After a shoulder replacement performed with my technique, there is no sling and no immobilisation. You go home the same day or the next day, you use your arm for everyday tasks from day one, you can drive again immediately, and rehabilitation lasts three to four months with three physiotherapy sessions a week.
This page describes what to expect, week by week, after a shoulder replacement. It applies to the anatomic replacement as well as to the reverse replacement, and the differences between the two are pointed out wherever they exist.
The operation takes between forty-five minutes and one hour. The incision is about eight centimetres long.
The stay is day surgery, meaning you come in and go home the same day, or it involves a single night in hospital. The choice depends on the time of your operation, on your general health and on who is at home with you. We decide it together in consultation, not at the last minute.
You go home with a prescription for painkillers, your physiotherapist's contact details, the date of your first follow-up appointment and a number to call if you have any doubt. A nurse changes the dressing at home.
There is real pain in the first few days, then it fades quickly. It is usually well controlled by the painkillers prescribed when you leave.
What often surprises patients is that the pain that brought them to see me, the arthritis pain, disappears the moment they are operated on. What they feel afterwards is healing pain, which is a different thing and which comes to an end.
Take your painkillers at the scheduled times rather than waiting for the pain to come back. It works better and it lets you do your rehabilitation in good conditions.
No. I do not prescribe a sling and I do not immobilise the shoulder.
The reason is technical. When I fit the implant, I do not detach the muscles. The subscapularis, the tendon that the conventional approach cuts and then repairs, stays intact. So there is nothing to protect while a tendon heals, and nothing that justifies locking the shoulder.
This is the most visible difference for you between this technique and techniques that require three to six weeks in a sling. A shoulder that moves from day one does not stiffen up, and does not have to be loosened afterwards.
There is no forbidden position, in the sense that no single movement would make the implant come out. The principle is a gradual one: you do what your shoulder accepts, you increase it each week, and you let pain and your physiotherapist guide you.
Eating, writing, using your phone, getting dressed, washing, opening a door, holding a glass. Every everyday movement made with the elbow close to the body is allowed immediately, and I ask you to make them rather than protect the arm.
A shoulder that is spared becomes stiff. That is the most common trap of the first few weeks, and it costs far more to put right than a little discomfort at the start.
Pushing up on the operated arm to get out of an armchair or out of bed, pulling on it, or making a sudden, uncontrolled movement. These are not absolute bans, they are stresses that the bone around the implant has no reason to take just yet.
Also avoid sleeping on the operated shoulder while it is still painful, and avoid putting your weight on that side with a walking stick or a crutch.
Light everyday objects can be carried straight away. For heavier loads, the rule is a gradual one and we decide it together at your follow-up appointments, depending on what the X-ray shows and on the quality of your bone.
A shoulder replacement is not designed to carry heavy loads repeatedly over many years. It is not a question of immediate risk, it is a question of how quickly the implant wears out in the long run.
Rehabilitation lasts three to four months in total, with three sessions a week. It starts as soon as you get home.
Three sessions a week is the rhythm that gives the best results. Two sessions are rarely enough to hold on to your gains from one week to the next during the first two months.
Between sessions, you do the exercises your physiotherapist shows you on your own, several times a day, for a few minutes at a time. That daily work counts as much as the sessions themselves.
In the first month, the work is on mobility: getting back elevation, external rotation and internal rotation, without forcing anything. Over the following months, the physiotherapist gradually adds strengthening of the muscles around the shoulder and work on coordination.
No forced manipulation is needed. A shoulder that has never been immobilised has no stiffness to break down.
Most of the recovery happens over the first three to four months. The shoulder then carries on gaining strength and ease until around one year, though less dramatically and without any need to continue physiotherapy for all that time.
You can drive again immediately. Because there is no sling and the arm is free, nothing stops you holding a steering wheel.
The only condition is common sense: do not drive while you are taking painkillers that affect alertness, and make your first trip a short one, in daylight, on a route you know, before going back on the motorway.
The first few nights are often the most uncomfortable part of recovery, more so than the days.
Sleep propped up in a half-sitting position against pillows, with a cushion under the elbow on the operated side to support the arm. Avoid lying on the operated shoulder while it is still painful. Most patients are sleeping normally again within two to three weeks.
For office work, most people go back after two to four weeks, sometimes sooner if they work from home. The shoulder is not immobilised, which makes screen work possible quickly.
For physical work, involving lifting or repeated movements above head height, allow three to four months, the time it takes to finish rehabilitation. We set the date together at a follow-up appointment, not in advance.
Walking, the exercise bike and road cycling start again early, as soon as your balance and your pain allow.
Swimming, golf and doubles tennis usually start again between the third and the sixth month, gradually, once agreed in consultation. Golf is a good example: you begin with putting, then short shots, then the full round.
Contact sports, climbing and heavy weight training above head height are not recommended after a shoulder replacement. These are not bans on principle, it is simply that these activities put the implant under stresses that shorten its life.
The figures that follow are those of my own practice. I perform around one hundred and fifty shoulder replacements a year.
The infection rate is one per cent. It is the most serious complication, because it often means further surgery. The signs that should make you call without waiting are a fever, a scar that turns red, hot or starts to weep, and pain that starts increasing again after having settled.
In primary cases, the dislocation rate is zero. That is a direct result of not detaching the muscles: the subscapularis, which is the front stabiliser of the shoulder, is never weakened. The risk does exist in revision surgery, when an existing implant is replaced.
This is the most common complication in the broad sense, and it is the one you have most influence over. It almost always comes from rehabilitation started too late or spaced too far apart, or from a shoulder the patient instinctively protects.
This is the implant gradually coming loose in the bone, after many years. It is the main reason a replacement is exchanged, and it is why regular X-ray follow-up is useful even when everything is going well.
The first check-up takes place a few weeks after the operation, with an X-ray. It confirms the position of the implant and lets us validate the progress of your rehabilitation.
The following check-ups are spaced further apart: at three months, at one year, then every year or every two years. These appointments are not a formality. Loosening picked up early is far easier to manage than loosening discovered because the pain has come back.
The full timetable is set out on the care pathway page.
You do not wear one at all. I do not prescribe a sling, because I do not detach the muscles during the operation. The shoulder moves from day one.
There is no movement that would make the implant come out. In the first few weeks, avoid pushing up on the operated arm to stand, avoid pulling on it and avoid sudden movements. Everything else comes back gradually, guided by pain and by your physiotherapist.
Three to four months in total, with three physiotherapy sessions a week, started as soon as you get home.
Immediately, as soon as you are no longer taking painkillers that affect alertness. There is no sling to get in the way of holding the steering wheel.
In a half-sitting position, propped against pillows, with a cushion under the elbow on the operated side. Avoid sleeping on the operated shoulder while it is still painful. Sleep is usually back to normal within two to three weeks.
Two to four weeks for office work, three to four months for physical work involving lifting or movements above head height.
Walking and cycling early on, swimming, golf and doubles tennis between the third and the sixth month once agreed in consultation. Contact sports and heavy weight training above head height are not recommended.
In primary cases with my technique, the dislocation rate is zero, because the subscapularis tendon that stabilises the shoulder is never cut. The risk exists only in revision surgery, when an existing implant is replaced.
The arthritis pain that brought you to see me disappears the moment you are operated on. What remains is healing pain, which fades over a few weeks and is controlled by painkillers.
A shoulder replacement is designed to last many years. Its lifespan depends above all on how it is used: heavy, repeated loading above head height wears it out faster. Regular X-ray follow-up picks up loosening long before it becomes a problem.
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