
You will receive antibiotics through your IV to help reduce the risk of infection. If you feel nauseated,
medications will be given through your IV or by injection.
Lung congestion prevention. To avoid lung congestion aer surgery you should breathe deeply and
cough frequently to clear your lungs and use your incentive spirometer (see page 13).
Blood clot prevention. Your orthopedic surgeon may prescribe one or more measures to prevent blood
clots and decrease leg swelling, such as inatable leg coverings (compression devices) and blood
thinners. Foot and ankle exercises will also help prevent leg swelling and blood clots (see page 14).
Numbness. You may feel some numbness in the skin around your incision. This will improve over time
following your surgery.
Pain management. You may have a nerve block placed aer your surgery. This is a tiny so tube to help
with pain relef aer your surgery it will be placed near your shoulder. It is connected to a portable pump
that delivers numbing pain medication around the bundle of nerves that leads to your operative shoulder
and arm. Depending on the dose you need, the pump will run for three to four days. You may still have
pain with a nerve block and need to take additional pain pills.
Your new shoulder may activate metal detectors required for security in airports and some buildings.
Tell the security agent about your shoulder replacement if the alarm is activated.
Continue to do the following:
Elevation and cold therapy are important to help control pain and swelling. Elevate your hand above your
elbow using a pillow or sling. Cold therapy may include ice packs, gel packs or cold machine.
Take special precautions to avoid falls and injuries. Individuals who have undergone total shoulder
replacement surgery and suer a fracture may require more surgery.
Tell your dentist that you have had a shoulder replacement. You may need to take antibiotics before any
dental surgical procedure to prevent possible infection. Please ask your surgeon for their recommendations.
You will have regular follow-up appointments orthopedic surgeon.
16 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
16
Recovery at Home
Activity. You should be able to resume most nor-
mal activities of daily living within three to six weeks
following surgery. Some pain with activity and at
night is common for several weeks aer surgery.
Constipation. Opioid induced constipation is a
side eect that is common when taking opioid
medications. To prevent this, drink 8 - 10 (8 oz.)
glasses of water or uids each day unless told
to limit your uids by your health care provider.
Warm liquid can also help bowels to move. Unless
you have dietary restrictions, increase the amount of ber in your diet such as dried/fresh fruit, popcorn,
berries, wholegrain breads/cereals. Take an over-the-counter stool soener (Colace) and laxative (Miralax
and Senna) each day you are taking opioid pain medication
Diet.
Some loss of appetite is common for several weeks aer surgery. Small frequent meals can be
helpful to regain your appetite. A balanced diet is important to promote proper tissue healing and restore
muscle strength.
Driving. You will not be able to drive aer surgery until approved by your surgeon. On average this can
take up to four weeks while you recover. You will also not be able to drive while taking opioids.
Hand washing. It is very important that you and anyone that is helping you care for your incision, wash
your hands oen and thoroughly. Bacteria carried on our skin and hands can lead to a wound infection.
Do not use the same soap and/or cloth you use on your body on your incision. Use an anti-bacterial
soap once it is okay for you to wash your incision. Your nurse will give you more incisional instructions
before you are discharged.
Pain control. You will be given a prescription for pain medications when you leave the hospital. These
medications can cause constipation (your ability to have a bowel movement is slowed down). Do not
drink alcohol or drive while taking opioid pain medication. Never take more than your prescribed dose.
Some pain medications can have serious side eects including slowed or stopped breathing, confusion
or changes in blood pressure. Others include dizziness, nausea or vomiting. If your pain is not relieved,
contact your surgeon’s oce. Do not take more than prescribed or combine medications without rst
talking to your surgeon. Caution must also be taken when you are taking other medications for other
conditions such as anti-depressants, sedatives, etc., as the side eects can become more noticeable.
Aer discharge, unless told otherwise, a plan will be made to help you safely stop your opioid medication.
This plan will decrease the amount of opioids you take. It is important that you follow this plan and do not
quickly stop these medications as they can cause symptoms of withdrawal.
TOTAL HIP/KNEE REPLACEMENT • 17
Total Shoulder Replacement Patient Guide
17
Prescriptions. Consider having your prescriptions lled at one of our on-site pharmacies before you
leave. If you want to have your prescriptions lled at the pharmacy you use frequently, you should call
and ask them before you are discharged to see if they carry your medications to ensure you have the
medications you need.
Incision care. You will have a dressing over your incision that will remain in place until you remove it on day
seven aer your surgery. Avoid submerging your incision in water until your incision has completely healed
You will be given instructions about removing your dressing and showering before you leave the hospital.
Swelling management. Elevation and cold therapy are important to help control pain and swelling.
Elevate your hand above your elbow using a pillow or sling. Cold therapy may include ice packs, gel
packs or cold machine.
18 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
18
Post-Operative Guide
Preventing Blood Clots
Follow your orthopedic care team’s instructions carefully to minimize
the potential of blood clots that can occur during the rst several
weeks of your recovery.
