Reverse Total Shoulder Replacement
How Is Reverse Total Shoulder Replacement Performed?
Reverse total shoulder replacement is a surgical procedure performed to treat severe shoulder arthritis, irreparable rotator cuff tears, rotator cuff arthropathy or complex fractures that cannot be repaired. In this operation, the normal ball-and-socket structure of the shoulder joint is reversed: a metal ball component is attached to the shoulder blade (glenoid), and a socket component is fixed to the upper arm bone (humerus). This reversal allows the deltoid muscle to move the arm instead of the damaged rotator cuff, improving stability and function. The procedure is performed under general anaesthesia, often using a combination of nerve blocks for pain control.
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 approximately 2–6 weeks.
Range of motion: Passive shoulder motion begins under physiotherapist supervision. Active movement and strengthening are gradually introduced over several 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 a Reverse 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 reduce discomfort and strain on 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 resulting in severe pain or loss of function.
Prompt review allows early management of potential complications.
When Can I Return to Normal Activities After Reverse Total Shoulder Replacement?
Recovery time varies depending on individual progress and the condition of the shoulder. As a general guide:
Light daily activities: Immediately, using your non-operated arm.
Shoulder movement: Gentle passive exercises begin early. Active range of motion starts at 2–4 weeks.
Strengthening: Typically begins around 6 weeks post-surgery.
Heavy lifting: Not recommended due to the risk of damaging 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: 6–12 weeks.
Heavy manual labour or overhead work: Not recommended, as the implant is not designed to withstand repetitive heavy lifting. This can reduce the longevity of the implant.
Should I See a Physiotherapist?
Physiotherapy is recommended for optimal recovery after reverse total shoulder replacement. Your physiotherapist will:
Guide you through a progressive rehabilitation program focusing on safe range of motion, deltoid activation, and gradual strengthening.
Help restore shoulder function and adapt movement patterns to protect the joint long-term.
Most patients continue physiotherapy for 4–6 months to achieve the best functional outcome.
What Are the Complications After a Reverse Total Shoulder Replacement Procedure?
Potential complications include:
Infection or wound healing issues.
Dislocation or instability of the shoulder prosthesis.
Fracture of the humerus, scapula, or acromion.
Nerve injury/stretching or temporary numbness.
Loosening or wear of the prosthetic components over time.
Shoulder stiffness or loss of motion.
DVT/PE – very rare.
Persistent pain or weakness.
Poor positioning of implants.
Cosmetic deformity of the shoulder/arm.
Numbness around the incision.
Failure of the implant.
Complications related to the anaesthetic block (nerve toxicity, temporary numbness, shortness of breath, or rarely pneumothorax).
