ORTHOPEDICS + SPORTS MEDICINE
Total Shoulder Replacement
Resurfacing the arthritic shoulder to relieve pain and rebuild dependable overhead reach.
Shoulder arthritis can gradually turn ordinary movements into painful challenges. Reaching overhead, getting dressed, combing your hair, fastening a seat belt, or sleeping on the affected side may become increasingly difficult as the joint surfaces wear down.
Total shoulder replacement, also called total shoulder arthroplasty or anatomic shoulder replacement, replaces the damaged surfaces of the shoulder while maintaining its natural ball-and-socket arrangement. The procedure may reduce pain, improve motion, and help patients return to daily activities when conservative treatments are no longer effective.
Anatomy of the Shoulder
The shoulder is formed by three bones: the humerus, scapula, and clavicle. The rounded head of the humerus acts as the ball of the joint, while a shallow portion of the scapula called the glenoid forms the socket.
Articular cartilage covers the surfaces of the humeral head and glenoid. This smooth tissue helps the bones move against one another with minimal friction. Arthritis causes the cartilage to thin and break down, eventually exposing the underlying bone.
The rotator cuff is a group of muscles and tendons that surrounds the joint. It helps stabilize the shoulder and keeps the humeral head centered in the socket as the arm moves. A functioning rotator cuff is an important consideration when determining whether an anatomic total shoulder replacement is appropriate.
Conditions Treated With Total Shoulder Replacement
Total shoulder replacement is most often performed for advanced arthritis that affects both sides of the shoulder joint. Common reasons for considering the procedure include:
- Osteoarthritis
- Rheumatoid or inflammatory arthritis
- Post-traumatic arthritis
- Osteonecrosis of the humeral head
- Certain severe shoulder fractures
- Joint damage following a previous injury
Arthritis does not always begin as severe pain. Early symptoms may include stiffness, reduced motion, aching after activity, or discomfort at night. As the cartilage continues to deteriorate, pain may occur with smaller movements or remain present even when the arm is resting.
Treatment Before Shoulder Replacement
Nonsurgical care is generally recommended before shoulder replacement. The treatment plan depends on the cause and extent of the joint damage and may include:
- Modifying activities that aggravate the shoulder
- Physical therapy
- Anti-inflammatory or pain medication
- Corticosteroid or other injections
- A home exercise program
These treatments cannot restore cartilage that has been lost, but they may help reduce symptoms and maintain shoulder function. Surgery may be discussed when pain and stiffness continue despite appropriate conservative care or when shoulder limitations substantially affect sleep, work, independence, or recreation.
How Total Shoulder Replacement Is Performed
During an anatomic total shoulder replacement, the damaged humeral head is removed and replaced with a metal ball. The worn surface of the glenoid is prepared and fitted with a smooth socket component.
The replacement components are selected and positioned according to the patient’s bone structure and shoulder anatomy. The surgeon also evaluates the rotator cuff and balances the surrounding soft tissues to support joint stability and movement.
The procedure is designed to:
- Recreate the natural ball-and-socket arrangement
- Restore smooth joint surfaces
- Improve alignment and stability
- Preserve healthy bone when possible
- Support more comfortable shoulder movement
The amount of bone removed and the method used to secure the components depend on the patient’s anatomy, bone quality, and extent of joint damage.
Total Shoulder Replacement vs. Reverse Shoulder Replacement
Anatomic and reverse shoulder replacements both replace damaged joint surfaces, but they arrange the components differently.
An anatomic total shoulder replacement keeps the ball on the upper-arm side and the socket on the shoulder-blade side. It relies on a functioning rotator cuff to stabilize and move the shoulder.
A reverse shoulder replacement places the ball on the shoulder-blade side and the socket on the upper-arm side. This changes the mechanics of the joint so the deltoid muscle can contribute more to lifting the arm. It may be considered when the rotator cuff is severely damaged, a complex fracture is present, or another shoulder replacement has failed.
The surgeon determines which configuration is more appropriate after evaluating the rotator cuff, bone quality, pattern of arthritis, and overall condition of the shoulder.
Preparing for Surgery
Before recommending shoulder replacement, the surgeon reviews the patient’s symptoms, medical history, previous treatments, and activity goals. X-rays are used to evaluate arthritis, bone loss, alignment, and changes in the shape of the joint. An MRI or CT scan may also be ordered when more information is needed about the rotator cuff or bone structure.
Patients receive instructions for preparing for surgery. These may include reviewing medications and supplements, completing medical clearance, stopping nicotine use, and arranging for help at home during the early recovery period.
Because use of the surgical arm will be limited, it can be helpful to prepare loose-fitting clothing and place frequently used household items within easy reach.
Recovery and Physical Therapy
The arm is typically supported in a sling after surgery while the incision and soft tissues begin to heal. Patients receive specific instructions for using the arm, caring for the incision, sleeping, bathing, and completing basic tasks.
Physical therapy is an important part of recovery. Rehabilitation progresses gradually, often beginning with protected or assisted motion. Active movement and strengthening are added as the shoulder heals.
Therapy may focus on:
- Protecting healing tissue
- Reducing stiffness
- Restoring shoulder motion
- Improving strength and control
- Returning safely to daily activities
Recovery varies from person to person. Light activities may resume earlier, while lifting, strenuous work, sports, and other demanding activities require additional healing and clearance from the surgeon.
Risks and Considerations
As with any surgery, total shoulder replacement has potential risks. These can include infection, bleeding, blood clots, nerve or blood vessel injury, stiffness, instability, fracture, component wear or loosening, and the possibility of another operation in the future.
A shoulder replacement may improve pain and function, but outcomes cannot be guaranteed. The condition of the bone and rotator cuff, overall health, activity level, and participation in rehabilitation can all influence recovery.
When to See a Shoulder Specialist
A shoulder replacement consultation may be appropriate when arthritis causes persistent pain, stiffness, or loss of motion that limits daily life.
Signs that it may be time for an evaluation include:
- Pain that interrupts sleep
- Difficulty reaching overhead or behind the back
- Trouble dressing, grooming, or driving
- Grinding or catching within the joint
- Pain that continues while resting
- Limited improvement with nonsurgical treatment
Summary
The decision to have total shoulder replacement is based on more than the appearance of arthritis on an X-ray. The condition of the rotator cuff, the pattern of cartilage loss, the patient’s symptoms, and the activities they hope to resume all help determine the appropriate treatment.
Dr. Christopher Sforzo and Dr. Christopher Dillingham are board-certified and fellowship-trained orthopedic surgeons who treat shoulder arthritis and complex shoulder conditions. Contact Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine to schedule a shoulder evaluation and discuss your options.