Total Shoulder Replacement at a Glance
| Anatomic total shoulder replacement |
|---|
Best for | Shoulder arthritis with a healthy rotator cuff |
What’s replaced | The ball (top of the arm bone) with a metal implant, and the socket (on the shoulder blade) with a plastic implant |
Anesthesia | General anesthesia plus a nerve block to numb the arm |
Surgery time | About 2 hours |
Hospital stay | [Many patients go home the same day; some stay one night] |
Sling | About 4–6 weeks |
Everyday activities | Most daily tasks by about 2–3 months |
Full recovery | 6–12 months as strength keeps building |
How long it lasts | About 90–95% of implants are still working 10 years after surgery |
What Is a Total Shoulder Replacement?
Your shoulder is a ball-and-socket joint. The ball is the top of your upper arm bone (the humeral head). The socket is a shallow cup on your shoulder blade (the glenoid). Smooth cartilage covers both surfaces, and the rotator cuff, a group of four muscles and tendons, holds the ball centered in the socket as you move.
Arthritis wears that cartilage away until bone rubs on bone. The result is deep, aching pain, stiffness, and a grinding or catching feeling when you move your arm.
In an anatomic total shoulder replacement (also called total shoulder arthroplasty), your surgeon resurfaces both sides of the joint with implants shaped like your natural shoulder: a polished metal ball on the arm bone and a smooth plastic socket on the shoulder blade. Because the new joint keeps the shoulder’s natural design, it relies on your own rotator cuff to move and stabilize the arm.
The metal ball is held in place either by a stem that fits down into the arm bone or, for some patients with good bone quality, by a stemless implant that preserves more of your natural bone.
Anatomic, Reverse or Partial: Which Shoulder Replacement Is Right for You?
The health of your rotator cuff is usually the deciding factor. Your surgeon checks it with a physical exam and imaging, then recommends the design most likely to give you a strong, pain-free shoulder.
Type | How it works | Usually recommended for |
|---|
Anatomic total (this page) | Metal ball on the arm bone, plastic socket on the shoulder blade, matching your natural anatomy | Arthritis with a healthy, working rotator cuff |
Stemless total | An anatomic replacement whose ball anchors in the top of the arm bone without a long stem | Anatomic candidates with good bone quality, often younger and more active patients |
Reverse total | Ball and socket swap places, so the larger deltoid muscle lifts the arm instead of the rotator cuff | Large, irreparable rotator cuff tears, rotator cuff arthropathy, complex fractures, or a failed earlier replacement |
Partial (hemiarthroplasty) | Only the ball is replaced; your natural socket stays | Damage limited to the ball, such as some fractures or avascular necrosis, when the socket is still healthy |
If your rotator cuff is severely torn or no longer functioning, a reverse replacement typically yields more reliable results than an anatomic one.
Who It’s For, Preparation and Surgery
Conditions Treated With Total Shoulder Replacement
- Osteoarthritis: wear-and-tear arthritis, the most common reason for shoulder replacement.
- Rheumatoid and other inflammatory arthritis, including psoriatic arthritis.
- Post-traumatic arthritis that develops years after a fracture or dislocation.
- Avascular necrosis: collapse of the ball after it loses its blood supply.
- Arthritis after earlier shoulder surgery, such as a past stabilization procedure.
Rotator cuff tear arthropathy and many severe fractures are usually better treated with a reverse total shoulder replacement.
Signs You May Be Ready for a Shoulder Replacement
- Pain that wakes you at night or aches even when you rest
- Trouble with everyday tasks like reaching overhead, washing your hair, dressing or reaching behind your back
- Stiffness, grinding or catching, and a shoulder that moves less each year
- X-rays that show bone-on-bone arthritis
- Several months of nonsurgical treatment that hasn’t brought lasting relief
Try These First: Nonsurgical Treatment
Surgery is not the first step. Most patients start with activity changes, anti-inflammatory medication, physical or occupational therapy, and shoulder injections for arthritis. See our shoulder arthritis treatment options. Shoulder replacement becomes worth considering when these stop working, and pain is limiting your life.
Who May Not Be a Good Candidate
Age alone doesn’t rule you out. Your surgeon may recommend a different treatment or a different implant if you have:
- An active infection in the shoulder or elsewhere in the body
- A torn or non-working rotator cuff (a reverse replacement is usually the better choice)
- Paralysis or nerve damage affecting the deltoid, the main shoulder muscle
- Severe bone loss in the socket, which may call for a specialized implant or a reverse replacement
- Health conditions that make anesthesia and surgery unsafe
- A job or sport that involves heavy, repeated lifting you can’t give up, since that wears the implant faster
- Difficulty following the sling and therapy plan after surgery
How to Prepare for Shoulder Replacement Surgery
- Consultation and imaging. Your surgeon examines your shoulder and reviews X-rays. A CT scan measures the socket and helps plan implant size and position. An MRI may be ordered if the health of the rotator cuff is in question.
- Medical clearance. Your primary care doctor confirms you’re healthy enough for surgery. You may need blood work or an EKG.
- Get your health ready. Stop smoking and nicotine, which slow healing and raise infection risk. If you have diabetes, work on getting your blood sugar under control. Treat any dental problems. Review all medications and supplements with your care team, and stop blood thinners or arthritis medications only as instructed.
