Rotator Cuff Repair

• Stop or cut down on smoking to reduce your surgery risks and improve your recovery
• Avoid chemical peels and needling

• Pain medications are prescribed to help with pain during the recovery phase. 
• After your operation, you will have a drip in your arm for pain medication and antibiotics.
• You may need between 1 - 3 nights in hospital.
• Crutches are required for 1 – 2 weeks following the replacement. Once you are off crutches, you can begin driving.
• If any postoperative problems arise with your knee, such as redness, increasing pain or fevers, do not hesitate to contact Dr Edward Graham. If unavailable, seek advice from the hospital or your doctor.
• Going home remember to arrange for someone to take you home, no driving is recommended.

• Regardless of whether you are expecting to have treatment or just a consultation please advise the doctor of any medications you are taking, including:
• Aspirin, Anti-inflammatory or Blood-thinning medications,
• discuss  which ones should be stopped before surgery like aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding 7 days before surgery to minimise bleeding
• review blood replacement options (including banking blood) with your doctor

Preparing mentally and physically for surgery is an important step toward a successful result.

your doctor will create a treatment plan and

Patients will also need to understand the process and their role in it.

Physical Preparation

• Eat a well-balanced diet, supplemented by a daily multivitamin with iron.
• consider losing weight (if overweight) before surgery to help decrease the stress on the new joint. 
• Treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection

Participating and completing a tailored exercise program before (ie. pre-hab) with a trained physiotherapist will achieve the best result after surgery.

Stop or cut down on smoking to reduce your surgery risks and improve your recovery

Report any infections prior to surgery as the procedure cannot be performed until all infections have cleared up.

Mental Preparation

Preparing mentally and physically for surgery is an important step toward a successful result. 

Your doctor will create a treatment plan and patients will also need to understand the process and their role in it 

• Report any infections to me prior to surgery as the procedure cannot be performed until all infections have cleared up.
• Do not consume alcohol - 24 hours prior to treatment,
• Do not eat or drink anything, including water, for 6 hours before surgery
• Avoid vigorous physical activity or exercise 24 hours prior to surgery

In the recovery ward

• You will awaken after surgery in the recovery ward
• You will be observed & monitored
• Advised of pain relief & what is next
• When appropriate you will be moved to the ward

• Administration of General Anaesthesia
• The entire procedure can take 60 minutes to two hours.
• The procedure is performed and sent to the recovery room, for observation
• Pain medications are prescribed to help with pain during the recovery phase.

• A bandage will be around the operated shoulder and the arm will be in a sling or brace.
• The sling will be worn for about 4-6 weeks to facilitate healing.
• Pain Management - Oral pain relievers will be prescribed to help you manage your pain.
• Apply an ice bag to the affected area to reduce both swelling and pain. 

Your doctor will see the patient prior to discharge and explain the findings of the operation and what was done during surgery.

• It is normal for the shoulder to swell after the surgery. 
• Placing Ice-Packs on the shoulder will help to reduce swelling. Ice packs should be applied to the area for 20 min 3-4 times a day until swelling has reduced.

• Undertake physical therapy to aid recovery & mobility
• When appropriate you will be discharged from Hospital  (1-5 days) 
• The bandage will usually be removed 48 hours post-surgery and place dressings provided by your surgeon over the area.
• Consume nutritious foods and plenty of water.
• Attend scheduled Follow Up Appointments

Your Rehab Program starts soon after your procedure, it involves

• Physical therapy to help you regain strength and control
• Setting recovery goals for pain relief, movement, strength

The patient should keep a pillow under their elbow while lying in bed.

The patient will not be allowed to lift anything over your head or anything greater than 1 kilo for the first 6 weeks.

7-10 days after surgery your doctor will see the patient monitor their progress and remove the sutures.

It is recommended that the patient not drive during the first 6 weeks while wearing a sling due to safety reasons and the risk of injury to the surgical site.

The patient will be given specific instructions regarding activity and a rehabilitation program of exercise and strengthening.

Your Rehab Program will have progressed

• Your weight-bearing is advanced to full weight
• 6 weeks post-op your brace is replaced with a lateral stabilizer brace.
• 8 weeks post-op your brace should no longer be required

• You will be added with progressive quadriceps strengthening and straight-leg raises can be trained with an unlocked brace if there is no patellar lag.
• Weight bearing is restricted to toe touch with crutches for the first four weeks.

