Follow-Up After Shoulder Replacement: The Check-Ups, the X-Rays, Dental Work, and Looking After It for Life

A shoulder replacement is followed for years, not weeks: most surgeons review it several times in the first year, commonly at the wound check, around six weeks, around three months, and at one year, and then at longer intervals with X-rays, because some of the ways a replacement can fail are silent at first.¹ Looking after it for life also means treating infections elsewhere promptly, knowing what to tell your dentist, and recognising the handful of changes that are worth an earlier call.

At my one-year review I half expected to be told I was done. Instead I was told I would be “on the books” for the long haul, which I took as bad news until the surgeon explained why. This is the plain account of what the check-ups are for, what the X-rays look for, how dental work and other infections fit in, and when not to wait for the next appointment, checked line by line by a consultant shoulder surgeon. The recovery months that come first are in the week by week recovery.

The first year of check-ups

The first year of reviews tracks recovery: the wound, the return of movement, and the progress of physiotherapy, with an X-ray to confirm the components are where they should be.² Schedules vary between surgeons and hospitals, but a common pattern is a wound check at about two weeks (often with a nurse or GP practice), a surgical review at about six weeks when the sling usually comes off, another at three months, and one at a year.

Each has a slightly different purpose. The early ones are about the wound healing cleanly and the arm moving as expected for the stage. The three-month review often marks the shift towards strengthening, and is where stiffness or a slower than expected recovery is picked up. The one-year review is when most of the final result has arrived; pain usually settles first, and the shoulder can keep gaining strength and movement for many months.² Taking a list of questions to each one makes them far more useful, and the physiotherapy guide explains what the rehab should look like between them.

Long-term X-rays and what they look for

After the first year, reviews become less frequent but often continue for many years, usually with X-rays, because loosening, wear, and bone changes around the implant can develop before you feel anything.¹ Some surgeons see patients every year or two; others ask them to return at set milestones or simply to get in touch if anything changes. Your surgeon will say which.

The films are compared over time. Around an anatomic total replacement, the commonest long-term concern is the plastic socket component loosening from the bone, which was the main reason for revision in a 2025 series of anatomic replacements followed for nearly ten years.³ Around a reverse, surgeons also look for scapular notching, a slow wear of the shoulder blade below the socket component that is common and usually harmless but worth tracking, explained in scapular notching after reverse shoulder replacement. In long-term reverse series, function in some studies begins to decline after about 6 to 8 years, with ageing, loosening, and notching among the factors thought to contribute.⁴ A single picture means little; the direction of travel across several is what decides whether anything needs doing.

Why infections elsewhere matter

Infection in a joint replacement usually appears early, but it can occur years later, because bacteria from an infection anywhere in the body can travel through the bloodstream and settle on the implant.² Minor wound infections are usually treated with antibiotics; a deep infection around the prosthesis may need further surgery, sometimes removal of the implant.

The practical upshot is simple. Infections of the skin, chest, urine, teeth, or anywhere else deserve prompt treatment rather than being left to run, and it helps to tell any doctor treating you that you have a joint replacement. Infection affects roughly 1 in 100 primary shoulder replacements overall, somewhat more after a reverse, and the full account of what it means is in shoulder replacement infection.

Dental work and antibiotics

Current American Dental Association guidance says that, in general, prophylactic antibiotics are not recommended before dental procedures for people with prosthetic joint implants, based on a systematic review that found no association between dental procedures and joint infections.⁵ For most people, a filling or a scale and polish needs no special preparation beyond telling the dentist about the replacement.

There are exceptions, and they are individual. The ADA says decisions about dental timing and the rare use of antibiotics should be shared between the dentist, the orthopaedic team, and the patient, rather than routine, and that where antibiotics are thought necessary the orthopaedic surgeon is best placed to recommend them.⁵ People with a history of complications with their joint, or with other conditions that lower resistance to infection, are the ones for whom that conversation matters. Good dental health in general is worth keeping up, since a neglected infected tooth is exactly the kind of infection elsewhere that should not be left. Some surgeons in the UK and elsewhere have their own local advice, so ask yours once and write the answer down.

Knowing your implant

It is worth keeping a record of which operation you had, the date, the hospital, and the implant details, because they matter if the shoulder ever needs attention somewhere other than where it was done.⁶ In the UK, shoulder replacements are recorded in the National Joint Registry, which tracks how implants perform over time, and many hospitals give patients a card or sticker with the implant details.

A typed note in a drawer is enough: the side, total or reverse or partial, the date, the hospital, the surgeon, and the implant name if you were given it. If you have it done abroad, ask for the operation note and implant details in writing before you leave, because chasing them later is hard; the wider follow-up questions for surgery abroad are in shoulder replacement abroad. A metal implant may set off airport security, and while staff are used to it, the card can save explaining.

When not to wait for the next review

The signs that justify an earlier review are change rather than baseline: new pain in a shoulder that had become comfortable, pain at night returning, a loss of movement or strength, a clunk or a sense of the joint slipping, swelling, redness, warmth, or a fever.² A fall onto the arm also deserves a call even if it feels fine afterwards, because a fracture around the implant is possible.

The common thread is that something is different from how the shoulder had settled. A shoulder that has always had some limit to reaching behind the back, especially a reverse, is not a new problem; a shoulder that could lift to the top shelf in spring and cannot in autumn is. Fever, spreading redness, or a hot, swollen joint is a same-day call rather than a wait for an appointment. Most replacements last well: a 2025 review of reverse replacements followed for at least 10 years found about 88% had not needed a revision at 10 years.⁴ The long-term follow-up exists so that the minority that do run into trouble are caught early, when the options are best; what longevity actually looks like is in how long does a shoulder replacement last.

I am now a few years past my one-year review, and the routine has become unremarkable: an X-ray, ten minutes with the surgeon, “nothing has changed.” I have come to see those ten minutes as cheap insurance. Your own schedule and what your X-rays show are for the surgeon who looks after your shoulder; this page can only explain why the appointments are worth keeping.