- Get your home ready. You’ll have one usable arm for several weeks. Move everyday items to waist height, lay out loose button-front shirts, set up a recliner or wedge pillow for sleeping, and arrange a driver and help at home for the first week or two.
- Follow your pre-surgery instructions, including when to stop eating and drinking.
What Happens on Surgery Day
- Anesthesia. An anesthesiologist places a nerve block that numbs your shoulder and arm for many hours, then you receive general anesthesia.
- Opening the joint. Your surgeon makes an incision on the front of the shoulder and reaches the joint between the muscles. The subscapularis tendon at the front of the rotator cuff is carefully released to open the joint. It is repaired at the end.
- Preparing the bone. The worn ball is removed, and the socket is smoothed and shaped.
- Placing the implants. The plastic socket is fixed to the shoulder blade, and the metal ball is attached to the arm bone with a stem or stemless anchor.
- Repair and closing. The subscapularis tendon is repaired, the incision is closed, and your arm is placed in a sling.
Surgery usually takes about two hours.
Recovery, Risks and Results
Recovery After Total Shoulder Replacement
Most patients have a pain-free, working shoulder within 6 to 12 months. The first six weeks protect the repaired tendon at the front of your shoulder, so following your sling and therapy plan matters more than pushing ahead. Your surgeon and therapist will tailor this timeline to you.
Time after surgery | Sling | What you’ll do | Milestones |
|---|
Days 1–14 | Wear it full-time, including sleep; off only for bathing and exercises | Ice, pain control, and moving your hand, wrist, and elbow several times a day. Gentle shoulder motion guided by your therapist. | Home the same day or next day; first follow-up visit and wound check |
Weeks 2–6 | Still worn most of the time and in public | Therapist-guided motion. No lifting, pushing up from a chair, or reaching behind your back with the operated arm. | Typing and desk work often resume within 1–4 weeks |
Weeks 6–12 | Weaned off | You begin using the arm on your own for light daily tasks. | Driving usually around 6 weeks, once out of the sling, off opioid pain medication, and cleared by your surgeon |
Months 3–6 | None | Strengthening exercises. Swimming, golf, and similar activities with your surgeon’s OK. | Most daily activities done independently by about 2–3 months |
Months 6–12 | None | Continued strengthening and endurance | Strength keeps improving for up to a year; physically demanding jobs often resume at 3–6 months |
After you recover, you can enjoy walking, swimming, cycling, golf, gardening and doubles tennis. To protect your implant long term, avoid heavy or repetitive overhead lifting, contact sports, and activities with a high risk of falling. Ask your surgeon for your personal lifting limit.
Risks and Possible Complications
Serious complications are uncommon, but every surgery carries risk. Your surgeon will review your personal risk and the steps taken to lower it.
Risk | What to know |
|---|
Infection | Can affect the wound or the implant and may need more surgery. Antibiotics before surgery, controlled blood sugar, and not smoking all lower the risk. |
Blood clots | Can form in the leg or arm veins. Moving early and walking the day of surgery help prevent them. |
Loosening or wear of the socket | The plastic socket can loosen or wear over many years. This is the most common long-term reason for an anatomic replacement to require revision. |
Rotator cuff or tendon problems | The tendon repaired during surgery can fail, or the rotator cuff can tear later. Following your sling and lifting limits protects it. |
Instability or dislocation | The ball can slip partly or fully out of the socket. |
Fracture | A break in the bone around the implant, during surgery or after a fall. |
Nerve injury | Usually temporary numbness, tingling, or weakness in the arm. |
Stiffness or ongoing pain | Some patients keep some stiffness or discomfort, especially without consistent therapy. |
How Long Does a Shoulder Replacement Last?
Most anatomic shoulder replacements last for many years. Studies report that about 90–95% are still working 10 years after surgery and about 85–90% at 15 years. Implants tend to last longest in patients with a healthy rotator cuff who avoid high-impact and heavy-lifting activities. If an implant wears out, revision shoulder arthroplasty, often converting to a reverse replacement, can restore comfort and function.
Why Choose Georgia Hand, Shoulder & Elbow
- 50+ years of care for patients across metro Atlanta
- Fellowship-trained surgeons. Real MDs, not physician extenders, at every visit.
- Our own Surgery Center [confirm shoulder replacement is performed there]
- Certified therapists who guide your recovery from the first week
- Two convenient offices: 2061 Peachtree Road NW, Suite 500, Atlanta, and 620 Cherokee Street, Suite 200, Marietta
- Most major insurance accepted, including Medicare, TRICARE, Aetna, Cigna, Humana, BCBS, and UnitedHealthcare. See insurance.
Take the Next Step
You don’t have to keep living with shoulder arthritis pain. Book a visit with one of our shoulder specialists to find out whether total shoulder replacement or a less invasive treatment is right for you.
- Atlanta: 2061 Peachtree Road NW, Suite 500, Atlanta, GA 30309
- Marietta: 620 Cherokee Street, Suite 200, Marietta, GA 30060
- Main line: (404) 551-2205 · After hours: 404-352-3522
