Shoulder Replacement
What Is Shoulder Replacement?
Shoulder arthroplasty, more commonly known as shoulder replacement, is a surgical procedure that resurfaces the damaged ball-and-socket joint of the shoulder with smooth metal and plastic implants. When the cartilage covering the humeral head (the “ball”) and the glenoid (the “socket”) has worn away — whether from arthritis, a severe fracture, or a longstanding, irreparable rotator cuff tear — bone grinds against bone, causing pain and stiffness that no longer responds to nonsurgical treatment. Replacing these worn surfaces relieves pain and restores a functional, gliding joint.
There are two main types of shoulder replacement, and which one is appropriate depends heavily on the condition of the rotator cuff:
- Anatomic total shoulder arthroplasty — replaces the ball with a metal implant and resurfaces the socket with a plastic component, recreating the shoulder’s normal anatomy. This relies on a functioning rotator cuff to power and stabilize the new joint.
- Reverse total shoulder arthroplasty — reverses the normal ball-and-socket configuration, placing a metal ball on the socket side and a plastic cup on the arm bone. This design allows the deltoid muscle, rather than the rotator cuff, to power the arm, making it the preferred option for patients whose rotator cuff is too damaged to function normally.
When Is Shoulder Replacement Needed?
Shoulder replacement may be recommended for patients with:
- Advanced shoulder arthritis causing significant pain and stiffness that hasn’t improved with physical therapy, medication, or injections
- A large, severely retracted rotator cuff tear that is no longer repairable, especially when combined with arthritis (a pattern known as cuff-tear arthropathy)
- A complex proximal humerus fracture, particularly in older patients, where the bone quality or fracture pattern make a reliable repair unlikely
- Failed previous shoulder surgery where the joint surfaces have deteriorated further
How Is Shoulder Replacement Performed?
Shoulder replacement is performed through an incision at the front of the shoulder, working between two of the shoulder’s major muscles to reach the joint. The damaged surface of the humeral head is removed and replaced with a metal component, secured either with a stem inside the arm bone or, in some newer designs, without a stem at all. The socket is then prepared and resurfaced with its corresponding implant.
For an anatomic replacement, the ball component is matched in size to recreate the patient’s own anatomy, relying on an intact rotator cuff to move and stabilize the new joint. For a reverse replacement, the ball and socket components are switched, changing the mechanics of the shoulder so that the deltoid muscle — rather than a damaged rotator cuff — becomes the primary driver of arm motion. Your surgeon will determine which design is the better fit based on imaging, the condition of your rotator cuff, and your specific pattern of arthritis or injury.
Anatomic vs. Reverse Shoulder Replacement
The key factor separating these two procedures is the health of the rotator cuff. An anatomic replacement depends on rotator cuff tendons that are still intact and functional, since these muscles power the joint in its normal configuration. When the rotator cuff is too damaged, torn, or retracted to reliably do this job, an anatomic replacement is prone to early failure or poor motion. A reverse replacement solves this problem by shifting the mechanical advantage to the deltoid muscle, which is almost always intact and powerful even when the rotator cuff is not — making it the more reliable option for patients with cuff-tear arthropathy, massive irreparable cuff tears, or certain complex fractures.
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Dr. Palsis utilizes innovative treatment techniques to get you back in motion and back to the life you love.
Recovery After Shoulder Replacement
- The majority of patients have this performed as an outpatient procedure; an overnight hospital stay is only required in selected patients
- A sling is worn for several weeks to protect the healing soft tissues around the new joint
- Physical therapy begins early, typically starting with gentle passive motion before progressing to active use of the arm
- Most patients see significant pain relief within the first few weeks, though full recovery of strength and motion continues over several months
- Return to lower-demand daily activities generally occurs within 6 weeks to 3 months, with continued improvement in strength for up to a year
Shoulder replacement has a well-established track record of reliably relieving pain, and most patients report high satisfaction with their range of motion and overall function afterward.
Get back to what moves you
Dr. Palsis specializes in the treatment of knee, shoulder, and sports injuries.