Shoulder Replacement Surgery: A Complete Guide

Key Takeaways

• Shoulder replacement effectively relieves pain and restores function for severe shoulder arthritis
• Two main types: anatomic (traditional) and reverse shoulder replacement
• Reverse replacement is ideal when the rotator cuff is damaged or absent
• Recovery takes 3-6 months, with continued improvement for up to a year
• Physical therapy is essential for regaining strength and motion
• Success rates exceed 90% for pain relief in appropriate candidates

Shoulder replacement surgery has come a long way. While not as common as hip or knee replacement, it’s highly effective for patients whose shoulder arthritis hasn’t responded to other treatments.

This guide covers everything you need to know about shoulder replacement options.

Understanding Shoulder Anatomy

The Shoulder Joint

Your shoulder is a ball-and-socket joint:

• Ball (humeral head): Top of the upper arm bone
• Socket (glenoid): Part of the shoulder blade
• Rotator cuff: Four muscles that stabilize and move the shoulder
• Labrum: Ring of cartilage around the socket

Why the Rotator Cuff Matters

Unlike the hip (a deep socket), the shoulder socket is shallow. The rotator cuff muscles are critical for:

• Keeping the ball centered in the socket
• Powering arm movement
• Stabilizing the joint

When these muscles are damaged, traditional replacement may not work well.

Types of Shoulder Replacement

Anatomic (Traditional) Shoulder Replacement

How it works:

• Replaces the ball with a metal ball
• Replaces the socket with a plastic cup
• Maintains normal shoulder anatomy
• Ball stays on the arm bone, socket on the shoulder blade

Best for:

• Intact rotator cuff muscles
• Severe arthritis with preserved muscle function
• Younger patients when possible

Reverse Total Shoulder Replacement

How it works:

• Reverses the ball and socket positions
• Metal ball attached to the shoulder blade
• Plastic socket attached to the arm bone
• Relies on the deltoid muscle instead of rotator cuff

Best for:

• Damaged or absent rotator cuff
• Failed previous shoulder replacement
• Complex fractures in older patients
• Arthritis with massive rotator cuff tear

Partial Shoulder Replacement (Hemiarthroplasty)

How it works:

• Replaces only the ball (humeral head)
• Leaves the natural socket
• Simpler procedure

Best for:

• Certain fractures
• Limited to ball-side disease
• Younger patients (sometimes)

Why the Reverse Design?

The Problem with Traditional Replacement

When the rotator cuff is damaged:

• The ball can’t stay centered in the socket
• Arm elevation becomes difficult or impossible
• Traditional replacement fails to restore function

The Reverse Solution

By reversing the ball and socket:

• The deltoid muscle (on the outside of the shoulder) takes over
• The ball is now fixed (on the shoulder blade)
• Arm elevation becomes possible without rotator cuff

A Transformative Innovation

Before reverse shoulder replacement:

• Patients with rotator cuff tears and arthritis had few options
• Results of traditional replacement were poor
• Many patients remained significantly disabled

Now, reverse replacement offers:

• Reliable pain relief
• Restored ability to lift the arm
• Return to daily activities

Are You a Candidate?

Common Indications

For anatomic replacement:

• Severe osteoarthritis with intact rotator cuff
• Rheumatoid arthritis
• Post-traumatic arthritis
• Avascular necrosis
• Failed conservative treatment

For reverse replacement:

• Rotator cuff tear arthropathy
• Massive irreparable rotator cuff tears
• Failed prior shoulder replacement
• Certain complex fractures
• Severe arthritis with rotator cuff deficiency

Not a Candidate If

• Active infection
• Absent deltoid muscle function
• Certain nerve injuries
• Unable to participate in rehabilitation
• Unrealistic expectations

Age Considerations

• No strict age limit
• Younger patients: Concern about implant longevity
• Older patients: May benefit from reverse design
• Individual factors matter more than age alone

Preoperative Evaluation

Imaging Studies

X-rays:

• Assess bone quality
• Show arthritis severity
• Evaluate bone loss

CT scan:

• 3D view of bone anatomy
• Planning for bone loss
• May be used for custom guides

MRI:

• Evaluates rotator cuff status
• Critical for choosing anatomic vs. reverse
• Assesses muscle quality

Medical Clearance

• Cardiac evaluation if needed
• Diabetes optimization
• Dental clearance (reduce infection risk)
• Medication review

The Procedure

Before Surgery

Day before:

• No food after midnight
• Shower with antibacterial soap
• Confirm ride home

Day of surgery:

• Arrive 1-2 hours early
• IV placement
• Anesthesia discussion
• Surgical site marked

Anesthesia

Options include:

• General anesthesia (asleep)
• Regional nerve block (numb the arm)
• Usually a combination

Nerve block benefits:

• Excellent pain control after surgery
• Reduces need for narcotic medication
• May last 12-24 hours

During Surgery

Typical steps:

1. Incision on front or side of shoulder
2. Exposure of the joint
3. Removal of damaged surfaces
4. Bone preparation
5. Implant placement
6. Closure and bandaging

