Shoulder Replacement Surgery: Indications, Options, and What to Expect

When the Shoulder Joint Wears Out

The shoulder is a ball-and-socket joint formed by the head of the humerus (upper arm bone) and the glenoid — the shallow socket of the scapula. The joint surfaces are covered by smooth articular cartilage that allows near-frictionless movement. When that cartilage is destroyed — by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis following a fracture or dislocation, or avascular necrosis — the result is chronic pain, stiffness, loss of motion, and significant impairment in daily function.

Shoulder replacement surgery resurfaces or replaces the damaged joint with prosthetic components, eliminating the bone-on-bone contact that drives pain. It is among the fastest-growing orthopedic procedures in the United States, with outcomes that consistently show marked improvement in pain and function for appropriately selected patients.

Who Is a Candidate?

Shoulder replacement is considered when pain and functional limitation from shoulder arthritis or structural damage are severe, persistent, and have not responded adequately to conservative measures. Typical candidates have:

• Significant pain with activity and at rest, including sleep disturbance from shoulder pain
• Loss of shoulder motion that limits daily activities such as reaching overhead, dressing, or personal hygiene
• X-ray evidence of joint space narrowing, bone spur formation, or structural deterioration consistent with the clinical presentation
• Prior non-surgical treatment — physical therapy, corticosteroid injections, anti-inflammatory medications — that has not produced acceptable pain relief

Age alone is not a criterion. The decision is based on symptom severity and functional impact.

Types of Shoulder Replacement

Anatomic total shoulder replacement (TSA) replaces both the humeral head and the glenoid socket with prosthetic components that replicate the normal joint geometry. It is the preferred option when the rotator cuff is intact and functioning, and it produces excellent results for osteoarthritis and inflammatory arthritis.

Reverse total shoulder arthroplasty (RSA) uses a different mechanical design — the ball is placed on the glenoid side and the socket on the humeral side — which changes the way the deltoid muscle powers shoulder motion. RSA is specifically designed for patients who have rotator cuff tear arthropathy (advanced arthritis combined with a large, irreparable rotator cuff tear), or for older patients with complex fractures and cuff insufficiency. It has also expanded to become the most commonly performed shoulder replacement overall because of its broad applicability and predictable outcomes.

Hemiarthroplasty replaces only the humeral head and is used in specific circumstances, such as proximal humerus fractures where the glenoid surface remains intact.

Recovery and Outcomes

Shoulder replacement is performed under general anesthesia, typically with a regional nerve block for post-operative pain control. Most patients go home the same day or after an overnight stay.

The first six weeks focus on protecting the repair — particularly the subscapularis tendon, which must be divided to access the joint and allowed to heal after closure. A sling is worn during this period, and motion is guided by a structured physical therapy protocol that begins within days of surgery.

By three to four months, most patients have regained substantial motion and are performing daily activities with reduced pain. Full recovery to maximum function typically takes six to twelve months.

Published outcome data for shoulder replacement are favorable. Survival rates for anatomic TSA and RSA exceed 90 percent at ten years, and the vast majority of patients report meaningful improvement in pain and quality of life. Patients who found it difficult to sleep, dress, or work before surgery typically report significant restoration of these activities afterward.

If you're experiencing severe shoulder pain from arthritis or structural damage, the specialists at Maryland Orthopedic Specialists can help. Call (301) 515-0900 or [schedule an appointment online](https://www.mdorthospecialists.com/contact).