shoulder replacement surgery, what are your options?

Considering shoulder replacement surgery? Options and what to expect

Shoulder replacement surgery is a procedure that is done to reduce pain and restore overall shoulder mobility. There are several types of shoulder replacement surgery, the most common include: reverse shoulder replacement, partial shoulder replacement and shoulder resurfacing.

As with many surgical procedures, shoulder replacement surgery is often highly successful, but typically pursued only after other non-surgical options have been exhausted. Before recommending surgery, your orthopedic surgeon will want to ensure you are a good candidate and determine which type of surgery is best for you. A few of the most common types of shoulder replacement surgery include:

Total shoulder replacement surgery

The traditional shoulder replacement procedure has been done in the United States for more than 70 years[1] and replaces a person’s natural “ball and socket” shoulder structure.

In this procedure, the damaged shoulder parts, commonly known as the “ball” and “socket” are replaced with prostheses (artificial parts). The socket, where the shoulder blade connects to the top of the arm bone, known as the humorous, receives a prosthetic cup and then is reconnected to a metal ball that has replaced the end of the humorous.

This procedure relies on a healthy rotator cuff muscle to stabilize and move the shoulder upon recovery.

Reverse shoulder replacement (also known as reverse total shoulder arthroplasty)
A reverse shoulder replacement is often recommended when there has been a major rotator cuff tear or deterioration (often due to arthritis), causing those muscles not to work properly anymore. In this procedure, the ball and socket arrangement are reversed, which allows for the deltoid muscle to control movement of the shoulder post-surgery instead of the rotator cuff. In this set-up, instead of being attached to the humorous, the metal ball is affixed to the damaged socket, while a socket-shaped cup replaces the ball at the top of the arm bone.

Partial shoulder replacement  

There are a couple of types of partial shoulder replacement. The first, known informally as a “ream and run,” keeps the natural socket intact and only replaces the head of the humorous (the “ball”) with a prosthetic ball.  If needed, the surgeon will also reshape or smooth the socket tissue to ensure the best possible shoulder joint movement for the new ball.

The second common type of partial shoulder replacement is known as shoulder resurfacing. In this procedure, rather than removing the damaged head of the humorous, it is topped with a round cap to improve joint movement.  The natural socket also remains in place.

When should I consider shoulder replacement surgery?

No matter which type of shoulder replacement is best for your condition, shoulder replacement surgery is often considered when there has been severe trauma, such as a shoulder fracture, or for those whose arthritis has progressed considerably. In these cases, other treatments, such as physical therapy, ice, rest, NSAIDs (non-steroidal anti-inflammatory drugs, like Advil) or cortisone shots are no longer effective at maintaining range of motion and minimizing pain. Patients often have severe stiffness, limited range of motion and even a grinding sensation when they move their arm.

While shoulder replacement surgery is highly successful for most patients, there are some circumstances when the procedure should not be pursued. These include but are not limited to people who have who have more severe impairment of both the rotator cuff and deltoid muscles, those recovering from an active infection, and people who have a progressive nervous system disease such as Parkinson’s.

Qualified orthopedic surgeons work closely with each patient, using physical examination, review of symptoms and overall health, and imaging resources such as an Xray, CT scan or MRI to make case-by-case recommendations. If nerve damage is suspected, an EMG test may also be conducted.

Preparing for surgery

How you prepare for shoulder replacement surgery can impact your recovery experience and timeline. Your level of fitness, weight and other factors all play a part in improving your outcome and minimizing your recovery time.

In addition, plan to have friends or family members available to take you and bring you home and give you support in the first few days or weeks post-operation. Expect to have limited strength and range of motion at first while you begin to heal. Don’t forget to plan support for everyday essentials immediately after the procedure, such as bathing, dressing, laundry, driving etc.

Shoulder replacement surgery is typically completed in a hospital or surgical center and most procedures take a couple of hours or less. After surgery, some patients are able to head home the same day, while others remain in the hospital for a few days.

