- Type
- Major joint arthroplasty
- Anaesthesia
- General + regional block
- Hospital stay
- 1 night
- Sling
- 4–6 weeks
- Driving
- 6 weeks
- Implant survival
- >95% at 10 years
What it is.
An anatomic total shoulder replacement (anatomic TSA, or aTSA) is a major joint replacement procedure for end-stage glenohumeral arthritis. Both surfaces of the joint — the humeral head (ball) and the glenoid (socket) — are replaced. The operation preserves the natural geometry of the shoulder: the artificial ball sits on top of the humerus, and the artificial socket replaces the worn glenoid. It is the right operation when the rotator cuff is intact and functioning.
How it is performed.
The operation is performed under general anaesthesia with an interscalene regional block. A deltopectoral approach (incision along the front of the shoulder) provides access without dividing the deltoid muscle. The worn humeral head is removed and the glenoid is exposed.
The glenoid is the most technically demanding component of the operation. Dr Coory plans the glenoid component pre-operatively using a CT scan converted to a 3D model, and prepares the bone using robotic or CT-navigated guidance to match the plan. The glenoid component is cemented in.
The humeral side is then prepared. A stemmed or stemless metal component is implanted, depending on the patient's bone quality and anatomy. The shoulder is reduced and the soft-tissue tension is checked. The wound is closed in layers with a buried subcuticular suture.
Recovery timeline.
Day 0–1
- Regional block lasts 12–18 hours.
- Sling fitted; discharge home usually the next morning.
- Inpatient physiotherapy begins pendulum and passive movements.
Week 1–6
- Sling worn for 4–6 weeks for cuff protection (the rotator cuff is preserved in anatomic TSA and must be allowed to heal undisturbed).
- Passive and active-assisted range of motion under your physiotherapist.
- No driving. No lifting more than a kilogram.
Week 6–12
- Sling removed. Active range of motion progresses.
- Driving resumed. Light daily activities resumed.
Month 3–12
- Strengthening commences under your physiotherapist.
- Most activities resumed. Final outcome generally reached at 12 months.
Outcomes.
Anatomic TSA produces reliable and substantial pain relief in well-selected patients. Functional improvement is consistent over the first year. Australian National Joint Replacement Registry survivorship for anatomic TSA exceeds 95% at 10 years.1 The most common reasons for revision over the long term are glenoid component loosening or wear and, in some patients, a late rotator cuff failure.
Rehabilitation protocol.
A written copy of this protocol is provided to your physiotherapist on the day of surgery. The timeline below is a guide — progression is based on clinical milestones, not the calendar alone.
Weeks 0–1 — immediate post-operative
- Sling at all times except during prescribed exercises.
- Ice and heat as directed for pain and swelling management.
- Pendular (Codman’s) exercises to maintain gentle movement.
- Hand-to-mouth movements permitted.
- Active range of motion for elbow, wrist and hand.
Weeks 1–6 — early rehabilitation
- Active-assisted forward flexion using pulleys.
- Progress toward full active forward flexion if scapula control is adequate.
- Hand behind back (HBB) stretching with a stick.
- External rotation with a stick in adduction.
- Wall walking in the shower for overhead range.
- Continue sling use between exercise sessions.
Weeks 6–14 — strengthening
- Wean off sling.
- Strengthening with emphasis on scapula stabilisers, external rotation and abduction at 90/90.
- Encourage full active range of motion in all planes.
- Proprioceptive and functional rehabilitation.
Week 14 onwards — unrestricted activity
- Full unrestricted activities permitted.
- Continue strengthening as required.
- No specific limitations from this point.
View the recovery roadmap for the full five-phase journey, or visit For Physiotherapists to request protocols directly.
Frequently asked questions.
Anatomic or reverse — what's the difference?
Anatomic preserves the natural ball-and-socket geometry and is used when the rotator cuff is intact. Reverse swaps the ball and socket and is used when the cuff is torn or deficient — the deltoid does the lifting instead.
How long does an anatomic shoulder replacement last?
Australian registry data show implant survivorship above 95% at 10 years. Modern designs are expected to last considerably longer.
Will I get full motion back?
Most patients regain functional motion — comfortable overhead and behind-the-back reach. The pain relief is more reliable than the final motion.
How long in hospital?
One night is typical for anatomic shoulder replacement.
Is robotic planning used for anatomic shoulder replacement?
No. The Mako shoulder platform is currently approved for reverse total shoulder replacement only. Anatomic total shoulder replacement is performed with conventional, well-validated instrumentation — supplemented by CT-based 3D pre-operative planning in selected cases, particularly where the glenoid is worn or deformed.
References.
- Australian Orthopaedic Association National Joint Replacement Registry. Shoulder Arthroplasty Annual Report. Adelaide: AOA; 2024.
- Walch G, et al. Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis: long-term outcomes. J Shoulder Elbow Surg. 2012;21(11):1526–1533.