Shoulder Replacement

In a shoulder replacement your surgeon removes the worn ball at the top of the arm bone and replaces it with a metal head on a stem set into the bone, and resurfaces the shallow socket on the shoulder blade with a plastic component.

There are two designs, and the difference between them is fundamental. An anatomic replacement reproduces the normal layout, with the ball on the arm bone and the socket on the shoulder blade. A reverse replacement swaps them, placing the ball on the shoulder blade and the socket on the arm, which changes the mechanics so that the large deltoid muscle over the outside of the shoulder lifts the arm. Your surgeon chooses between them from your scans, the condition of the tendons and bone, and what you need the arm to do.

The shoulder is not a weight-bearing joint, so the implant is not loaded in the way a hip or knee is. What it is sensitive to is heavy lifting and repeated overhead work, and your surgeon will set lifting limits that apply permanently instead of only during recovery.

The operation is done under a general anaesthetic, almost always combined with a nerve block in the neck or shoulder that numbs the arm for the first twelve to twenty-four hours. That block does most of the work of keeping the first night comfortable, and your arm will feel heavy and useless until it wears off, which is expected.

You are positioned in a semi-sitting posture with the head supported. Your surgeon makes an incision at the front of the shoulder, works between the muscle planes to reach the joint, removes the worn surfaces, prepares the bone and implants the components, testing the stability and range before closing. The operation usually takes ninety minutes to two hours.

This is an Inpatient procedure with a stay of one to two nights. You wake in a sling, and a physiotherapist will see you before you leave to show you how to manage dressing, sleeping and the gentle movements permitted in the first weeks. Sleeping flat is uncomfortable at first, and most people spend the first two to three weeks propped up or in a reclining chair, so arrange that before you come in.

The sling stays on for four to six weeks, coming off only for the exercises you are given and for washing. During that period you may use the hand and elbow for light tasks at waist level with the arm kept close to the body.

Physiotherapy runs in stages and is what determines the result. Passive movement, where the therapist or your other hand moves the arm, comes first. Active movement follows at around six weeks, and strengthening usually begins at around three months. Rushing that sequence risks the repair of the tissues that were divided to reach the joint.

Driving is usually possible at around six weeks once the sling is off and you can control the wheel. Desk work is realistic within two to three weeks if you can work one-handed, and manual or overhead work takes three to six months. Movement and strength continue improving for a full year. Your surgeon will give you a permanent limit on how much weight to lift with that arm, commonly in the range of a few kilograms for the reverse design.