Shoulder Replacement

Procedures

Shoulder Replacement

Overview
Shoulder replacement surgery is a highly effective option for patients with severe shoulder arthritis, complex fractures, or chronic rotator cuff problems that lead to joint damage and pain. The procedure involves replacing the damaged parts of the shoulder with artificial components to restore motion, relieve pain, and improve quality of life. There are two main types of shoulder replacement: anatomic total shoulder replacement and reverse total shoulder replacement. The choice depends on the condition of the rotator cuff and the overall health of the shoulder joint.

Factors Influencing Outcomes
Several factors impact the success of shoulder replacement surgery:

  • Condition of the rotator cuff: An intact rotator cuff is important for an anatomic replacement, while a damaged rotator cuff often leads to the choice of a reverse replacement.

  • Severity of arthritis or bone loss: Significant damage to the joint surfaces or bone structure may affect the surgical approach.

  • Patient activity level and goals: Active patients with good bone quality often have excellent outcomes.

Anatomic Total Shoulder Arthroplasty
An anatomic total shoulder replacement closely replicates the natural anatomy of the shoulder. The ball (humeral head) is replaced with a smooth metal ball, and the socket (glenoid) is resurfaced with a durable plastic liner. This option is ideal for patients with:

  • Healthy rotator cuff tendons to move and stabilize the new joint.

  • Primary shoulder arthritis without significant bone loss.

  • Good bone quality to support the implants.

Anatomic replacement relies on the rotator cuff muscles and tendons to function properly. If the rotator cuff is healthy, this option provides excellent pain relief and restores natural shoulder movement.

Reverse Total Shoulder Arthroplasty
In a reverse total shoulder replacement, the normal ball-and-socket arrangement is reversed. A metal ball is placed where the socket was, and a plastic socket is placed where the ball of the humerus was. This design allows the deltoid muscle to power the shoulder, even if the rotator cuff is torn or nonfunctional.

Reverse shoulder replacement is often recommended for patients with:

  • Severe rotator cuff tears (called rotator cuff tear arthropathy).

  • Failed previous shoulder surgery.

  • Complex fractures of the shoulder.

  • Advanced arthritis with rotator cuff dysfunction.

Reverse replacement offers excellent pain relief and restores function for patients who otherwise could not rely on the rotator cuff.

The Procedure
Shoulder replacement surgery is performed under anesthesia, most often as an outpatient procedure or under observation status, allowing patients to return home the same day or after a brief overnight stay. Through an incision over the front of the shoulder, the damaged bone and cartilage are removed. The new components are securely placed to restore alignment and function. Depending on your specific needs, your surgeon will perform either an anatomic or reverse replacement.

Addressing Associated Issues
During shoulder replacement surgery, your surgeon will also address any other issues that could affect your recovery, such as:

  • Bone loss: Bone grafting or specialized implants may be used if there is significant bone loss.

  • Soft tissue balancing: Tight or loose tissues around the shoulder are adjusted to ensure proper movement of the new joint.

Recovery Process

  • Initial Phase (0–6 Weeks): The arm is placed in a sling. Physical therapy focuses on gentle range of motion exercises to prevent stiffness.

  • Intermediate Phase (6–12 Weeks): Therapy progresses to active motion and gentle strengthening exercises.

  • Advanced Phase (3–6 Months): Therapy continues with more advanced strengthening and functional activities.

  • Full Recovery: Most patients experience significant improvements in pain and motion by 3–6 months, with continued improvements up to one year.

Risks and Considerations

  • Infection, which is rare but serious.

  • Nerve injury or blood vessel injury (rare).

  • Dislocation of the new joint, especially in reverse replacements.

  • Wear or loosening of implants over time.

  • Need for revision surgery in the future.

  • Risk of stiffness if post-operative exercises are not followed.

  • Potential bone loss requiring special implants or bone grafting.

Conclusion
Shoulder replacement surgery is an excellent solution for patients with advanced shoulder arthritis, complex fractures, or severe rotator cuff damage. Whether an anatomic or reverse replacement is right for you depends on your shoulder’s unique condition. Our goal is to relieve pain, restore function, and help you return to the activities you enjoy. Contact our office for a full evaluation and personalized treatment plan.