Total shoulder replacement replaces the shoulder's original ball-and-socket joint (or glenohumeral joint) with similarly shaped prosthetics. After recovering from surgery, patients typically have significantly less pain, increased shoulder strength, and better range of motion. 1 Carter MJ, Mikuls TR, Nayak S, Fehringer EV, Michaud K. Impact of total shoulder arthroplasty on generic and shoulder-specific health-related quality-of-life measures: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012 Sep 5;94(17):e127. Review. PubMed PMID: 22992856.
Sometimes called traditional shoulder arthroplasty, total shoulder replacement is considered the gold standard for surgical treatment of severe shoulder osteoarthritis. Experts estimate more than 90% of traditional total shoulder replacements last 10 years, and 80% last at least 20 years. 2 Singh JA, Sperling JW, Cofield RH. Revision surgery following total shoulder arthroplasty: analysis of 2588 shoulders over three decades (1976 to 2008). J Bone Joint Surg Br. 2011 Nov;93(11):1513-7. doi: 10.1302/0301-620X.93B11.26938. PubMed PMID: 22058304.
See What Is Shoulder Osteoarthritis?
Total shoulder replacement surgeries are considered as safe as the more common hip and knee replacement surgeries.
Why Have Total Shoulder Replacement Surgery?
Most candidates for traditional total shoulder replacement have osteoarthritis or rheumatoid arthritis, with moderate to severe joint degradation that shows up on X-rays and other imaging. These patients often report the following:
- Pain that is moderate to severe with activity
- Pain that affects sleep
- Inability to lift the affected arm to perform daily tasks, such as reaching high shelves or washing hair
- Stiffness and pain with overhead movement
- Insufficient pain relief from non-surgical treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and steroid injections
Candidates may have tried non-major surgery, such as arthroscopic shoulder surgery, but did not get adequate relief from symptoms.
Other reasons for having shoulder replacement surgery include a badly broken bone(s) or a tumor.
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Total Shoulder Replacement vs. Reverse Shoulder Replacement
Reverse shoulder replacement is becoming more common in the U.S. There are two major differences between a total shoulder replacement and a reverse shoulder replacement: the position of the shoulder's new ball and socket and the muscle groups on which they rely.
- A total shoulder replacement replaces the joint's original anatomy and relies on the shoulder's rotator cuff muscles and tendons for strength and function.
- A reverse shoulder replacement switches the position of the joint's ball and socket, and it relies on the shoulder's deltoid muscle for strength and function.
See Reverse Shoulder Replacement Surgical Procedure
When shoulder arthritis is caused by rotator cuff tears, it is called cuff tear arthropathy. Reverse shoulder replacement was developed to address the condition of cuff tear arthropathy. Total shoulder replacements are less successful in patients with rotator cuff tear arthropathy, as they tend to fail earlier.
Postponing Surgery Can Lead to More Shoulder Joint Damage
For shoulder arthritis patients who have healthy rotator cuffs, postponing surgery for too long can lead to irreparable rotator cuff damage that makes them ineligible for total shoulder replacements. A reverse shoulder replacement is often a reasonable surgical alternative for these patients.
See Who Gets Reverse Shoulder Replacement?
However, a reverse shoulder replacement surgery cannot restore the rotator cuff function, and while the majority of surgeries are successful, reverse shoulder replacement does have more limitations than total shoulder replacement. 3 Katz JN, Earp BE, Gomoll AH. Surgical management of osteoarthritis. Arthritis Care Res (Hoboken). 2010 Sep;62(9):1220-8. doi: 10.1002/acr.20231. Review. PubMed PMID: 20506552; PubMed Central PMCID: PMC2942971.
Deciding Whether to Have Shoulder Replacement Surgery
A doctor and patient should talk about the existing wear-and-tear on the shoulder as well as the patient's lifestyle, hopes and expectations, and potential surgical risks. A frank discussion can help a patient determine if traditional shoulder replacement surgery is an appropriate choice and if so, when to schedule it.
See Orthopedic Surgeon for Arthritis Treatment
If a patient opts not to have surgery, a doctor can suggest exercises to do as well as activities to avoid that can help preserve the existing rotator cuff and other supporting soft tissue around the shoulder joint.