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Shoulder Replacement

In the event that symptoms of arthritis do not improve with conservative care, surgery is an option. Two options exist.

The first is an arthroscopic procedure. This procedure requires general anesthesia, takes about 45 minutes to perform, and patients go home the same day. Two to three small incisions are made in the shoulder, a scope is inserted, and the adhesions and bone spurs are directly released. This is most likely to be successful in patients with mild arthritis. While the procedure is low risk, it does not alter the underlying condition. A sling is worn for 2 weeks after surgery and immediate motion is encouraged. Strengthening is allowed at 4 to 6 weeks and full activities are progressed at 3 months after surgery. This is most successful for patients have >2 mm of joint space remaining. The success rate is about 2 in 3.

The second option is shoulder replacement. Many people have heard of a hip or knee replacement but don’t know about shoulder replacement. While less common than hip or knee replacement, the surgery is very effective and has a lower risk of complication than hip or knee replacement. This procedure requires general anesthesia with an incision in front of the shoulder and takes about 1 hour to perform. The ball and the socket joint are resurfaced with a metal and high-strength plastic prosthetic implant in order to remove pain and improve range of motion. This is an outpatient procedure, meaning that people go home the day of surgery.  A sling is worn for 4 weeks after surgery with use of the elbow, wrist, and hand only for general activities. The patient may shower 2 days after surgery. Absorbable sutures are placed so that there is no need for suture removal. The sling is removed at 4 weeks and range of motion is started. Strengthening starts at 8 weeks and full activities are allowed at 4 months. The success rate is over 90%. Range of motion improvement can be substantial and pain relief can be complete since the arthritis is removed. Risks include infection (less than 1% in my patients), and component loosening over time (90% of the implants are still in 10 years after surgery and 70-80% are in 20 years after surgery).

Commonly Asked Questions:

What is the anatomy of the shoulder?

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 anatomy
When is a shoulder replacement needed?

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.

What are the types of replacement?

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.

Anatomic Shoulder ReplacementAnatomic Shoulder Replacement
How successful is shoulder replacement?

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.

How do the results of a complete replacement compare to partial replacement?

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.

How common is shoulder replacement compared to hip and knee replacement?

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.

What are the complications?

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.

Who should perform a shoulder replacement?

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.

The surgery

What is involved in the surgery?
Shoulder replacement is performed in the hospital or surgery center with the help of an experienced, specialized surgical team. The procedure generally takes 1 hour. The goal for most patients is to go home the same day. Patients under the age of 65 with approved insurances can have their surgery at the surgery center. As of 2021, Medicare considers shoulder replacement an outpatient procedure, but still requires the procedure to be done at the hospital. This means that an overnight stay in the hospital is only allowed if there is substantial justification. Examples would be lack of mobility or lack of home support. If a night in the hospital is required, 90% of time one is able to go home the next day after surgery. In rare cases, for people who do not have assistance at home, a brief stay in a skilled nursing facility may be necessary for additional assistance.

To get to the shoulder joint an incision is made on the front of your shoulder. After exposing the shoulder joint, the damaged ends of the bone (humerus and glenoid) are removed. The bone is prepared for the replacement with the artificial joint. The artificial joint is made of metal, usually a titanium or a cobalt-chrome alloy.

For a standard shoulder replacement the stem is placed inside the humerus bone, usually without cement using a “press-fit” technique. The glenoid component is made of a special plastic (polyethylene). The glenoid is cemented into place. Not all patients require a glenoid component and the final decision to use a glenoid component is made during the surgery.

For reverse shoulder replacements the ball is secured to the socket with a press-fit and supplemented with screws. The humeral stem is then press-fit or cemented into place. A high-strength plastic then is placed to act as a spacer between the stem and the ball.

After Surgery

Will I be able to care for myself?

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.

When can I shower?

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.

When can I drive?

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.

When can I return to work?

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.

Will I be able to return to my normal activities?

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.

How common is shoulder replacement compared to hip and knee replacement?

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.

Will I set off a metal detector?

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.

Do I need antibiotics if I have dental work?

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.

How well do people function after surgery?
To see some of our patient outcomes follow us on Instagram below. It is always good to have information about how our patients are doing:

Rotator Cuff Tear Symptoms

The rotator cuff is made up of four muscles (subscapularis, supraspinatus, infraspinatus, and teres minor). The rotator cuff surrounds the ball and socket joint (glenohumeral joint) and provides stability to the joint as well as movement. Because the shoulder is a shallow joint and the most mobile joint in the body, it requires the rotator cuff for stability. If let untreated tears can lead to arthritis of the shoulder (rotator cuff arthropathy). This doesn’t mean that good function can’t be maintained with a tear. In fact, many people are able to maintain function despite a tear because the shoulder remains balanced with the remaining rotator cuff and other muscles that control shoulder movement.