Naturally, patients feel some pain after surgery, most can be managed with mild pain relievers (NSAIDs) or local anesthetics. Surgeons recommend minimizing the use of opioid pain relievers, which are highly addictive.

Recovery after shoulder replacement surgery

Your surgeon will provide specific instructions, such as what to wear post-surgery (hint: a button up shirt is often easiest to put on after the procedure) and send you home in a sling, which will protect your shoulder for the first 2-4 weeks as it heals. You will also need to take care of the incision site, keeping it clean and dry as it heals.

Depending on the type and nature of the surgery, it can take three to six months to fully heal.  During that time, physical and/or occupational therapy is extremely valuable to help regain strength and ensure full mobility. Many patients are referred to therapy almost immediately after surgery. Your surgeon will likely provide a home exercise plan for the first few weeks and then may recommend working with a professional therapist as you progress.

Many patients enjoy a noticeable reduction in pain after surgery but take care not to overdo it during recovery. Avoid lifting anything heavy or using your arm to push yourself up to a sitting or standing position. Doing so puts too much pressure on the incision point. Patients should avoid many household tasks and driving for up to a month, so asking for help is essential.

Shoulder replacement surgery can significantly improve quality of life for people who’ve suffered from pain and limited range of motion. If you’re considering your options, see one of our board-certified orthopedic surgeons for a recommendation:

Best Shoulder Replacement Surgeons

James Ferrari, MD

Dr. James Ferrari


H. Andrew Motz, MD

Dr. H. Andrew Motz


John Papilion, MD

Dr. John Papilion


[1] Source: https://orthoinfo.aaos.org/en/treatment/shoulder-joint-replacement/

Rotator Cuff PT Exercises Video

Rotator Cuff PT Exercises

For patients recovering from an injury of the rotator cuff PT exercise are key. PT – or physical therapy – supports the healing of rotator cuff injuries – whether post-surgery, or for someone working to stabilize and strengthen their rotator cuff.

Your doctor or orthopedic surgeon may prescribe rotator cuff PT exercises that you do in a clinic with a specialist, and they may also recommend exercises you can do at home. Physical therapist Carole Reda helps rotator cuff patients on the road to recovery every day. She walked us through three common rotator cuff PT exercises that can be done at home with just a few simple and affordable resistance bands and light weights. Both can be found at most sporting goods stores, or online.

Each exercise is described below and is often done in two “sets” of 10 each, but check with your doctor for your specific needs, and be sure to watch Carole’s demonstration in the video to follow the correct form:

Rotator Cuff PT Exercise #1: The Row
This exercise is excellent for shoulder stability.
1. First, loop the band through a sturdy item like a handrail or door handle and center the band so there are equal amounts of band on each side. [Important safety tip: always avoid looping the band through furniture or any other item that could tip and fall when pulled.]
2. Stand away from the anchor point so that the band is loose in your hands when your upper arms are straight at your side and your elbows are at a 90-degree angle.
3. Then, keeping your shoulders down, slowly pull the band toward you, extending your elbows back and squeezing your shoulder blades together.
4. Keep your motions slow and controlled.

Rotator Cuff PT Exercise #2: Shoulder External Rotation
1. Stand sideways so that the anchor point of your band is on one side of your body. Position the shoulder you want to exercise furthest from the anchor point.
2. Hold the band in your hand, keeping your elbow tight against your body and position your forearm in front of your stomach.
3. Rotate your forearm out and away from your stomach, keeping your upper arm and elbow against your body.

Rotator Cuff PT Exercise #3: “Is, Ys and Ts”
1. I’s: Stand with small weights (or no weight as recommended by your doctor) in each hand. Keep your arms straight and start with your hands by your sides. Raise your arms in front of you until they are even with your shoulder.
2. Y’s: Start in the same position with the weights, but this time raise your arms out at a 45-degree angle from your body, to create a “Y” shape with your arms.
3. T’s: Again, start with your arms at your sides. Raise both arms straight out from each side to shoulder height to make a “T” shape with your body, and then lower them back to your sides.

