X-rays of a shoulder before and after shoulder replacement

Total Shoulder Replacement

Arthritis of the shoulder is much less common than arthritis of the knee or hip. When evaluating patients with shoulder arthritis my first consideration is the condition of the rotator cuff, a group of tendons that envelop the ball of the shoulder joint and are necessary for normal shoulder function. If I suspect a rotator cuff tear or patients have had a previous rotator cuff repair, I proceed with an MRI to fully evaluate the rotator cuff tendons for a tear. Depending on the integrity of the rotator cuff, I will recommend one of two surgical options for treatment of shoulder arthritis.

Diagram of total shoulder components

Total Shoulder surgery involves replacement of the joint surface with an artificial ball and socket and is very similar in concept to a total hip replacement. The surgery takes roughly 2-3 hours through a 4-5 inch incision over the front of the shoulder. I routinely replace both the humeral surface (ball) and the glenoid surface (socket) to give patients the maximal pain relief from the surgery. The repair of the rotator cuff tendons over the prosthesis is critical to achieving a good outcome. Most patients stay 1-2 days in the hospital and are discharged with a sling for comfort. Unlike hip and knee arthroplasties, blood clots after shoulder surgery are uncommon, and I do not routinely use blood thinners (heparin) after shoulder replacement surgery. In my experience, most patients leave the hospital with less pain in their shoulder that before surgery and full recovery involves a fairly intensive physical therapy program to achieve full function. Total recovery takes 3-6 months depending on the condition of the shoulder prior to the initial repair.