Shoulder replacement surgery has become much more common in Johor over the past decade, split between two approaches: traditional total shoulder arthroplasty (TSA) for osteoarthritis with an intact rotator cuff, and reverse total shoulder arthroplasty (rTSA) for cuff-tear arthropathy or failed cuff repair.
The recovery arcs for the two are related but not identical - and the right rehab program is surgeon-specific and approach-specific.
Here's how the 12-month arc actually runs in Johor.
The two approaches - and why the rehab differs
Total shoulder arthroplasty (TSA) - anatomic replacement. The ball-and-socket joint is replaced in its natural orientation.
Needs a functional rotator cuff to work. Rehab prioritises cuff preservation and progressive range.
Reverse total shoulder arthroplasty (rTSA) - the ball-and-socket is inverted (ball on the scapula, socket on the humerus).
The deltoid takes over what the cuff used to do. Rehab prioritises deltoid strengthening and avoids positions that destabilise the prosthesis.
Don't guess which one your surgeon did - ask them, and get the precautions written on the discharge summary.
Weeks 0–6: sling and passive range only
Universal across both approaches. Sling worn continuously except for hygiene and prescribed exercises.
The surgeon's post-op protocol (usually issued at discharge) specifies:
- Passive external rotation limit - typically 30° for TSA, 0° for rTSA.
- No active arm lifting.
- No bearing weight through the arm (no pushing up out of a chair with that arm).
- Sleep in a semi-reclined position for the first 2–3 weeks.
JB rehab during this phase is minimal - mostly teaching the patient and family the passive range-of-motion routine and reinforcing the don'ts. 1 session per week, RM120-250 per session.
Weeks 7–12: active-assisted to active range
The sling comes off between week 6 and week 8 depending on surgeon preference. Rehab content shifts to active-assisted range, then active range without weight.
Typical milestones:
- Week 8: 90° active forward elevation, 60° external rotation (TSA) or 20° (rTSA).
- Week 10: 120° forward elevation, reaching for objects at table height.
- Week 12: 140–150° forward elevation, starting light resistance band work for TSA; rTSA still no resistance.
Frequency: 2 sessions per week. Home program three times daily.
Weeks 13–24: progressive strengthening
Resistance work begins.
TSA pathway focuses on cuff-and-scapular strength with progressive band and light dumbbell work. rTSA pathway focuses on deltoid and periscapular strength with specific avoidance of heavy loaded external rotation.
- Week 16: loaded scaption (TSA: 1–2 kg; rTSA: 0.5–1 kg), reaching overhead for light tasks.
- Week 20: loaded external rotation (TSA only), pushing and pulling light objects, return to driving if surgeon clears.
- Week 24: full functional reach, most daily activities restored, sleep on the operated side beginning to feel normal.
Months 7–12: return to activity
From month 7 the patient returns to the pre-surgical activity profile the surgeon has cleared.
For most TSA patients that means golf, swimming, yoga, and light gym work.
For rTSA patients the ceiling is lower - no heavy overhead lifting, no aggressive throwing, no chin-ups.
Recreational golf is usually fine for both.
Typical RM costs in Johor
Post-shoulder-replacement rehab in Johor runs RM120-250 per session.
The full 24-week course is typically 35–45 sessions, total RM120-250.
The 6–12 month maintenance phase adds another 8–15 sessions. Total course cost is roughly one-third to half of the SG private-clinic equivalent.
How PhysioJohor matches shoulder replacement patients
WhatsApp us with: which hospital and surgeon, approach (TSA or rTSA), side operated, week post-surgery, and JB location.
We match to a physio with specific shoulder arthroplasty experience - these protocols are unforgiving of guesswork - and run the surgeon's written protocol without deviation.
Related guide: Post-surgery rehab in Johor