Shoulder Arthroplasty (Replacement)

Shoulder arthroplasty, or shoulder replacement surgery, is a proven solution for patients suffering from severe shoulder arthritis or rotator cuff-related joint damage. The procedure involves replacing the damaged shoulder joint with a metal and plastic prosthesis.

Most commonly, Dr Sanders performs one of two types of shoulder arthroplasty: anatomic total shoulder replacement and reverse total shoulder replacement.

While both surgeries aim to relieve pain and restore function, the mechanics, indications, and expected outcomes differ. Choosing the correct procedure is critical—selecting the wrong type of implant for a patient’s anatomy or condition can lead to poor function and premature failure of the replacement.

Anatomic Total Shoulder Arthroplasty (Replacement)

Anatomic total shoulder arthroplasty is a joint replacement surgery for a variety of painful shoulder joint conditions – most commonly osteoarthritis of the joint. Osteoarthritis is a condition where the cartilage degenerates leading to bone on bone contact and bone spur formation around the joint. This leads to pain, stiffness and decreased shoulder function.

The primary reason to consider a shoulder replacement is pain relief. Generally, there is also a significant improvement in shoulder range of motion and function as well.

During anatomic shoulder replacement, the ball and socket portion of your shoulder will be replaced with metal and plastic parts that are similar in shape and size to your own shoulder anatomy – hence the name “anatomic”. The socket portion of your shoulder is resurfaced with a plastic socket and the ball portion (humerus) is replaced with a metal ball attached to a metal stem of various lengths secured within the humerus.

Expected outcomes after Anatomic Total Shoulder Arthroplasty

Shoulder arthroplasty has been performed in the United States since the 1950’s. At that time, it was used to treat severe shoulder fractures. In recent years, this surgery has become more common and is used for many painful shoulder conditions.

Anatomic replacement is very reliable for pain relief and improvement in shoulder range of motion and function in over 95% of patients. It is expected that an anatomic replacement will last 10 years in over 90% of patients. Our shoulder surgeons perform about 300 total shoulder replacement surgeries each year.

Most patients can be very active. You can golf, play tennis, swim, hunt, do yard work and garden. Patients with shoulder replacements can perform light and medium demand labor jobs. However, it is not designed for sustained heavy manual labor. You can lift lighter weights with higher repetitions. However, it is important to remember the socket portion of the implant is plastic and excessive activity can result in early failure and loosening of the implant.

Reverse Total Shoulder Arthroplasty (Replacement)

Reverse total shoulder arthroplasty is a joint replacement surgery for a variety of painful shoulder conditions where the rotator cuff tendons are badly damaged and beyond repair or there is severe destruction of the socket (glenoid bone). Severe rotator cuff problems can occur in association with arthritis, shoulder instability, certain fractures, failure of a previous joint replacement or failed rotator cuff repair surgery.

Reverse shoulder replacement surgery changes the mechanics of the shoulder transferring more load to the deltoid muscle and less load to the rotator cuff muscles for adequate function. The best clinical results for a reverse replacement are seen in patients who have some functioning rotator cuff tendons/muscles; however, very good results can be seen even with large rotator cuff tears.

In the reverse total shoulder the ball and socket are replaced, but they are reversed. The socket portion of your shoulder is replaced with a prosthetic metal ball that attaches to a metal baseplate secured to the socket/scapula. The humeral head (ball portion) of your shoulder is replaced with a plastic cup that is attached to the top of a metallic stem placed within the humerus (the upper arm bone).

Expected outcomes after Reverse Total Shoulder Arthroplasty

Reverse shoulder arthroplasty has been performed in the United States since 2004. Therefore, long-term outcomes and risks of long-term complications are not known at this time. This surgery is reliable for pain relief in over 90% of patients.

While some patients have complete relief of pain, most experience mild activity related pain in the shoulder and down the arm. This is generally felt to be muscular pain and is usually mild. Most patients will also have an improvement in the ability to raise the arm overhead but this is somewhat dependent on the age of the patient, the strength of the deltoid muscle and the presence of some remaining rotator cuff tissue.

On average patients can expect to be able to raise the arm above shoulder level to 140 degrees, external rotation for 45 degrees, and internal rotation behind back to their beltline by one year after surgery. Most patients rate their pain from 0.5 - 1 out of 10 and rate their shoulder function as a percentage of normal as 95% - 90%. Your ability to rotate the arm outward is dependent on the presence of some intact rotator cuff tendon as well. The reverse also improves strength when lifting away from the body.

