Total Shoulder Replacement
A total shoulder replacement is a procedure used to relieve pain and restore function in a shoulder that has been damaged by arthritis or other conditions.
During surgery, the worn-out ball-and-socket joint is replaced with smooth, artificial components. The damaged ball at the top of the upper arm bone is replaced with a metal ball attached to a stem going down the arm bone, or sometimes without a stem. The worn socket is resurfaced with a durable plastic implant that is often cemented into place. These new surfaces are designed to move smoothly together, reducing the painful bone-on-bone contact that causes stiffness and discomfort.
The goal of shoulder replacement is to help you return to everyday activities with less pain and better movement. Patients often go home the same day or the day after surgery. Most patients notice significant pain relief soon after surgery, while strength and motion continue to improve over several months with physical therapy and home exercises. Many patients are able to return to activities such as golfing, swimming, gardening, and other recreational pursuits once they have fully recovered.
Who May Benefit from a Standard Total Shoulder Replacement?
A standard (anatomic) total shoulder replacement may be a good option if you have ongoing shoulder pain, stiffness, and loss of function that has not improved with treatments such as medications, injections, physical therapy, or activity changes. It is most successful when the muscles and tendons around the shoulder (the rotator cuff) are still working well.
You may be a candidate if you have:
- Wear-and-tear arthritis (osteoarthritis) – The smooth cartilage in your shoulder has worn away over time, causing pain, stiffness, and grinding.
- Rheumatoid arthritis or other inflammatory arthritis – Arthritis caused by your immune system attacking the joints, leading to pain and joint damage.
- Arthritis after a shoulder injury – Damage from a previous fracture, dislocation, or other injury has led to arthritis over time.
- Loss of blood supply to the shoulder bone (avascular necrosis) – Part of the ball of the shoulder has been damaged because it did not receive enough blood flow.
- Arthritis after previous shoulder surgery – A prior shoulder procedure has resulted in pain, stiffness, or arthritis.
- Shoulder arthritis caused by repeated shoulder instability – Years of recurrent shoulder dislocations or looseness have worn out the joint.
- Failure of a previous partial shoulder replacement – A previous shoulder implant is no longer working well and needs to be converted to a full shoulder replacement.
- Long-term problems after a shoulder fracture – An old fracture has healed poorly or has caused arthritis and persistent pain.
- Less common causes of shoulder arthritis – Certain medical conditions can damage the shoulder joint and lead to severe arthritis.
The Best Candidates Usually Have:
- Significant shoulder pain that limits daily activities
- Pain that may interfere with sleep
- Stiffness and loss of shoulder motion
- X-rays showing advanced arthritis
- Symptoms that have not improved with non-surgical treatment
- Healthy shoulder muscles and tendons (especially the rotator cuff)
When a Different Type of Shoulder Replacement May Be Better
If the tendons that help lift and rotate your shoulder (the rotator cuff) are badly torn and cannot be repaired, a reverse total shoulder replacement is often a better option. Your surgeon will determine which type of shoulder replacement is best based on your examination, imaging studies, and overall shoulder function.
An ideal candidate for an anatomic standard total shoulder replacement has:
- End-stage glenohumeral arthritis
- An intact or reparable rotator cuff
- Adequate glenoid bone stock
- Functional deltoid muscle
- Realistic expectations and willingness to participate in postoperative rehabilitation
The key principle is that anatomic TSA requires a functioning rotator cuff, whereas reverse TSA is designed to compensate for rotator cuff deficiency by relying on the deltoid muscle to elevate the arm.
When It May Not Be Recommended
A shoulder replacement can provide excellent pain relief and improved function for many people. However, there are certain situations where surgery may not be safe or may not provide a good result. In some cases, these conditions can be treated first, making shoulder replacement possible at a later time.
You may not be a candidate for shoulder replacement if you have:
- An active infection – An infection anywhere in your body, especially in or around the shoulder, must be treated before a shoulder replacement can be safely performed.
- A severe shoulder infection in the past that has not been fully cleared – Persistent or recurrent infections increase the risk of infection after joint replacement.
- Poor overall health that makes surgery unsafe – Serious heart disease, lung disease, or other medical conditions may make the risks of surgery outweigh the benefits.
- Poorly controlled diabetes or other medical conditions – These conditions can increase the risk of infection and slow healing. Improving your health before surgery can reduce these risks.
- Severe nerve damage affecting the shoulder or arm – If the nerves that control the shoulder muscles are not functioning properly, a replacement may not restore useful movement.
