Outpatient Surgery Magazine - Subscribers

Worth of Every Penny - January 2021 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/1324438

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Page 24 of 67

should recline so the patient can be placed in the beach chair posi- tion, which is the only option for shoulder replacement surgery because it allows surgeons to see all areas of the joint in an anatom- ically correct way. Patients should be reclined at approximately 45 degrees to offload pressure on the sciatic nerve and specialized attach- ments are needed to stabilize the head, including a foam mask that supports the patient during the entirely of the procedure. Attachment are also available that allow surgeons to position the arm in a way that provides opti- mal access to the surgical site. The 6cm to 8cm incision is made with dissection through the deltopectoral total interval, down to the fascia and under the con- joint tendon. The subscapularis muscle is approached and removed from the humerus with either a peel or osteotomy. The shoulder is then dislocated, and the replacement performed. Implants are typically placed based on pre-op planning and surgeon experience. Cases range from one to two-and-a-half hours, depending on the patient and the severity of their arthritis. I use an open shoulder tray (instrumentation is dependent on the specific implant used), an oscillating saw and a drill. Patients receive pre- and post- operative doses of tranexamic acid, which minimizes the amount of blood loss. Patients who shouldn't receive it include those with stroke histories or a clotting disease. The incision is J A N U A R Y 2 0 2 1 • O U T P A T I E N T S U R G E R Y . N E T • 2 5 Shoulder replacement patients should be sent home with a clear under- standing of physical therapy requirements and post-op care instructions. Educational videos are helpful, as is a post-opera- tive assessment by an occupational or physical therapist. Additionally, take-home materials should include detailed information that address the following issues: • Sling instructions. Instruct patients how to put a sling on and take it off, how to hold their arm while showering without it, how to get dressed and undressed while wearing it, and any restric- tions they're under while having it on, such as driving. • Wound care. Patients need to know how to shower with the wound dressing on, making sure they don't submerge it in water, and how to dry it if it gets wet. • Blood clot prevention. Even though shoulder replacement patients are less likely to develop DVT than hip and knee patients, they should still take an 81mg aspirin daily for four weeks post-surgery. They should also ambulate as much as possible and perform ankle pumps by moving their feet up and down to contract calf muscles. • Physical therapy. Shoulder patients have an advantage over hip and knee patients because they move around after sur- gery. They can't, however, perform aggressive strengthening exercises right away —surgeons must take down and repair a portion of the rotator cuff to perform a shoulder arthroplasty, and that alone takes weeks to heal. We therefore recommend a series of passive range-of-motion exercises for the shoulder area, as well as active-motion exercises for the elbow, forearm, wrist and hand. — J. Gabriel Horneff III, MD, FAAOS POST-OP CARE Provide Patients With Detailed Discharge Instructions ROAD TO RECOVERY With proper rehab, patients can expect a full range of motion and complete use of the shoulder. Penn Medicine

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