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If your shoulder aches when you reach for a high shelf, wakes you up at night or no longer lets you lift your arm the way it used to, you know how much shoulder arthritis can affect your daily life. Getting dressed, carrying groceries, sleeping on your side and playing a round of golf can all become harder than they should be.
When physical therapy, medication and injections no longer control the pain, total shoulder replacement may be the next step toward getting back to the activities you enjoy. At Panorama Orthopedics & Spine Center, our shoulder replacement surgeons perform both anatomic and reverse total shoulder replacement for patients across Denver and Colorado.
Article Written by
Dr. Daniel Haber, MD
Board-Certified Orthopedic Surgeon, Shoulder & Knee
Total shoulder replacement, also called total shoulder arthroplasty, is a surgery that removes the damaged surfaces of the shoulder joint and replaces them with smooth artificial parts. Your shoulder is a ball-and-socket joint. The ball at the top of your upper arm bone (the humerus) rests in a shallow socket on your shoulder blade (the glenoid). When the cartilage that cushions those surfaces wears away, bone grinds on bone. The result is pain, stiffness and lost motion.
During a total shoulder replacement, the worn ball is replaced with a polished metal ball and the socket is resurfaced with a durable plastic component. The goal is straightforward: relieve pain and restore the motion you need for everyday life.
Shoulder replacement surgery is a well-established procedure and one of the fastest-growing joint replacements in the United States. Hear what recovery looked like for one of Dr. Haber’s patients in Mark’s shoulder story.
There are two main types of total shoulder replacement. The right one for you depends largely on the health of your rotator cuff, the group of muscles and tendons that keeps the ball centered in the socket and helps lift your arm.
An anatomic total shoulder replacement recreates the shoulder’s natural design, with a new ball on the upper arm and a new socket on the shoulder blade. It is typically recommended for patients with osteoarthritis whose rotator cuff tendons are intact and working well.
Best for: osteoarthritis with an intact, working rotator cuff.
A reverse total shoulder replacement switches those positions. The ball is attached to the shoulder blade and the socket is attached to the upper arm. This changes the mechanics of the joint so the large deltoid muscle can lift the arm in place of a damaged rotator cuff. Reverse shoulder replacement is often the preferred option for patients with a large rotator cuff tear that cannot be repaired, arthritis combined with rotator cuff failure, certain complex fractures in older adults or a previous shoulder replacement that needs revision.
Best for: shoulder arthritis with a torn rotator cuff, large rotator cuff tears that cannot be repaired, rotator cuff tear arthropathy, complex fractures and revision surgery.
In select cases, only the ball is replaced. This procedure, called hemiarthroplasty, is usually reserved for specific fracture patterns or shoulders with a healthy socket.
This may be recommended in young patients with arthritis and patients with isolated avascular necrosis of the humeral head (disruption of the blood supply to the ball). The materials used in partial shoulder replacement have improved significantly in the last few years, making this an appealing option for more people than previously thought.
Your surgeon will recommend an approach based on your imaging, exam, age and activity goals.
Shoulder replacement may be recommended for:
At Panorama, surgery is never the first step. Most patients with shoulder arthritis start with conservative care, which may include:
You may be a candidate for total shoulder replacement if:
An evaluation with a shoulder specialist, including X-rays and sometimes a CT scan or MRI, is the best way to know whether replacement makes sense for you and which type fits your shoulder.
Preparation starts several weeks ahead. You may have a preoperative medical evaluation, imaging to plan the size and position of your implant and a review of your medications. It also helps to prepare your home: move everyday items to waist height and arrange help with meals and driving for the first few weeks. Our Shoulder Replacement Guidebook and pre-op shoulder exercises walk you through each step.
Total shoulder replacement usually takes 1 to 2 hours. It is performed under anesthesia, and a nerve block is commonly used to keep the shoulder numb for 1-3 days afterwards. This minimizes the amount of pain medication needed after surgery. Your surgeon makes an incision at the front of the shoulder, removes the damaged bone and cartilage and positions the new components.
Many patients go home the same day or the day after surgery, depending on their health and needs. You will wear a sling for roughly four weeks to protect the healing shoulder. In most instances your surgeon will have you start physical therapy within 1-2 weeks of surgery. Learn how to adjust and wear your sling before your procedure so you feel confident at home.
Every recovery is different, but most patients follow a similar path:
Your surgeon and physical therapist will adjust this timeline to your progress and the type of replacement you had. Keeping up with your home exercise program is one of the most important things you can do for an excellent result.
Total shoulder replacement has a strong track record. Most patients experience significant pain relief and better function, and many shoulder replacements last 15 years or longer.
As with any surgery, there are risks. They include infection, blood clots, nerve injury, fracture around the implant, dislocation and loosening or wear of the components over time. Some patients also have lasting limits on heavy lifting. Your surgeon will review your personal risk factors and the steps our team takes to reduce them.
If shoulder pain is limiting your life, schedule an appointment to find out whether total shoulder replacement is right for you.
Panorama Orthopedics & Spine Center. Serving Denver, the Front Range and communities across Colorado.
Many shoulder replacements last 15 years or longer, and many patients keep theirs for life. Your activity level, bone quality and the type of implant all play a role.
An anatomic total shoulder replacement keeps the ball and socket in their natural positions and relies on a healthy rotator cuff. A reverse shoulder replacement swaps them so the deltoid muscle can power the arm when the rotator cuff is badly damaged. See the full comparison above.
A nerve block and a combination of pain medications help keep you comfortable in the first days after surgery. Most patients find that post-surgical discomfort eases steadily over the first few weeks, and many say it is more manageable than the arthritis pain they lived with before.
Many patients go home the same day or after one night. Your surgeon will recommend the right plan based on your overall health and support at home.
Most patients can drive once out of their sling (generally after 4 weeks), are off prescription pain medication and are cleared by their surgeon.
Many patients return to activities like walking, swimming, golf, gardening, strength training, skiing or snowboarding and jogging. Your surgeon may recommend avoiding heavy lifting and contact sports to protect the implant.
There is no strict age limit. Candidacy depends on your pain, joint damage, overall health and goals. A consultation with a shoulder specialist is the best way to find out whether shoulder replacement is right for you.