So, now you know three new rotator cuff PT exercises that can help support your treatment plan. As You can find all of these and more info about physical therapy on our website.

Shoulder Replacement - How to choose the right doctor

What to consider when choosing a shoulder replacement doctor

If you’ve been coping with chronic pain and low range of motion in your shoulder and have exhausted other treatment options, it might be time to look for a shoulder replacement doctor. According to the American Academy of Orthopedic Surgeons (AAOS), more than 50,000 people in the US have shoulder replacement surgery each year, and while it’s not as common as hip or knee replacements, it’s just as effective in improving joint pain for many patients. But having shoulder replacement surgery is still a serious decision, so take time to find the right surgeon for your needs. In addition to reviewing the credentials of a prospective shoulder replacement doctor, you should be sure you’re working with a surgeon who will:

  1. Exhaust non-surgical options first
  2. Evaluate the cause of your shoulder condition
  3. Recommend the right type of surgery for your condition
  4. Thoroughly explain the procedure risks, benefits, process, timeline and recovery
  5. Serve as your health partner following the procedure, monitoring your rehab, recovery and addressing any complications or concerns.

 

  1. Choosing a shoulder replacement doctor: Exhaust non-surgical options first: Before pursuing surgery, an experienced shoulder replacement doctor will first work with you to ensure that you are a good candidate for surgery and determine if other options, such as rest, physical therapy and injections, can give you the relief and activity level you’re seeking. Once those options have been exhausted, surgery may be the most appropriate recommendation.
  1. Choosing a shoulder replacement doctor: Evaluate the cause of your shoulder condition: A shoulder replacement doctor will also want to know the cause of your shoulder damage, which can include a wide range of conditions. These may include various types of arthritis, such as osteoarthritis or rheumatoid arthritis, which cause degeneration of the joints, or less common conditions like Osteonecrosis, in which the blood supply to the joint is limited. Injuries are another major cause of shoulder damage either as a direct result of a fracture or over time due to post-traumatic arthritis.
  1. Choosing a shoulder replacement doctor: Recommend the right type of surgery for your condition: Your surgeon should have experience with and can recommend the type of procedure that is most appropriate for your condition. Depending on the severity and type of injury you have, you may be looking at any of the following types of shoulder replacement surgery.
  • Reverse shoulder replacement surgery is often the best procedure when the rotator cuff or other shoulder tendons have sustained major damage especially if you have arthritis in the shoulder joint.
  • If your damage is isolated to the ball of the humerous (the upper arm bone), your shoulder replacement doctor may recommend partial shoulder replacement.
  • And total shoulder replacementsurgery is often recommended when arthritis has damaged ball and socket.
  1. Choosing a shoulder replacement doctor: Thoroughly explain the procedure risks, benefits, process, timeline and recovery: Look for a shoulder replacement doctor that takes time to explain the procedure to you, including risk and expected outcomes, any pre-surgery preparations and requirements, what to expect on the day of surgery, the anticipated hospital stay, and – perhaps most importantly, the plan for recovery.
  2. Choosing a shoulder replacement doctor: Serve as your health partner following the procedure, monitoring your recovery and addressing any complications or concerns.: While recovery can be lengthy (up to several months), the reward can be significant, with many patients enjoying major improvements in pain and motion after successful surgery and rehabilitation. But a good shoulder replacement doctor will ensure that you understand the commitment and effort required for a successful rehabilitation too, so that you can get back to being active and pain free. They will also check in following surgery to check for complications and see you for office visits as you progress.

There are three shoulder replacement doctors within Advanced Orthopedics, all of who are board certified surgeons who specialize in shoulder replacement and repair of other shoulder conditions.

