Total Shoulder Replacement

Overview

Patient imaging de-identified per HIPAA (45 CFR §164.514)

The shoulder is a ball-and-socket joint; doctors call it the glenohumeral joint. The ball is the head of the humerus, your upper arm bone. The socket (glenoid) is the shallow, cupped face of your shoulder blade. Smooth cartilage lines both surfaces and lets the ball glide in nearly every direction. That cartilage can wear away from osteoarthritis (slow mechanical wear over years) or inflammatory arthritis (the immune system attacks the joint lining). An old fracture or dislocation can also wear it down over time. Once the cartilage is gone, raw bone grinds on raw bone. The joint stiffens into a painful arc that limits everything from reaching overhead to sleeping on that side.

An anatomic total shoulder replacement resurfaces both sides of the joint. The worn ball is replaced with a polished metal ball on a stem fixed inside the arm bone. The socket is resurfaced with a smooth plastic (polyethylene) liner. The new pairing is low-friction metal on plastic, shaped to match the joint's natural geometry. One requirement is critical: an intact rotator cuff. The cuff is the four-muscle sleeve that keeps the ball centered in the socket as you move. Without a working cuff, the ball levers upward instead of turning cleanly, and the plastic socket loosens over time. Some patients have severe arthritis plus a large cuff tear that cannot be repaired. They need a different design, the reverse total shoulder replacement. That design changes the joint's geometry to work without the cuff.

For the right patient, total shoulder replacement reliably reduces pain and restores useful range of motion. Most people return to daily activities within a few months. Most keep significant improvement at ten or more years after surgery.

How the Procedure Works

We reach the joint through a natural gap between two muscles at the front of the shoulder. This well-worn surgical corridor avoids cutting through either muscle. One cuff muscle at the front, the subscapularis, must be carefully detached for access. We repair it securely at the end. A failed repair here is a leading cause of an unstable shoulder later. We then remove the worn ball, seat the metal ball-and-stem implant, and prepare the socket for its smooth plastic liner. Getting the socket angle right is the most demanding part of the case. If the angle is even slightly off, it changes how the ball loads the socket over the years, and that can speed up wear. We size the new ball to restore the joint's natural position. We test motion with trial parts in place, confirm the cuff repair is solid, then close. Your rotator cuff and deltoid work the same way they always did. The implant simply gives them a smooth surface to move against.

When to Consider Total Shoulder Replacement

We generally offer total shoulder replacement when your symptoms, your imaging, and a full course of non-surgical care all point the same way. The typical picture includes:

1. Advanced glenohumeral arthritis

   X-rays show bone-on-bone arthritis, with pain and motion loss to match.

2. Intact rotator cuff

   A working cuff is required for an anatomic replacement to succeed.

3. Exhausted non-operative care

   Activity changes, NSAIDs, therapy, and injections into the joint have not worked.

Risks & Why We Still Recommend It

Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause end-stage pain with every arm motion and a steady loss of the ability to dress, reach, and sleep on that side. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.

The risks we discuss with you before total shoulder replacement include:

• bleeding and infection (including rare deep periprosthetic infection)
• anesthesia risk
• stiffness
• component loosening, particularly on the socket side, over the long term
• periprosthetic fracture
• rotator cuff failure years after surgery, which can cause the ball to migrate and, in some cases, require conversion to a reverse total shoulder replacement (a design that bypasses the rotator cuff)
• transient nerve irritation from surgical positioning or the nerve block used for postoperative pain control
• blood clot (rare in upper-extremity surgery)

The reason to proceed is advanced shoulder arthritis with an intact rotator cuff, in someone who has run out of non-surgical options. If this operation is not right for you, we will not recommend it.

Further Reading

Outside reading we trust, plus related OSI pages:

• AAOS OrthoInfo, patient education library
• OSI glossary, orthopedic terminology in plain language

Physicians Who Perform Total Shoulder Replacement

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Providers Who Surgically Assist with Total Shoulder Replacement

Sydney Georg, PA-C

Ben Swanner, PA-C