Shoulder replacement · Preparing for surgery
A clear plan.
A prepared shoulder.
Preparing for anatomic or reverse shoulder replacement starts before the day of surgery. This guide organizes skin preparation, infection prevention, and early wound care into a practical timeline.
This suggested regimen is for uncomplicated primary shoulder replacement. Confirm it with your surgical team before starting products or prescriptions. Your hospital’s instructions take priority. Revision surgery, previous infection, or suspected infection requires a separate plan.
Start at your preoperative visit
- Tell the team about any infection, open wound, rash, inflamed hair follicle, or skin irritation, especially near the shoulder or armpit. These may need treatment before surgery.
- Discuss smoking, nutrition, anemia, and diabetes control. Bring a complete medication and allergy list, including supplements and the reaction you had to each medication.
- Changes to medicines that suppress the immune system should be coordinated with the clinician who prescribes them. Do not stop prescribed medicines on your own.
- Report the date of your most recent steroid injection into the shoulder being replaced. When feasible, allow at least three months between that injection and elective replacement.
- Arrange a nasal swab for MSSA and MRSA early enough to complete treatment if it is needed. These are types of Staphylococcus aureus bacteria that can live in the nose without causing symptoms.
Also confirm your fasting instructions, which medicines to take or hold, transportation home, and the help you will need after surgery.
Your skin-preparation timeline
Count backward from your scheduled surgery date. The nasal treatment and body wash have different start dates. Ask the office to write the dates down if anything is unclear.
Nasal treatment, only if prescribed
If your MSSA or MRSA screening is positive, the suggested regimen is mupirocin 2% inside the front of both nostrils, twice daily for the five days before surgery. Use the prescribed intranasal product and instructions.
Some facilities instead use an approved intranasal povidone-iodine preparation shortly before surgery. Do not substitute an ordinary skin antiseptic or use both protocols unless instructed.
Begin daily chlorhexidine washing
If approved by your team, use chlorhexidine 4% body wash once daily for five washes: four days before surgery, three days before, two days before, the day before, and the morning of surgery.
Include the operative shoulder and armpit. Follow the product’s washing, rinsing, and drying directions. Keep it away from your face, eyes, ears, mouth, and genital area. If you are allergic to chlorhexidine, ask for an alternative.
Start benzoyl peroxide, if instructed
Apply a thin layer of benzoyl peroxide 5% leave-on gel to the front and back of the operative shoulder and the skin of the armpit, morning and evening. Apply to intact skin after washing and drying. Avoid eyes and other sensitive areas.
Continue the schedule
Continue the daily chlorhexidine wash and morning/evening benzoyl peroxide. Complete the prescribed nasal-treatment course. Do not shave the shoulder or armpit with a razor; the facility can clip hair if necessary.
Finish the skin-preparation course
Complete the fifth chlorhexidine wash. After washing and drying, apply the fifth and final benzoyl peroxide application if this is part of your team’s instructions. Follow any facility-specific directions about products left on the skin, fasting, and morning medicines.
Benzoyl peroxide can bleach towels and clothing. Stop and contact the office if substantial irritation develops. Studies show reduced Cutibacterium acnes on the skin; they have not yet established that this regimen reduces actual prosthetic shoulder infections.
Do not start oral doxycycline or another antibiotic simply to “sterilize” your shoulder. Routine oral antibiotic decolonization is not recommended.
What the surgical team handles
The team selects and times IV antibiotics, performs the surgical skin preparation, monitors temperature and glucose, and applies the dressing. These are not home treatments. Allergy history, MRSA status, kidney function, and the operation itself may change the plan.
Read the infection-prevention approach and supporting evidence →
Protect the incision after surgery
- Leave the sealed sterile dressing in place for its recommended wear time and minimize handling. A wet, loose, or saturated dressing needs an aseptic change; contact the team if you have not been shown how.
- Showering may begin after about 48 hours only if your closure, dressing, and surgical team permit it. Do not soak the incision until it is healed and you have clearance.
- Do not put benzoyl peroxide, hydrogen peroxide, chlorhexidine scrubs, or antibiotic ointment directly on the healing incision.
- An uncomplicated primary replacement does not routinely require a take-home course of antibiotics for infection prevention. Do not start, stop, or extend a prescribed antibiotic without clarifying its purpose with the treating team.
Call promptly about wound changes
Contact your surgical team for new or persistent drainage, spreading redness, fever, wound separation, or unexpectedly increasing pain. Do not wait for your next routine appointment. Use your established postoperative contact number; seek emergency care for severe symptoms or if you are acutely unwell.
Continue preparing for recovery
Sources and further reading
- Surgical-site infection prevention: 2022 guidance update, published 2023
- Five-application benzoyl peroxide randomized trial, 2020
- Steroid injection timing before shoulder arthroplasty: systematic review
- Oral doxycycline decolonization randomized trial, 2017
General education for primary shoulder replacement. Individual instructions and facility protocols take priority.