Anatomic Total Shoulder Replacement
How Is Anatomic Total Shoulder Replacement Performed?
Anatomic total shoulder replacement is a surgical procedure designed to treat advanced shoulder arthritis in the setting of an intact rotator cuff. In this procedure, the damaged joint surfaces are replaced with prosthetic components that replicate the shoulder’s natural anatomy. A metal humeral head component is attached to the humerus, and a polyethylene socket (glenoid component) is secured to the shoulder blade. To appropriately expose and place the implants, a rotator cuff tendon (subscapularis) must be detached and repaired at the end of the procedure. This tendon must heal properly to ensure appropriate function and reduce the risk of implant complications. Therefore, patients must wear a sling to protect the rotator cuff repair for 6 weeks. The operation aims to relieve pain, restore motion, and improve function while maintaining the normal biomechanics of the shoulder. The procedure is performed under general anaesthesia, often with a nerve block to help manage postoperative pain.
What Is the Recovery in the Immediate Postoperative Period?
Hospital stay: Most patients stay 2–3 days in hospital, working with physiotherapy.
Sling: You will wear a sling to support and protect the arm for 4–6 weeks.
Range of motion: Passive shoulder motion begins under physiotherapist supervision. Active movement and strengthening are gradually introduced at 6 weeks.
Ice: Used frequently to control pain and swelling. You should ice for 20 minutes, 3–4 times per day immediately after surgery. An ice/compression machine can be hired from a third party.
Sleep: You may find it more comfortable to sleep in a reclined or semi-upright position with the sling on for the first few weeks.
How Is the Wound Managed?
A waterproof underlay dressing should be left on for 2 weeks.
Incisions typically heal within 2 weeks.
Showers are permitted while wounds are covered with waterproof dressings during the first 2 weeks.
Do not submerge incisions in water (baths, pools, or ocean) for 6 weeks.
A wound check with your GP, allied health provider, or our clinic is recommended at 2 weeks.
Absorbable sutures are usually used and do not require removal, though small remnants may surface naturally during healing.
How Do I Manage My Pain After an Anatomic Total Shoulder Replacement Procedure?
Your anaesthetist may use a regional nerve block to help control pain immediately after surgery.
Local anaesthetic will also be injected into the shoulder during the procedure.
Use ice regularly (20 minutes, 3–4 times per day). An ice machine may be hired from a third party.
Take prescribed pain medication as directed. Opioids may be used short-term but have known side effects (nausea, constipation, dependence). Non-opioid medications such as paracetamol or anti-inflammatories are preferred when tolerated.
Keep the arm supported in the sling to minimise pain and protect the repair.
What Issues Should I Call the Clinic Regarding?
You should contact your surgeon or clinic immediately if you notice:
Increasing redness, swelling, or drainage from the wound.
Persistent or worsening pain not controlled by medication.
Fever, chills, or night sweats.
Numbness, tingling, or weakness that does not improve after the nerve block wears off.
Any acute injury or sudden movement causing severe pain or loss of shoulder function.
When Can I Return to Normal Activities After Anatomic Total Shoulder Replacement?
Recovery time varies depending on your shoulder condition and progress. As a general guide:
Light daily activities: Immediately, using your non-operated arm.
Desk or computer work: 2–3 weeks, if comfortable.
Shoulder movement: Gentle passive exercises begin early, with active movement typically starting around 6 weeks.
Strengthening: Usually begins at 6–12 weeks post-surgery.
Heavy lifting or high-impact activities: Not recommended, as these may shorten the lifespan of the implant.
When Can I Drive?
You can usually drive once you can safely control the steering wheel and perform emergency manoeuvres comfortably. This is typically around 6–8 weeks after surgery. You must not drive while taking strong pain medication (e.g. opioids).
When Can I Return to Work?
Return to work depends on your occupation:
Office or sedentary work: 2–3 weeks, once you can commute safely.
Light manual work: 6–10 weeks.
Heavy manual labour or overhead work: Not recommended due to implant wear and the risk of component loosening.
Should I See a Physiotherapist?
Physiotherapy is recommended for optimal recovery after anatomic total shoulder replacement. Your physiotherapist will:
Guide you through a staged rehabilitation program focusing on range of motion, strength, and shoulder stability.
Progress exercises gradually to restore functional use of the arm and improve endurance.
Ensure safe return to daily and recreational activities.
Most patients continue physiotherapy for 4–6 months to achieve their best outcome.
What Are the Complications After an Anatomic Total Shoulder Replacement Procedure?
Potential complications include:
Infection or wound healing problems.
Stiffness or loss of shoulder motion.
Loosening or wear of implant components over time.
Nerve or blood vessel injury (axillary nerve, cephalic vein, musculocutaneous nerve).
Rotator cuff failure or tear (progression of rotator cuff tears or failure of subscapularis repair to heal).
Failure of implants.
DVT/PE – very rare.
Poor positioning of implants.
Fracture of the humerus or glenoid during or after surgery.
Instability or dislocation of the prosthesis.
Persistent pain or weakness.
Complications from anaesthetic or nerve block (nerve toxicity, temporary numbness, shortness of breath, or rarely pneumothorax).
