Shoulder Replacement Surgery: Total and Reverse

• What Is Shoulder Replacement Surgery?
• Types of Shoulder Replacement
• Who Needs Shoulder Replacement Surgery?
• What to Expect from Shoulder Replacement Surgery

The shoulder is a ball-and-socket joint. The ball is the rounded top of the upper arm bone, called the humeral head, and the socket is a shallow cup on the shoulder blade, called the glenoid. Smooth cartilage normally lets the ball glide in the socket. When that cartilage wears away or the joint is badly damaged, bone rubs on bone, which causes pain and stiffness. Shoulder replacement surgery removes the damaged surfaces and replaces them with metal and plastic components that restore a smooth, gliding joint. Which components are used, and where they go, depend on the type of replacement.

Anatomic Total Shoulder Replacement

In an anatomic total shoulder replacement, the surgeon replaces the joint in a way that mirrors its natural design. The damaged humeral head is replaced with a metal ball, and the worn socket is resurfaced with a smooth plastic cup. This option works well when the rotator cuff, the group of muscles and tendons that stabilizes the shoulder, is still healthy enough to support the joint. It is most often used for shoulder arthritis in a shoulder with an intact rotator cuff.

Reverse Total Shoulder Replacement

In a reverse total shoulder replacement, the surgeon switches the positions of the ball and socket. A metal ball is attached to the socket side, and a plastic cup is placed on the upper arm. This reversed design is meant for shoulders where the rotator cuff is torn or not working, letting the deltoid muscle lift the arm instead. That is why it is often chosen when the rotator cuff is torn beyond repair, including a condition called rotator cuff tear arthropathy, where a long-standing cuff tear has led to arthritis. It is also used for certain complex fractures and when a previous shoulder replacement needs to be revised.

Stemless and Bone-Preserving Options

Shoulder replacement components have traditionally used a stem that fits down into the upper arm bone. Newer stemless designs anchor the ball to the top of the bone instead, which preserves more of the natural bone. For the right candidate, a bone-preserving approach can mean a less invasive procedure. Your surgeon can explain whether a stemless option is appropriate for you.

Shoulder replacement is usually considered after nonsurgical treatments have been tried. Your physician may discuss it if you have:

• Severe Arthritis: Bone-on-bone pain and stiffness, such as from osteoarthritis or rheumatoid arthritis
• Disrupted Sleep or Activity: Shoulder pain that disrupts your sleep or limits everyday activities
• Pain Despite Treatment: Pain that has not improved with rest, anti-inflammatory medication, physical therapy or injections
• Irreparable Rotator Cuff Tear: A large rotator cuff tear that cannot be repaired, sometimes with related arthritis
• Severe Fracture: A shoulder fracture that cannot be reconstructed

Shoulder replacement is usually planned after imaging and an evaluation of your shoulder and overall health. The surgery is done under general anesthesia, and your surgeon will discuss whether you go home the same day or stay overnight. You are monitored in a recovery room afterward, and your arm is placed in a sling to protect the joint while it heals.

Recovery centers on physical therapy. It typically begins with gentle, guided movement and progresses to exercises that rebuild strength and range of motion over the following weeks and months. As with any surgery, there are risks, which can include infection, dislocation, loosening of the implant or nerve injury. Many people experience less pain and better function after recovery, though the pace of recovery varies from person to person. Your Resurgens surgeon and care team will give you a recovery plan tailored to your procedure and your goals.

Please Note: Following your physical therapy plan is an important part of recovery. Avoid lifting, pushing or reaching with the operated arm until your surgeon says it is safe.

If shoulder pain is limiting your life and you want to understand whether shoulder replacement could help, a shoulder specialist can walk you through your options. Book an appointment online today with Resurgens Orthopaedics or call us at (404) 847-9999.