• The sling can be removed. 
• Reapplied for short periods only if pain. No sling after 8 weeks post-surgery
• Can be active at waist level with the elbow by side. No lifting more than 1kg in daily activities

All exercises 3 times per day, 10-20 repetitions per exercise

Shoulder Blade Exercises

• Elevation / depression
• Retraction (pictured) / protraction 
• Desk Slide Exercises
• External Rotation Exercises: with elbow locked in by side of the body. Can be active if no infraspinatus tendon repair
• Passive Elevation Exercises lying down. Use a good arm to lift the operated arm. Do not bring arm all the way down until final repetition. Gradually increase range

Active arm elevation can start, initially while laying down, in water or with a bent elbow (decreased lever arm).

• A rubber band strengthening program can commence with the upper arm and elbow remaining close to the chest.
• Eating a healthy diet and not smoking will promote healing.

General Complications With Surgery

All operations have risks. Apart from pain, most patients don’t have any of these problems. The general risk of a surgical complication is about 5%, the Risk of serious complications is less than 1%. General complications from surgery can include: 

• Anesthetics - Allergic reactions to medications
• Bleeding & Blood Loss -Blood loss requiring transfusion with its low risk of disease transmission
• Blood Clotting - Blood clots can form in the leg’s calf muscles causing Deep Venous Thrombosis (DVT) and can travel to the lung (Pulmonary Embolism). These can occasionally be serious and even life-threatening (Heart Attack, Stroke). If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
• Infection - During or Postoperative Infection can occur with any operation. Infection rates are approximately 1%, if an infection occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
• Death Due to Surgery - Serious medical problems can lead to ongoing health concerns (kidney failure, pneumonia, bladder infections, causing prolonged hospitalization and in rare cases death.
• Delayed Healing - Some patients take longer to heal than others, particularly people with more than one illness
• Difficulty Breathing - Most patients can be removed from the breathing machine after their surgery. Some patients can require the ventilator longer or lung function rehab
• Surgical Injury - When having surgery there is the risk that parts of the body will be damaged in the process
• Other Complications - Tingling, Numbness or Discomfort Around the Operative Region, Swelling & Bruising, Muscle Stiffness, Reflex Sympathetic Dystrophy, Scarring

Specific Surgery Complications

Specific complications for surgery are rare but may include:

• Dislocation or instability of the implanted joint
• Fracture of the humerus or scapula
• Shoulder Stiffness- Shoulder stiffness with loss of range of motion is a common complication that can be greatly minimized with strict adherence to your occupational therapy program prescribed by your surgeon.
• Arm length discrepancies
• Damage to the joint- Joint damage to the cartilage or other structures can occur during surgery and may require another operation to repair.

If the patient suffers arm pain, redness or swelling, or have shortness of breath at any stage, contact our practice

Dislocation - The risk of dislocation is low. If the hip dislocates from its socket it needs to be put back into place with an anaesthetic. Rarely this becomes a recurrent problem needing further surgery. 

The risk of  dislocation is greatly reduced where patients follow these precautions for the first 6 weeks after surgery the:

 - Keeps your legs apart and feet facing forwards

 - Do not bend at the waist beyond a right angle

 - Do not twist at the waist or cross your legs

• Damage To Nerves Or Blood Vessels - Complications from nerve blocks such as infection or nerve damage are rare but can lead to weakness, numbness, and loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing.
• Wound Irritation - Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint. Local discomfort can take months to fully resolve.
• Leg Length Inequality - Any limb length discrepancy is due to the difficulty of making the legs exactly the same length as each other. Occasionally the leg is deliberately lengthened to make the hip stable during surgery. There are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated by a simple shoe raise on the shorter side.
• Limp Due To Muscle Weakness - Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
• Wear & Loosening - All joints eventually wear out. The more active you are, the quicker this will occur. In general 80-90% of hip replacements survive 15-20 years.
• Failure To Relieve Pain - Very rare but may occur especially if some pain is coming from other areas such as the spine.
• Scarring - Unsightly or thickened scar
• Fractures - Breaks of the femur (thigh bone) or pelvis (hipbone) are also rare but can occur during or after surgery. This may prolong your recovery, or require further surgery. Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. 

Surgery can be regarded as part of your treatment plan - it may help to restore function to your damaged joints as well as relieve pain.

• Check Up with Surgeon
• X Rays

• Check-Up with Surgeon
• X Rays
• After 3 months, more physical activities, such as sports will be possible

• Check Up with Surgeon
• X Rays

At the 6 Week Check-Up your surgeon, who will assess your progress:

• Check-Up with Surgeon
• X Rays

At this time you should be able to:

• Bend the knee to 90 degrees, 
• Use a cane and walk comfortably, 
• Drive a car

• Check Up with Surgeon
• X Rays

You should continue to see your surgeon for the rest of your life to check your knee and take X-rays. 

This is important as sometimes your knee can feel excellent, but there can be a problem only recognised on X-ray