Warning signs of possible blood clots in your leg include:
Increasing pain in your calf
Tenderness or redness above or below your knee
Increasing swelling in your calf, ankle and foot
Warning signs a blood clot has traveled to your lung include:
Sudden increased shortness of breath
Sudden onset of chest pain
Localized chest pain with coughing
Avoiding Falls
A fall during the rst few weeks aer surgery can damage your new shoulder and may result in a need
for further surgery. Your surgeon and physical therapist will help you decide which assistive aides will be
required following surgery, and when those aides can safely be discontinued.
Managing Swelling and Pain
Expect swelling and bruising on your shoulder and hand. Wear your sling as instructed by your surgeon
and keep your hand higher than your elbow to prevent swelling.
Ice your shoulder. You can use dierent options for cold therapy. Whether you are using a cold machine,
gel bag or ice bag, you can use it continuously. Ensure you have some protection between the cold and
your skin. Using cold therapy can help with pain, swelling and bruising.
Take your pain medicine as soon as you begin to feel pain. It helps to take it before exercise and at
bedtime. Take the pain medicine with food.
Watch for side eects of pain medicine such as dizziness, nausea, sleepiness or constipation. If you
become dizzy when standing, sit back down, so that you will not fall.
Managing Constipation
Drink uids. It is important to drink water frequently during the day. Your water intake is important to help
prevent constipation. Avoid alcohol or drinks with caeine.
Eat plenty of ber-rich fruits and vegetables, such as berries, carrots, beans and peas.
Take an over-the-counter stool soener (Colace) and laxative (Miralax and Senna) each day you are
taking opioid pain medication.
If you have not had a bowel movement within three days aer discharge and you have been taking
the above bowel medications call your surgeons oce for further instructions.
Constipation recipe: 2 oz. prune juice + 2 oz. clear soda + 2 oz. milk of magnesia. Mix and drink, follow
with 8 oz. of warm water.
TOTAL HIP/KNEE REPLACEMENT • 19
Total Shoulder Replacement Patient Guide
19
Recovery Tips
Walk a few minutes indoors every hour while awake to
prevent blood clots.
Don’t spend too much time sitting.
It may be easier to rise from a higher chair with arms.
Do deep breathing exercises every hour while awake
to help keep lungs clear. Use your incentive spirometer.
Incision care remove your dressing seven days aer
your surgery. You may shower with the dressing in place.
You can wash your incision with soap and water aer
dressing removal. Don’t put cream or lotion on your incision.
Expect your arm/shoulder to be swollen and bruised aer surgery. Your incision may also be warm and red.
Precautions
Avoid reaching out to the side.
Avoid turning the arm in or putting your hand across the body.
Do not use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.
Do not li anything heavier than a glass of water, until allowed by your surgeon.
When to Seek Medical Help
If you experience any of the following aer surgery:
Increased pain or stiness in a previously well-functioning joint
Pain that is not controlled by your pain medication, elevation,
rest and cold therapy
Calf pain
A fall or injury to your surgical arm/shoulder

Swelling not controlled by elevation, rest and cold therapy
Drainage from the incision
Increasing warmth and redness around the incision
Wound drainage or foul odor

Fever over 101.0° F for one day or 100.0° F or more for three days in a row; if you develop chills or night sweats
that are new for you.
It’s recommended to take your temperature at the same time every day (between 3-7 p.m.). You can purchase a
thermometer at any pharmacy or grocery store.
Unexplained bleeding or bruising
If you have not had a bowel movement by the third day aer surgery
Go to an Emergency Room, if you notice the following:
Chest pain
Shortness of breath at rest
Mental status changes/confusion
20 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
20
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Acvies Aer Shoulder Surgery
Please follow your restricons as outlined by your physician
Physical Medicine and Rehabilitaon
St Joseph Mercy Ann Arbor
Saint Joseph Mercy Health System
Geng Dressed
Wear loose ed clothing for increased ease of dressing. While geng dressed try to minimize movement at the shoulder,
using your non-operated arm to do the work. It is best to sit while geng dressed to prevent losing your balance.
Thread surgical arm into sleeve. Pull up sleeve as
much as you can, without moving the shoulder
Using your non-surgical arm,
pull the shirt around your back
Thread non-surgical arm through sleeve. You
may use both arms to zip or buon up your
shirt. If applicable place sling to surgical arm
Thread surgical arm through sleeve rst, pull
up sleeve as high to armpit as you can
Using “good arm”, pull your shirt over
and through head opening
Then feed through other arm, avoiding moving
your surgical arm. Adjust shirt as needed. Re-
place sling if indicated once shirt is on
Sling Management
Please wear your sling as directed by your surgeon
__________________________________________________________________________________________________________________
Place operated arm in sling,
you may need to sit and lay it
on your lap to thread, making
sure your elbow is all the way
back in the sling
Using your unaected arm,
bring the strap around the
back of your shoulder and
neck
With Velcro side facing up,
thread strap through ring and
aach, unl arm is elevated to
at least 90 degrees at elbow
Make sure sling is posi-
oned correctly with elbow
all the way to the back of
the sling, strap is adjusted
so arm is parallel to hips
Daily Activities After Surgery
Please follow your restrictions as outlined by your physician.
