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gradually improves over several weeks, with long-term pain relief typically better than before surgery.","preparation":["Pre-operative medical assessment and fitness for anesthesia","Blood tests, imaging (X-ray, CT/MRI) and surgical planning","Review of medications with the surgical and anesthesia team","Fasting before general anesthesia as instructed","Smoking cessation and optimization of chronic conditions","Plan home help and sling/one-handed activity arrangements","Screening for infection (e.g., dental, skin)"],"recovery_timeline":[{"phase":"Hospital stay (days 0-2)","description":"Pain control, sling, early gentle movement guided by therapist.","restrictions":["Sling use","No active lifting of the arm"]},{"phase":"Early recovery (weeks 1-6)","description":"Passive and assisted motion, wound healing, sling use as directed.","restrictions":["No lifting or pushing with the operated arm","No driving while in sling or on opioids"]},{"phase":"Active motion (weeks 6-12)","description":"Sling weaned; 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lower in first 2 years."},"scars":"A single scar about 10-15 cm, usually along the front of the shoulder (deltopectoral approach); fades over many months.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single operation for a primary one-sided shoulder replacement."},"stages":[{"code":"surgery","label":"Shoulder replacement operation","after":{"min":0,"max":0,"unit":"days","qualifier":"Day of surgery"}}],"qualifier":"Single-stage primary replacement of one shoulder."},"success":{"metric":"Patients with significant pain relief and improved function","value":90,"unit":"percent of patients","horizon":"2 years after surgery","population":"Adults with end-stage glenohumeral arthritis undergoing primary shoulder replacement","evidence_status":"limited"},"techniques":[{"name":"Anatomic total shoulder arthroplasty","suits_whom":"Arthritis with intact rotator cuff and adequate glenoid bone","recovery":"Sling about 4-6 weeks, progressive rehab over 3-6 months"},{"name":"Reverse total shoulder arthroplasty","suits_whom":"Cuff tear arthropathy, deficient rotator cuff, complex fractures, older patients","recovery":"Similar timeline; sling about 4-6 weeks, with specific motion precautions"},{"name":"Hemiarthroplasty","suits_whom":"Selected fractures or avascular necrosis with intact glenoid","recovery":"Similar to total replacement; rehab may be slower if tuberosities need healing"}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":1.5,"max":3,"unit":"hours","qualifier":"Operative time for a primary shoulder replacement, excluding anesthesia and recovery."},"initial_assessment_documents":["Shoulder X-rays","Shoulder MRI or CT scan report","Orthopedic clinic notes on shoulder","List of blood thinners","Previous shoulder surgery reports (if available)"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single-stage surgery; 1-2 nights in hospital, then about 10-14 days in country until wound check. Later reviews at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Confirm the surgeon is trained and experienced in the exact procedure you are considering, not just in surgery generally","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Verify that the surgeon is trained and experienced in performing the procedure you are considering.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C2","text":"Ask for certification information and the name of the body that certified the surgical setting","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Ask for certification information and the name of the certifying body when assessing a surgical setting.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C3","text":"Check that the surgeon who consults with you is the same person who will carry out the procedure","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Check that the surgeon you consult with, will be the same person carrying out the procedure.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C4","text":"Ask whether a doctor is always present in the clinic and whether a high dependency or intensive care unit exists","scope":"treatment_abroad","source":{"url":"https://www.bapras.org.uk/public/patient-information/cosmetic-surgery/cosmetic-surgery-abroad","host":"bapras.org.uk","quote":"Is there always a doctor in the clinic and is there a high dependency or intensive care unit?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C5","text":"Ask whether the surgeon and the facility use a surgical safety checklist, which can reduce complications","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Do the surgeon and his/her facility use a safety checklist?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"An advert or information that guarantees complete success should raise concerns","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should raise concerns.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F2","text":"Forceful persuasion or cheap, time-limited offers pushing you into a quick decision","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"A price that sounds too good to be true probably is","scope":"treatment_abroad","source":{"url":"https://www.plasticsurgery.org/news/articles/will-economic-uncertainty-drive-more-patients-overseas-for-plastic-surgery-what-to-consider-and-how-to-stretch-your-dollar-back-home","host":"plasticsurgery.org","quote":"If the price sounds too good to be true, it probably is.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Worsening pain in arm, hand or wrist","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/8290-shoulder-replacement","host":"my.clevelandclinic.org","quote":"New or worsening pain in your arm, hand or wrist","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"W2","text":"Leaking, swelling or odor at surgery site","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/8290-shoulder-replacement","host":"my.clevelandclinic.org","quote":"Signs of infection at your surgery site including leaking, swelling, discoloration, odor or a feeling of warmth","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"W3","text":"Shortness of breath","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/procedures/reverse-shoulder-replacement","host":"my.clevelandclinic.org","quote":"Shortness of breath (dyspnea)","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"W4","text":"Fever higher than 101 degrees Fahrenheit","urgency":"contact_clinic","general":true,"source":{"url":"https://my.clevelandclinic.org/health/treatments/8290-shoulder-replacement","host":"my.clevelandclinic.org","quote":"Fever higher than 101 degrees Fahrenheit (39 degrees Celsius)","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T2","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge summary","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"When you have treatment abroad, you must ask the treatment provider for their follow-up recommendations documented within a written discharge summary in English.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T3","text":"Ask for copies of all prescriptions before you leave","document":"prescription 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