- Weak or non-functioning shoulder muscles – Shoulder replacements rely on healthy muscles to move the arm after surgery.
- Severe bone loss – If there is not enough healthy bone to support the implants, additional procedures or a different treatment may be necessary.
- An inability to participate in rehabilitation – Physical therapy and home exercises are essential for a successful recovery. Patients who cannot safely participate may not achieve a good result.
- Unrealistic expectations – Shoulder replacement is designed to relieve pain and improve function, but it does not restore a shoulder to “new.” Heavy lifting, repetitive overhead work, and high-impact activities may still be limited.
- Poor skin or soft tissue around the shoulder – Healthy skin and soft tissues are important for proper healing and to reduce the risk of infection.
Conditions That May Delay Surgery Until They Are Improved
Some conditions do not permanently prevent shoulder replacement but should be addressed before surgery, including:
- Active smoking or nicotine use
- Obesity that significantly increases surgical risk
- Poor nutrition
- Uncontrolled high blood sugar (diabetes)
- Untreated dental infections or other infections elsewhere in the body
- Certain medications that increase the risk of infection or bleeding
Every Patient Is Different
Having one of these conditions does not automatically mean you cannot have a shoulder replacement. Many of these issues can be treated or improved before surgery. Your orthopedic surgeon will carefully evaluate your overall health, shoulder condition, and personal goals to determine whether shoulder replacement is the safest and most effective treatment option for you.
Total Shoulder Replacement Surgical Procedure
How a Standard Total Shoulder Replacement Is Performed
- Anesthesia is given – You are put to sleep with general anesthesia. A nerve block is often also used to numb the shoulder and help control pain during the first several hours after surgery.
- The surgeon reaches the shoulder joint – An incision is made over the front of the shoulder. The muscles are carefully moved aside so the surgeon can reach the ball-and-socket joint.
- A rotator cuff tendon is temporarily released – One of the tendons at the front of the shoulder is typically carefully opened or detached so the joint can be exposed. This tendon is repaired near the end of the operation.
- The damaged ball is removed – The worn-out ball at the top of the upper-arm bone is removed. The surgeon makes a precise cut so the new artificial ball will sit in the correct position.
- The upper-arm bone is prepared – The center of the upper-arm bone is carefully shaped to hold the new metal ball and implant.
- The damaged socket is prepared – The remaining worn cartilage is removed from the shoulder socket. The socket is then carefully smoothed and shaped to accept the new artificial surface.
- The new socket is inserted – A smooth plastic socket is secured to the shoulder blade, usually with special bone cement. This replaces the worn surface of the natural socket.
- The new ball and stem are inserted – A metal implant is placed into the upper-arm bone. This implant is sometimes a stem going down the arm bone or else a platform on top of the arm bone that the new ball can be secured to. A smooth metal ball is attached to the top of the implant to replace the damaged natural ball. If a stem is used, depending on the implant design and bone quality, the stem may be cemented or press-fit into the bone.
- The new joint is tested – The surgeon moves the shoulder through a range of motion to check the implant’s fit, stability, tension and movement. Adjustments can be made before the final parts are secured.
- The tendon is repaired – The rotator cuff tendon that was opened to reach the joint is securely repaired. Protecting this repair is an important part of the early recovery process.
- The incision is closed – The tissues and skin are closed with stitches, staples or surgical adhesive. A sterile dressing is placed over the incision.
- The arm is placed in a sling – The sling protects the shoulder while the tissues begin to heal. You are then taken to the recovery area, where the surgical team monitors you and begins pain control.
What the Replacement Does
The new metal ball moves against the smooth plastic socket, creating a new joint surface. The main goals are to reduce pain, improve shoulder movement and make everyday activities easier. Physical therapy and home exercises are then used to gradually restore motion and strength.
Shoulder Replacement Surgery Recovery
Many patients go home the same day or the day after surgery. While recovering, you may receive physical therapy to help keep the muscles around your shoulder from getting stiff, and your physical therapist will teach you how to move your arm safely using your other arm for support. Most patients notice significant pain relief soon after surgery, while strength and motion continue to improve over several months with physical therapy and home exercises. With proper activity modification and follow-up care, modern shoulder replacements can last 15 years or more.
Schedule Your Total Shoulder Replacement Consultation
If shoulder pain is limiting your mobility and quality of life, contact Midwest Orthopedic and Musculoskeletal Alliance today at 414-384-6700. Our orthopedic specialists in Southeastern Wisconsin are here to help.