Getting Dressed
Wear loose tted clothing for increased ease of dressing. While getting dressed try to minimize movement
at the shoulder, using your non-operated arm to do the work. It is best to sit while getting dressed to prevent
losing your balance.
Thread surgical arm into sleeve.
Pull up sleeve as much as you can,
without moving the shoulder.
Using your non-surgical arm,
pull the shirt around your back.
Thread non-surgical arm through
sleeve. You may use both arms to zip
or button up your shirt. If applicable,
place sling to surgical arm.
Thread surgical arm through
sleeve rst, pull up sleeve as high
to armpit as you can.
Using “good arm,” pull your shirt
over and through head opening.
Then feed through other arm, avoiding
moving your surgical arm. Adjust shirt
as needed. Re-place sling if indicated
once shirt is on.
Sling Management
Please wear your sling as directed by your surgeon
Using your unaected
arm, bring the strap
around the back of your
shoulder and neck.
With Velcro side facing
up, thread strap through
ring and attach, until arm
is elevated to at least 90
degrees at elbow.
Make sure sling is
positioned correctly with
elbow all the way to the
back of the sling, strap is
adjusted so arm is parallel
to hips.
Place operated arm in
sling, you may need to
sit and lay it on your lap
to thread, making sure
your elbow is all the way
back in the sling.
TOTAL HIP/KNEE REPLACEMENT • 21
Total Shoulder Replacement Patient Guide
21
Bathing
While sitting or standing, lean forward at hips and let gravity take your surgical arm away from the body to
wash under your arm, do not actively li the arm away from the body.
Grooming and Eating
You may use your surgical arm for things like feeding your- self, however do not li your arm to comb or
brush your hair.
Household chores
Avoid liing anything heavier than a glass of water with your operated arm and nothing heavy with your
non-operated arm. Housework will also need to go on hold until aer your rst post-op visit.
Toileting
Use non-surgical arm to manage clothing and to wipe, if you are unable, you may need to use a reacher or
bathroom aid.
Mobility Aer Surgery
Therapy will be prescribed per your surgeon’s recommendation-usually two weeks aer surgery.
Avoid movements at the shoulder such as reaching out to the side or reaching across your body.
Avoid placing your arm in any extreme position, such as straight out to the side or behind your body.
Do not use the arm to push yourself up in bed or from a chair because this requires forceful
contraction of muscles.
Do not li anything heavier than a glass of water, until allowed by your surgeon.
Increase your walking everyday. It is important to get up every hour when you are awake to
prevent blood clots.
Come out of the sling for this exercise. Bend
and straighten at the elbow joint only with
the assistance of the other arm. You may
also need support at the elbow, from a
hand or tabletop. Do not push past pain.
Extend ngers and clench in st.
Helps promote circulation and
prevent swelling.
Daily Acvies Connued…
Toileng
Use non-surgical arm to manage clothing and to wipe, if
you are unable, you may need to use a reacher or
bathroom aid.
Bathing
While sing or standing, lean forward at hips and let gravity
take your surgical arm away from the body to wash under
your arm, do not acvely li the arm away from the body.
Grooming and Eang
You may use your surgical arm for things like feeding your-
self, however do not li your arm to comb or brush
your hair
______________________________________________________________________________________________________________________
Household chores
Avoid liing anything heavier than a glass of water with your oper-
ated arm and nothing heavy with your non-operated arm. House-
work will also need to go on hold unl aer your rst post-op visit.
Mobility Aer Surgery
•Therapy will be prescribed per your surgeon’s recommendaon-usually 2 weeks aer surgery
•Avoid movements at the shoulder such as reaching out to the side or reaching across your body
•Avoid placing your arm in any extreme posion, such as straight out to the side or behind your body
•Do not use the arm to push yourself up in bed or from a chair because this requires forceful contracon of muscles
•Do not li anything heavier than a glass of water, unl allowed by your surgeon
•Increase your walking everyday. It is important to get up every hour when you are awake to prevent blood clots.
_____________________________________________________________________________________________________________________
General Exercises
*These exercises are a general guideline. Please perform exercises to your surgeon’s guidelines if otherwise indicated. *
Extend ngers and clench in st. Helps promote
circulaon and prevent swelling.
Flex and extend the wrist up and
down. Also assists with circulaon
and to prevent swelling.
Come out of the sling for this exercise. Bend
and straighten at the elbow joint only. You
may need support at the elbow, from a
hand or tabletop. Do not push past pain.
Flex and extend the wrist
up and down. Also assists
with circulation and to
prevent swelling.
General Exercises
These exercises are a general guideline. Please perform exercises to your surgeon’s guidelines,
if otherwise indicated.
22 • TOTAL HIP/KNEE REPLACEMENT
Orthopedic Services
22
Notes
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
TOTAL HIP/KNEE REPLACEMENT • 23
Total Shoulder Replacement Patient Guide
23
Notes
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
________________________________________________
stjoeshealth.org
ST. JOSEPH MERCY ANN ARBOR
ST. JOSEPH MERCY CHELSEA
ST. JOSEPH MERCY LIVINGSTON
ST. JOSEPH MERCY OAKLAND
ST. MARY MERCY LIVONIA
38910-032 N 9/20T