After a reverse shoulder replacement, some patients will lose some motion reaching behind the back. Most patients will be able to reach their belt line or back pocket but some can go a little higher. For patients with shoulder dislocation problems, shoulder stability is reliably restored. However, the risk of early dislocation following a reverse shoulder replacement is slightly greater than a standard replacement and can occur in up to 2-3% of patients.

After recovery, most patients can be very active. You can golf, play tennis, swim, hunt, do light yard work and garden. We recommended that patients do not routinely lift more than 50 pounds overhead after surgery, but there are no lifting and push/pull restrictions below shoulder height.

Patients with shoulder replacement can perform light and medium demand labor jobs; however, it is not designed for sustained heavy manual labor. It is better to implant longevity to lift lighter weights with higher repetitions. Long-term durability of the reverse replacement is not known; the more you take care of your shoulder the longer it will likely last. Dr. Sanders expects 90% of properly done modern implants to last 20 years.

Shoulder replacement surgeries commonly performed by Dr. Sanders

• Anatomic total shoulder arthroplasty

• Reverse total shoulder arthroplasty

• Pyrocarbon hemiarthroplasty

• Conversion of anatomic to reverse total shoulder arthroplasty

• Revision reverse total shoulder arthroplasty

• Explant of total shoulder arthroplasty for infection

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Frequently Asked Questions

Anatomic & Reverse Total Shoulder Arthroplasty

What is shoulder arthroplasty?

Shoulder arthroplasty—also known as shoulder replacement—is a surgery that replaces the damaged parts of your shoulder joint with metal and plastic components. It’s used to relieve pain and restore movement in patients with arthritis, joint damage, or major rotator cuff problems.

What’s the difference between anatomic and reverse shoulder replacement?

• Anatomic shoulder replacement uses implants that mimic the natural shape of your shoulder and is ideal for patients with arthritis and an intact rotator cuff.

• Reverse shoulder replacement reverses the ball and socket to shift the work to the deltoid muscle. It’s best for patients with severe rotator cuff damage or failed previous surgeries.

How do I know which type of shoulder replacement I need?

Dr. Sanders will determine the best type of replacement based on your symptoms, physical exam, imaging studies (like X-rays or MRIs), and the condition of your rotator cuff and bone structure.

What are the main benefits of shoulder replacement surgery?

• Significant pain relief

• Improved range of motion

• Better shoulder function

• Ability to return to daily activities and low- to moderate-impact sports

How long do shoulder replacements last?

• Anatomic replacements typically last 10+ years in more than 90% of patients.

• Reverse replacements are expected to last in over 90% of patients at 20 years with proper care and modern implants.

Will I be able to return to normal activities?

Yes. Most patients return to activities like:

• Golf

• Tennis

• Swimming

• Hunting

• Gardening

• Light to moderate physical work

Heavy, repetitive overhead labor is discouraged to prolong the life of your implant.

What should I avoid after shoulder replacement?

• Lifting more than 50 pounds overhead (especially after reverse replacement)

• High-impact or contact sports

• Repetitive heavy lifting or pushing above shoulder height

What kind of pain relief can I expect?

Most patients report:

• Anatomic replacement: Significant or complete pain relief, average less than 1 out of 10 pain scale.

• Reverse replacement: Over 90% experience major pain improvement; some may have mild, occasional muscle soreness with a average of less than 1 out of 10 pain scale.

How long is the recovery time?

Most patients:

• Wear a sling for a few weeks after surgery

• Start physical therapy early to restore motion

• Gradually return to activities over 3 to 6 months

• Reach maximum improvement by 9 to 12 months

Are there risks with shoulder replacement surgery?

As with any surgery, there are risks, including:

• Infection

• Implant loosening or wear over time

• Dislocation (more common in reverse replacements)

• Nerve or blood vessel injury (rare)

Dr. Sanders will discuss these risks in detail and take every precaution to ensure a safe and successful outcome.

Why choose Dr. Sanders for your shoulder replacement?

Dr. Eric J. Sanders is a fellowship-trained shoulder and elbow surgeon who performs hundreds of shoulder replacements each year. He uses advanced techniques, personalized care, and the latest technology—including 3D planning and custom implants—to ensure the best possible results.