Duration: 1-2 hours typically

Implant Options

Fixation:

• Cemented: Immediate stability
• Cementless: Bone grows into implant
• Surgeon chooses based on bone quality

Materials:

• Cobalt-chrome metal
• Titanium
• Polyethylene (plastic)
• Some with specialized coatings

Recovery Timeline

Hospital Stay

Typical:

• 1-2 nights (sometimes same-day discharge)
• Pain management established
• PT begins day 1
• Learn to put on sling

First 2 Weeks

What to expect:

• Arm in sling most of the time
• Gentle pendulum exercises
• Ice and elevation
• Pain medication as needed
• Wound care

Restrictions:

• No lifting
• No reaching
• Sleep in recliner or propped up
• Sling even during sleep

Weeks 2-6

Progress:

• PT sessions 2-3 times weekly
• Passive range of motion (therapist moves arm)
• Gradual weaning from sling
• Increasing comfort

Milestones:

• Sutures removed (2 weeks)
• Sling use decreasing
• Some active motion beginning

Weeks 6-12

Progression:

• Active-assisted motion
• Beginning to strengthen
• Weaning off sling completely
• Return to light activities

Typical abilities:

• Light household tasks
• Desk work
• Eating and grooming normally
• Driving (if off pain medication)

3-6 Months

Goals:

• Continued strengthening
• Improving range of motion
• Return to more activities
• PT may continue or transition to home exercises

6-12 Months

Full recovery:

• Maximum improvement often by 1 year
• Some continued strength gains possible
• Final range of motion established
• Return to recreational activities

Outcomes and Expectations

Pain Relief

• 90-95% achieve significant pain relief
• Most patients very satisfied
• Night pain typically resolves
• Function improves substantially

Range of Motion

Anatomic replacement:

• Often good to excellent motion
• May approach normal range
• Depends on preoperative status

Reverse replacement:

• Elevation typically improved
• Rotation may be limited
• Functional range achieved

Activity Level

Usually possible:

• Swimming
• Golf
• Doubles tennis (sometimes)
• Hiking
• Cycling

Generally avoid:

• Contact sports
• Heavy weightlifting
• Repetitive overhead work
• High-impact activities

Complications

General Surgical Risks

• Infection (1-2%)
• Blood clots
• Anesthesia complications
• Wound healing problems

Shoulder-Specific Risks

Instability/Dislocation:

• Higher with reverse (2-5%)
• May require revision
• Activity precautions reduce risk

Nerve injury:

• Usually temporary
• Numbness or weakness
• Most recover

Implant issues:

• Loosening over time
• Fracture around implant
• Component wear

Stiffness:

• May require manipulation
• PT crucial for prevention

Reverse-Specific Complications

• Scapular notching (bone erosion)
• Acromial stress fractures
• Instability

Implant Longevity

How Long Do They Last?

Anatomic replacement:

• 15-20+ years commonly
• 90%+ survival at 15 years

Reverse replacement:

• Newer procedure, less long-term data
• 10-15+ year survival excellent
• Continued design improvements

Revision Surgery

If replacement fails:

• Revision surgery possible
• More complex than first surgery
• Results typically good but not as good as primary

Cost and Insurance

Typical Costs

• Total charges: $25,000-$50,000+
• Surgeon fee: $3,000-$7,000
• Hospital stay: Major portion of cost
• PT: $1,500-$4,000 additional

Insurance Coverage

• Medicare covers when medically necessary
• Most private insurance covers
• Prior authorization often required
• Out-of-pocket varies by plan

Choosing a Surgeon

What to Look For

Volume and experience:

• Surgeons doing 25+ shoulder replacements yearly
• Higher volume associated with better outcomes
• Experience with both anatomic and reverse

Questions to ask:

• How many do you perform yearly?
• Which type do you recommend for me and why?
• What are your complication rates?
• What outcomes should I expect?

Frequently Asked Questions

How is shoulder replacement different from hip or knee?

The shoulder is more complex with greater range of motion demands. Recovery focuses more on regaining motion than weight-bearing. The rotator cuff status is a major consideration not present with hip/knee.

Why might I need a reverse instead of regular replacement?

If your rotator cuff is significantly damaged, a traditional replacement won’t work well—you won’t be able to lift your arm. Reverse replacement uses your deltoid muscle instead, allowing function without the rotator cuff.

When can I drive after surgery?

Typically 4-6 weeks, when you’re out of the sling and have adequate motion and strength. You must also be off narcotic pain medication. Always check with your surgeon.

Will I set off metal detectors?

Possibly. Carry your surgical card. Most airport security uses advanced scanners that don’t trigger for joint replacements, but be prepared to explain if needed.

Can I still do PT exercises at home or do I need ongoing therapy?

After formal PT ends (usually 3-4 months), you’ll transition to home exercises. Most patients continue a maintenance exercise program indefinitely to maintain strength and motion.

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Exploring treatment options? Read about rotator cuff injuries or learn about physical therapy for shoulder pain.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Discuss shoulder replacement options with your orthopedic surgeon, who can evaluate your specific condition and recommend the best approach.