What Is Total Shoulder Replacement?
Your shoulder is a ball-and-socket joint. The ball is the upper end of the arm bone (humeral head) and the shallow socket is part of the shoulder blade (glenoid). Smooth cartilage covers both surfaces. In osteoarthritis, the most common reason for this surgery, that cartilage wears away, so bone rubs on bone and the shoulder becomes painful and stiff.
In a total shoulder replacement, the surgeon removes the damaged surface of the ball and replaces it with a metal ball, usually attached to a stem or anchor in the arm bone. The socket is resurfaced and lined with a plastic component. The surgery is also called an anatomic shoulder replacement. Anatomic means the new ball and socket keep their natural positions: the ball stays on the arm bone and the socket stays on the shoulder blade.
Because the joint keeps its natural layout, it relies on the rotator cuff, the group of four muscles and tendons that hold the ball in the socket and help you lift and rotate your arm. If the rotator cuff is badly torn or not working, a reverse shoulder replacement, which switches the ball and socket, is usually the better fit. Your surgeon will explain which design suits your shoulder.
Performed at a hospital or surgery center where our surgeons operate, with evaluation, imaging, follow-up visits and physical and occupational therapy here in our Boynton Beach office.
Who Is a Candidate?
You may be a candidate if you have:
- Shoulder osteoarthritis with pain that keeps you up at night or limits reaching, dressing, lifting or grooming.
- Arthritis from other causes, such as rheumatoid arthritis or an old injury, that has damaged the joint surfaces.
- A rotator cuff that is still healthy enough to support the new joint, confirmed by your exam and imaging.
- Symptoms that have not improved enough with non-surgical care.
When it is reasonable, our surgeons start with non-surgical care such as physical therapy, activity changes, medication when safe for you and injections. Surgery becomes a reasonable choice when those no longer give you enough relief. Your overall health and goals matter as much as your X-rays.
What to Expect
Your evaluation includes an exam and X-rays in our Boynton Beach office, and sometimes an MRI to check the rotator cuff. Your surgeon reviews the images with you and explains whether an anatomic or reverse design fits your shoulder. Our on-site therapists can show you how to use the sling and prepare your home before surgery.
Surgery usually takes about two hours. Most patients receive general anesthesia, often with a nerve block that numbs the shoulder and arm for pain relief. Depending on your health and the facility, you may go home the same day or stay in the hospital for a night or two. You will leave in a sling.
Risks and Side Effects
Total shoulder replacement is an established operation, but it carries risks. These include infection, blood clots, dislocation or instability of the new joint, nerve injury, fracture of the bone around the implant, loosening or wear of the implant over time, and risks from anesthesia or the nerve block. The rotator cuff can also tear or weaken after surgery, which may affect how the shoulder works. Your surgeon will explain the steps used to lower your risks and what to watch for.
Recovery
Recovery varies. Most patients wear a sling for several weeks, often around four to six, to protect the tendon that the surgeon repairs at the front of the shoulder during the operation. Therapy is staged: gentle motion first, then active motion as the shoulder heals, and strengthening later, often starting around two to three months. Many people return to everyday tasks within a few months, with gradual improvement for six months to a year.
Your physical and occupational therapists work in our office and share your chart with your surgeon, so each stage of therapy matches how your shoulder is healing. Your surgeon will give you guidelines on lifting, reaching and pushing up from a chair while the shoulder heals.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Total shoulder replacement for arthritis is usually covered by Medicare and most commercial PPO plans when it is medically necessary, often with prior authorization. HMO and managed-care plans require a referral from your primary care physician before your visit. Co-pays, co-insurance and deductibles apply. Call our office and our team will verify your benefits.
When to Talk to a Specialist
Schedule an evaluation if shoulder pain or stiffness limits daily tasks or disturbs your sleep, especially if it has not improved with several months of treatment. After surgery, go to the emergency room or call 911 if you have fever, spreading redness or drainage from the incision, or if your shoulder suddenly looks out of place or you cannot move it after a pop or fall, which can be a sign of dislocation. For other questions after hours, call our main office number to reach the answering service. Call 911 for sudden shortness of breath or chest pain.
