The shoulder joint is very complex and involves three bones and more than one joint. These bones are the clavicle (collar bone), the scapula (shoulder blade), and the humerus (upper arm bone). Numerous muscles, ligaments, and tendons surround the joint (Figure). The upper end of the arm bone (humerus) and the outside edge of the scapula bone (glenoid) form a “ball-and-socket joint”. This joint is remarkable because it typically allows greater range of motion than any other joint in your body.

Shoulder replacement surgery is most commonly used for severe degenerative joint disease (osteoarthritis) of the ball-and-socket joint. When the smooth surfaces (cartilage) of the ball and socket become rough, they rub against each other rather than glide. This rubbing causes pain, stiffness and swelling. Most patients who decide to have shoulder replacement surgery have experienced shoulder pain for a long time. Many patients have developed pain that limits their daily activities, as well as interferes with their sleep. Shoulder stiffness also interferes with the use of their arm for everyday activities. A shoulder replacement is performed to alleviate shoulder pain. It also helps to improve the range of motion of your shoulder joint, which also improves your function and the quality of your life.

The two most common types of shoulder replacement are an anatomic shoulder replacement and a reverse total shoulder replacement.

With an anatomic total shoulder replacement, the ball (humeral head) of the shoulder joint is replaced with an implant that includes a stem with a smooth, rounded metal head. The socket (glenoid) is replaced with a smooth, specialized plastic that is cemented into place. In essence the diseased cartilage is removed and resurfaced with the two components (Figure 2). In some cases, just the ball is replaced, which is called a partial replacement or hemiarthroplasty.

With a reversed total shoulder replacement, the normal structure of the shoulder is “reversed.” The ball portion of the implant is attached to the scapula (where the socket normally is) and the artificial socket is attached to the humeral head (where the ball normally is) (Figure 3). This allows the stronger deltoid muscles of the shoulder to take over much of the work of moving the shoulder, increasing joint stability. A reversed procedure is use for patients with a severely torn and compromised rotator cuff. It is also commonly used in revision surgery cases.

In most cases shoulder replacement is very successful. Typically, patients gain 50 degrees in forward elevation (raising the arm straight ahead). In other words, most patients go from raising their arm at or below shoulder level to being able to raise the arm above the shoulder. Similarly, rotation out to the side improves on average by 30 degrees. Rotation behind the back also improves. The survival of the implant is 90 to 95% at 10 years after surgery and approximately 80% 20 years after surgery.
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In partial replacements only the ball or just a portion of the ball is replaced. Sometimes this is called a resurfacing. A partial replacement can be successful in select cases depending on patient age and the quality of the glenoid. However, the vast majority of patients will have a better outcome with a total shoulder replacement. Study after study has demonstrated that in most cases a total shoulder replacement leads to improved motion, less pain, and less need for repeat surgery compared to a partial replacement.1,2,5,6 This makes sense since arthritis affects both sides of the joint (the ball and socket). Additionally, the approach to the shoulder joint requires the same incision whether a partial or complete replacement is used.

Most people know someone who has had a hip or knee replacement. Knee replacement is the most common replacement performed in the US each year. Hip is the next most common and shoulder is the 3rd most common. The results of shoulder replacement are similar to hip and knee replacement. Studies have also shown that the complication rate is lower with a shoulder replacement compared to hip and knee replacement.

As with any surgery, there is always a risk of complications. Infection and glenoid (socket) component failure are the most common complications in shoulder replacement. This risk of complication that affects outcome is roughly 5% for an anatomic shoulder replacement. For reverse shoulder replacements the complication rate is slightly higher at about 10% and includes component failure, acromion stress fracture, and dislocation.  Infection following shoulder replacement is about 1-2% in published studies. My infection rate is less than 1%. The need for a blood transfusion after shoulder replacement surgery is very low at less than 5% as reported in studies.8-10 My rate of blood transfusion is less than 1%. As of this writing I’ve never given a blood transfusion after a primary shoulder replacement (first procedure); I’ve only had patients need this after a revision procedure on occasion.

Most shoulder replacements are performed by surgeons who perform less than 10 replacements a year.11 Multiple studies, however, have shown that complication rates are lower in the hands of an experienced surgeon, performing the surgery in a high-volume hospital.12-14 I do shoulder surgery only and perform approximately 300 shoulder replacements a year.  In 2019-20 was in top 5 in the US in total number of shoulder replacements.

Most people are able to return to normal everyday activities such as dressing themselves and grooming within the first two weeks after successful shoulder replacement surgery. It is good to have someone who can help with daily activities for the first couple of weeks after surgery.

In most cases your surgical incision will be closed with absorbable sutures and covered with surgical glue. In that case you may shower 2 days after surgery. Water can pass over the wound, but please do not soak in a pool or hot tub until 2 weeks after surgery.  To wash under your armpit, lean over and dangle the arm at the side. After a couple of days a bandage is not needed. If the incision is closed with staples, showering may occur 3 days after surgery and a bandage should cover the incision until the 2 week follow-up.

You cannot drive while taking narcotic pain medication.  Legally, I must recommend that you delay driving until you are out of your sling.  A sling is worn for 4 weeks after surgery. Some people chose to drive in town while they are still wearing a sling. You must be off of narcotics and please avoid driving on freeways/high speed due to decreased reaction time while you are in a sling.

Return to work will be dictated by your type of work and your desire to return.  In general, I advise taking 2 weeks off of work. Some patients wish to return earlier but it is better to plan for more time off and return early then vice versa.  Immediately after surgery you can move your elbow and wrist up and down. This allows you to eat, drink, write, use a keyboard and do other minimal activities that do not require the use of your shoulder.

Most people return to all of their normal activities after shoulder replacement. In fact, many patients are able to do more because their motion is improved and their pain is decreased. Activities that involve a significant lifting or accelerate the arm (golf, tennis) are allowed 6 months after surgery. I no longer provide a hard and fast lifting restriction. But, if someone does frequent lifting, particularly at or above shoulder level, the prosthesis is more likely to wear out.

Most people know someone who has had a hip or knee replacement. Knee replacement is the most common replacement performed in the US each year. Hip is the next most common and shoulder is the 3rd most common. The results of shoulder replacement are similar to hip and knee replacement. Studies have also shown that the complication rate is lower with a shoulder replacement compared to hip and knee replacement.

Shoulder replacements do contain metal so this is a possibility, but it depends on the sensitivity of the detector and the amount of other metal in your body/on your clothes. If you do set off the detector you simply will need a manual scan. We do not provide cards stating that you have a joint replacement since these are not accepted by the TSA.

The American Academy of Orthopaedic Surgeons and the American Dental Association have made a joint clinical practice guideline recommendation in 2012 that antibiotics are NOT needed prior to dental work. The reason for this is that there is a lack of evidence to show that it makes any difference. In general, I recommend waiting at least 3 months after shoulder replacement to have dental work.