James Ferrari, MD

Dr. James Ferrari


H. Andrew Motz, MD

Dr. H. Andrew Motz


John Papilion, MD

Dr. John Papilion


If shoulder pain is severely limiting your daily activities or range of motion, and any of these descriptions apply, it might be time to raise your hand for shoulder replacement surgery. Contact our office to set an appointment.

Shoulder Replacement

When is it time to consider shoulder replacement surgery?

And what type of surgery is right for you?

Shoulder replacement surgery requires careful thought and planning, but for those who’ve exhausted other treatment options, it can be the best way to restore range of motion, relieve pain and help you return to an active lifestyle.

Many different conditions can lead to the severe pain and joint degeneration that necessitates a shoulder replacement, including various types of arthritis (osteoarthritis, rheumatoid arthritis, post-traumatic arthritis), serious fractures, or a combination of muscle tears and arthritis (such as rotator cuff tear arthropathy).

Understanding the source and nature of your shoulder pain will allow your orthopedic specialist to recommend the right procedure. Depending on the severity and type of condition, there are three types of shoulder replacements that are often considered.

Partial shoulder replacement surgery is often recommended when there is major damage to the head or ball of the upper arm bone (humerus), but the rest of the shoulder is healthy and intact. In this procedure, the ball portion of the upper arm bone is removed and replaced with metal.

Total shoulder replacement surgery is typically used to address arthritis and replaces both the damaged ball (the head of the humerus bone) and socket with metal and/or plastic. While total shoulder replacement recovery can take several months, patients often experience significant improvements in pain and motion following successful surgery and rehabilitation.

Otherwise healthy adults whose rotator cuff and deltoid are intact tend to be good candidates for total shoulder surgery. While there are few age or weight limits obesity, nicotine use and advanced age always increase the risk for post-surgical complications. Patients with severe osteoporosis or susceptibility to infections also have higher risks. 

Reverse shoulder replacement surgery may be the best option when there is significant damage to the shoulder tendons, namely the rotator cuff. If the shoulder joint is arthritic and there is a rotator cuff tear that cannot be repaired, a reverse shoulder replacement may be the best option for surgical treatment.

In this procedure, a prosthetic “ball”, usually metal, is placed on the shoulder socket. A plastic “cup” is then placed where the arthritic ball of the shoulder used to be. In doing so, the anatomy of the shoulder is “reversed” and the deltoid muscle is used to move the shoulder rather than the torn rotator cuff tendons.

Advanced Orthopedic has 10 board certifiedsurgeons who specialize in treatment of shoulder issues. The American Academy of Orthopaedic Surgeons considers patients with the following situations potential candidates for reverse rotator cuff surgery:

• A completely torn rotator cuff that cannot be repaired
• Rotator cuff tear arthropathy
• A previous shoulder replacement that was unsuccessful
• Severe shoulder pain and difficulty lifting your arm away from your side or over your head
• A complex fracture of the shoulder joint
• A chronic shoulder dislocation
• A tumor of the shoulder joint
• Patients who have tried other treatments, such as rest, medications, cortisone injections, and physical therapy, that have not relieved shoulder pain

If shoulder pain is severely limiting your daily activities or range of motion,and any of these descriptions apply, it might be time to raise your hand for shoulder replacement surgery. Contact our office to set an appointment.

Best Shoulder Surgeons

A. Todd Alijani, MD

Dr. A. Todd Alijani



Dr. Mark Failinger


James Ferrari, MD

Dr. James Ferrari


Wayne Gersoff, MD

Dr. Wayne Gersoff


Davis Hurley, MD

Dr. Davis Hurley


Cary Motz, MD

Dr. Cary Motz


H. Andrew Motz, MD

Dr. H. Andrew Motz



Dr. Justin Newman


John Papilion, MD

Dr. John Papilion


Dr. Micah Worrell

Dr. Micah Worrell