Total Shoulder Replacement Surgery: Causes, Diagnoses, Results

A total shoulder replacement surgery is a highly beneficial procedure that treats the intense pain, stiffness, and discomfort caused by different forms of arthritis affecting the shoulder. Doctors often recommend the procedure to patients suffering from the end stages of shoulder arthritis. Also referred to as a total shoulder arthroplasty, this procedure often restores the shoulder to its full range of motion while reducing pain and stiffness.

A total shoulder replacement surgery involves removing the damaged parts of the shoulder and replacing them with artificial parts. This is a very common procedure, with an estimated 53,000 total shoulder replacement surgeries occurring yearly.

In this blog, we’re going to go over the causes and symptoms leading up to a total shoulder replacement surgery, as well as the diagnostic, surgical, and recovery process. Have a question about having a total shoulder replacement surgery in North Carolina? Please don’t hesitate to reach out to us directly here at Wilson Shoulder.

Who is a Candidate for Total Shoulder Replacement? Causes and Symptoms

A total shoulder replacement is ideal for patients suffering from intense pain as a result of late-stage shoulder arthritis and similar conditions. You should consider a total shoulder replacement surgery if non-surgical methods of treatment are no longer effective in controlling your shoulder pain.

Your shoulder has three key parts that keep it moving comfortably and efficiently: the ball (humeral head), socket (glenoid), and the rotator cuff that helps holds the two together.

Shoulder arthritis is a medical condition in which the smooth cartilage of the shoulder ball and socket is worn away and destroyed from degeneration, injury, inflammation and other conditions. It is characterized by severe pain and limited mobility.

Essentially, as the cartilage wears down and is destroyed, it results in “bone on bone” contact—an extremely painful condition of the shoulder.

What Kinds of Arthritis Cause This?

When it comes to the shoulder, there are two main types of arthritis we frequently see in total shoulder replacement surgeries.

  • Osteoarthritis of the shoulder can be caused by years of overuse. We often see this in athletes like tennis players and weight lifters. Additionally, serious injuries on the rotator cuff and shoulder can, over time, contribute to osteoarthritis.
  • Some forms of inflammatory arthritis–the causes of which are usually unknown–may also be alleviated from a total shoulder replacement surgery.

Other Causes for Total Shoulder Replacement Surgery

There are a number of other conditions or injuries that may require a total shoulder replacement surgery over time. Typically, these conditions worsen over time causing different forms of arthritis to develop. Some of these conditions include:

  • A painful condition known as avascular necrosis occurs when the bone loses its supply of blood. As a result, the bone cells will die and painful arthritis may develop.
  • When a patient has a longstanding and severe rotator cuff tear, it may lead to the development of rotator cuff tear arthropathy. This often results in shoulder osteoarthritis and destruction of the cartilage in the shoulder joint.

What Does the Diagnostic Process Look Like?

To begin, a patient or doctor may begin to consider a total shoulder replacement if the following symptoms are present:

  • Intense shoulder pain
  • Limited mobility
  • A grinding or grating sensation within the shoulder
  • Progressive stiffness or loss of motion

Next, the doctor will likely take a series of X rays of the shoulder to determine if a replacement surgery is needed. To get a closer look at the patient’s bone structure, as well as any surrounding tissue, the doctor may then recommend a CT scan or an MRI.

Finally, if the doctor believes that there is nerve damage as a result of shoulder osteoarthritis, they will order an EMG test. This test allows the doctor to see if any nerves in the shoulder area are impacted.

Is Surgery the Only Option?

In some patients, certain preventative or moderative methods may be prescribed before a total shoulder replacement is recommended. This commonly includes physical therapy of the shoulder, anti-inflammatory medication, and corticosteroid injections.

However, if these treatment methods are not effective at controlling shoulder pain and mobility, then the patient should consider surgery.

An Overview of the Surgical Process

A total shoulder replacement surgery usually takes about two hours. The patient is sedated with general anesthesia and has the ball and socket of their shoulder replaced.

Here is a general step-by-step overview of the surgical process for a total shoulder replacement:

  1. To minimize nerve damage, the surgeon will enter the shoulder area by separating the deltoid and pectoral muscles. This part of the shoulder is largely free of nerves.
  2. Next, the surgeon enters the shoulder by cutting through a muscle of the rotator cuff. This allows the surgeon to access the arthritic parts of the shoulder ball and socket.
  3. The surgeon removes the damaged and arthritic parts of the shoulder ball and socket.
  4. The new implant ball, socket, and stem are inserted in place of the damaged parts.
  5. The incision is stitched back up, cleaned, and covered with a bandage.

Depending on the severity of the osteoarthritis, there are a few different options for replacing the ball and socket the surgeon may opt to use.

Typically, a metal ball is used to rest against a polyethylene (plastic) shoulder joint. The plastic socket is normally placed over the patient’s existing glenoid, and attached to a stem that extends down the patient’s humerus bone. The plastic socket is cemented to the existing bone so that it attaches immediately.

How Should a Patient Prepare for Surgery?

In the weeks leading up to the surgery, your surgeon will likely perform a full body exam to ensure that you’re healthy and your body is able to handle a surgery.

They’ll likely also recommend you stop taking certain medications, including blood thinners, that may cause you to bleed too much during surgery. These include anti-inflammatory and arthritis medications.

Are Surgical Complications a Possibility?

While there is always a chance that complications from the surgery may arise, it is highly unlikely with a total shoulder replacement surgery. The complication rate for a total shoulder replacement surgery is 5%.

For this specific type of surgery, some of the complications that are possible include:

  • Nerve injury
  • Infection
  • Shoulder stiffness
  • Instability
  • Glenoid (shoulder “socket”) loosening

How Long is the Recovery Process?

All in all, the recovery process is usually around six to eight weeks, but returning to normal activity often takes longer and requires physical therapy.

On the day after the surgery, your doctor will take an X ray to make sure everything is correctly positioned within your shoulder. If everything looks good, physical therapy will start immediately. Right away, the patient should begin to notice that their shoulder mobility is a little easier, and they shouldn’t experience any of the grinding that occurred from the arthritis.

The shoulder and arm are then placed in a sling to ensure that the tendons in the shoulder have time to heal.

The Gradual Return of Shoulder Mobility and Strength

A man in a green outfit swinging a golf club.

After about six weeks or so, you should regain full mobility of your shoulder and arm. At this point, you should be able to use your full arm for light activities.

At the eight week period, you should be able to return to unrestricted activity. However, you’ll likely notice some weakness in the shoulder and arm. After six months, you should be pain-free (aside from the occasional weather-related ache) with your strength restored about 60-70% or so. Finally, after about a year has passed, you should be returned to full strength and full mobility of your shoulder and arm.

Your North Carolina Shoulder Specialist

If you’re suffering from shoulder arthritis or severe shoulder pain and want to explore your options, please don’t hesitate to contact my team and I. As a longstanding orthopedic surgeon and North Carolina shoulder specialist, I’m here to provide information, resources, and support.


The material contained on this site is intended for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE– it is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always consult with a physician or a qualified healthcare provider directly with any questions or concerns you may have regarding your health.