Total Shoulder Arthroplasty (Shoulder Replacement)

Overview

Total shoulder arthroplasty is a surgical procedure to replace the damaged surfaces of the shoulder joint with artificial components. The procedure may be performed as a conventional (anatomic) replacement or as a reverse shoulder replacement, depending on the condition of the rotator cuff and bone quality. Shoulder replacement aims to relieve pain and improve function in patients with severe shoulder arthritis or other conditions.

Indications

This procedure may be considered when:

• •Severe glenohumeral osteoarthritis with pain and functional limitation unresponsive to conservative treatment
• •Rheumatoid arthritis or other inflammatory arthritis of the shoulder
• •Post-traumatic arthritis following shoulder fractures
• •Avascular necrosis of the humeral head
• •Irreparable rotator cuff tears with arthropathy (typically reverse shoulder replacement)
• •Failed prior shoulder surgery with significant arthritis
• •Severe fractures of the proximal humerus in elderly patients

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative evaluation includes imaging to assess bone quality, rotator cuff status, and glenoid morphology
• •Surgery is performed under general or regional anesthesia
• •An incision is made at the front of the shoulder (deltopectoral approach most common)
• •The humeral head is resected and replaced with a metal component with a stem that fits into the humerus
• •The glenoid (socket) may be resurfaced with a plastic component
• •In reverse shoulder replacement, the ball and socket configuration is reversed to allow the deltoid muscle to power the arm
• •Components may be cemented or press-fit depending on bone quality and implant design
• •Rotator cuff is repaired if applicable, and soft tissues are balanced
• •Incision is closed and the arm is placed in a sling

Risks

As with any surgical procedure, potential risks include:

• •Infection of the surgical site or prosthesis
• •Instability or dislocation of the prosthesis
• •Nerve injury (particularly axillary nerve)
• •Blood clots
• •Rotator cuff failure or insufficiency
• •Glenoid component loosening or wear
• •Periprosthetic fracture
• •Persistent pain or stiffness
• •Scapular notching (specific to reverse shoulder replacement)
• •Need for revision surgery

Recovery Expectations

Recovery follows a gradual progression:

• •Hospital stay typically ranges from 1 to 3 days
• •Arm is supported in a sling for several weeks
• •Passive range of motion exercises begin early under supervision
• •Active motion and strengthening progress gradually over months
• •Physical therapy continues for 3 to 6 months or longer
• •Driving typically resumes after 4 to 6 weeks
• •Return to daily activities progresses over 3 to 6 months
• •High-impact activities and heavy lifting may be permanently restricted

Alternatives

Depending on individual circumstances, alternatives may include:

• •Continued conservative management with physical therapy, medications, and injections
• •Hemiarthroplasty (replacing only the humeral head)
• •Arthroscopic debridement (limited role in end-stage arthritis)
• •Shoulder fusion (arthrodesis) for specific salvage situations
• •Biologic resurfacing or interpositional arthroplasty (rarely used)
• •Activity modification and pain management

Sources

• Mayo Clinic – Shoulder Replacement Surgery
• Cleveland Clinic – Shoulder Joint Replacement