Rotator Cuff Tear Symptoms

Muscle inserts into bone via tendon. In the vast majority of cases, when a tear occurs the tendon pulls away from the bone. Broadly speaking, tears are classified as partial or full-thickness. Partial tears go part way through the tendon while full-thickness tears represent complete detachment. Frequently, an MRI will report “partial-tearing.” Since most people over the age of 40 to 50 have some changes within the rotator cuff, partial tears usually not a problem. The distinction with partial tears is when the tears are considered “high-grade,” meaning that they go almost all the way through the tendon.


Rotator cuff tears may occur after an injury or repetitive activity over time, but most cases occur without an injury. As we age the rotator cuff tendon degenerates and age and genetics are the greatest risk factors for a tear. Studies show that about 50% of people over the age of 65 have a full-thickness rotator cuff tears. Most of these people don’t even know they have a tear!


Treatment for rotator cuff tears is based on age, health, and response to conservative treatment. The rotator cuff tendon is not capable of repairing itself. Rather then tear will stay the same size or enlarge over time. In people under the age of 60, the risk of progression is about 50% in a two-year period. The ability to get healing with a surgical repair depends upon age, the tear size, muscle atrophy, associated arthritis, and health (smoking and diabetes for instance). One must also consider timing of repair. Traumatic tears have a better outcome if fixed within 6 months of injury. Additionally, after about six months of symptoms atrophy may occur. Unfortunately, atrophy of the rotator cuff is not considered reversible. Based on this, if someone desires repair, I typically recommend performing this within six months of beginning treatment.

Guidelines for surgery are general and must be individualized as noted above. But, as a general guideline, I recommend repair for all full-thickness tears in people under the age of 60 given the risk of increase in tear size. For people between the ages of 60 and 70, treatment is based on the above factors with health and activity expectations being the most important factors. For people over the age of 70, I nearly always recommend an attempt at conservative treatment. Surgery is then considered if one does not respond to conservative treatment.

For partial tears, conservative treatment should almost always be attempted first since these tears progress slowly or may not progress at all. Then surgery is considered if one does not respond to 4 to 6 months of conservative treatment.

Treatment options include:


Anti-inflammatories such as ibuprofen (Motrin or Advil) and naproxen (Aleve) are used to reduce pain and inflammation. The max does for ibuprofen is 800 mg three times per day. The max does for naproxen is 500 mg twice daily. Prolonged usage should be avoided and these should be taken with food since they can affect the stomach lining. If one experiences an upset stomach these should be stopped.


Injection of a steroid (cortisone) may be used to provide pain relief and facilitate physical therapy. I perform these injections with an ultrasound machine. This allows direct visualization of the joint and improved accuracy of the injection. Up to 3 injections over a 2 year period are allowed. Beyond this there are typically diminishing returns and excessive injections may be detrimental to the rotator cuff.

Alternative injections include Toradol (an anti-inflammatory agent similar to ibuprofen), prolotherapy, or platlet-rich plasma (PRP). ). I use Toradol in people who do not tolerate steroids. Prolotherapy involves injecting a substance such as sugar into tissue to “stimulate a healing response.” I do not perform prolotherapy as it has not been shown to improve symptoms in rotator cuff tears. PRP involves taking a small amount of blood from a patient, spinning in a centrifuge to separate the growth factors from the red blood cells, and then injecting the growth factors back into the shoulder to potentially decrease pain. While PRP has anti-inflammatory properties, it has not been shown to heal the rotator cuff. Therefore, it is not covered by insurance and is an out-of-pocket expense. Typically a series of 3 injections are performed at weekly intervals for 3 weeks.


Physical therapy with strengthening is one of the mainstays of treatment of rotator cuff tears. Long-term studies show that despite not healing the rotator cuff, therapy can lead to substantial improvements in function with good patient satisfaction. The core exercises in strengthening the rotator cuff are provided at the end of this handout. These exercises can be performed twice per day, 5 days a week.

Rotator Cuff Tear Symptoms


Most tears, regardless of size can be repaired. I perform all my rotator cuff repairs arthroscopically. This is less invasive and therefore less painful than an open incision. It also allows a better view of the rotator cuff. This procedure requires general anesthesia, takes about 60 to 90 minutes to perform, and patients go home the same day. Small incisions are made in the shoulder, a scope is inserted, and the rotator cuff is repaired with anchors. Anchors are essentially headless screws which are placed flush with the bone. These anchors have sutures that are used to bring the tendon done to the bone so that the tendon can heal to the bone. The long-term outcome of this procedure is very good (>90% success in most cases) and the risk of complication is very low (1/5000 chance of infection). However, repair requires a long recovery period and the tendon takes about 12 weeks to heal into the bone. Therefore, a sling is worn for 6 weeks after surgery. Specific motion exercises afterwards are tailored to the tear pattern (patient-specific). The sling is removed at 6 weeks and motion is progressed. Strengthening is allowed at 12 weeks, followed by gym activities at 4 months. Full recovery takes 6 months for small tears and 12 months for large or massive tears.