Types of shoulder replacement and restrictions to consider after surgery

When arthritis or pain in your shoulder becomes severe enough to affect your daily life, you might consider shoulder replacement surgery. There are many options, ranging from total replacement surgery to partial. The best option for you depends on your specific needs, concerns and goals for your body.

Your shoulder joint is like a ball and socket: the round top of your humerus bone in your upper arm rests within a shallow cup on your shoulder blade. Wear and tear, injuries or arthritis can damage the joint over time. Shoulder replacement surgery offers pain relief by replacing parts of the joint.

“Shoulder replacement surgery offers pain relief by replacing a portion or all of that joint – either the ball alone or both the ball and socket,” said Dr. Mark Dillon, an orthopedic surgeon at IU Health specializing in shoulder injuries and disorders.

Recovery typically involves wearing a sling for six weeks after surgery. Physical therapy can help improve range of motion, and it’s followed by strengthening. Implants used in these surgeries ideally last 15 years or longer. So, having more than one surgery during a lifetime is possible. Talk with your doctor about your needs and goals to determine the best type of shoulder replacement.

Anatomic Total Shoulder Replacement Surgery

A patient with severe shoulder pain, joint stiffness and grinding may be a candidate for anatomic total shoulder replacement surgery. This pain is often caused by conditions like degenerative arthritis that can’t be relieved by partial replacement surgery.

Anatomic total shoulder replacement surgery replaces the damaged top of the humerus bone with a metal ball. A plastic liner is then secured to the shoulder socket. This new joint allows the shoulder to move freely. Within three months, most patients feel better than they did before shoulder replacement surgery.

A total replacement offers excellent pain relief and can restore range of motion. However, there are permanent restrictions after shoulder replacement surgery.

“We recommend that patients not lift more than 25 pounds after total replacement surgery,” Dr. Dillon said. “Activities such as weightlifting and pushups can damage the socket.” This surgery also risks complications like hardware loosening, socket wear and rotator cuff tears.

Reverse Total Shoulder Replacement Surgery

Reverse total shoulder replacement surgery was approved for use in the United States in 2004. It is a relatively new option for patients with arthritis and a rotator cuff tear. The rotator cuff is a group of muscles that keep the arm in the shoulder socket.

Reverse total replacement surgery is historically recommended for people over 70, although its use is expanding. It is also recommended for patients with fractures or other inflammatory conditions, such as rheumatoid arthritis. It is also often used to redo or revise prior shoulder replacements.

“This surgery reverses the anatomy of a patient's shoulder. First, the top of the humerus bone is hollowed out into a socket shape. A ball is then attached to the existing socket. The reversal of the ball and socket changes how a shoulder moves, recruiting new muscles for improved motion,” Dr. Dillon said.

This surgery has many of the same risks and permanent lifting restrictions as anatomic total shoulder replacement. Reverse surgery can also limit your shoulder rotation, which can make it more challenging to reach behind you in certain cases.

Partial Shoulder Replacement Surgery

A partial shoulder replacement surgery repairs the top of the humerus bone by drilling into the bone and attaching a metal ball "head." In the past, surgeons used resurfacing shoulder replacement surgery to avoid drilling deep into the bone. However, stemless implants now allow partial surgeries to do the same.

“The benefit of a partial shoulder replacement surgery is there are no permanent lifting restrictions. If I have a younger patient or a body builder, this could be an option worth discussing,” Dr. Dillon said. “It is also beneficial for people with conditions that affect the humerus ball, such as avascular necrosis.”

There are some risks to partial shoulder replacement. Pain relief with a partial shoulder replacement may not be as complete as a total replacement and can take longer to achieve. The partial shoulder replacement may also wear out the original bone socket, requiring additional surgery.

Revision Shoulder Replacement Surgery

When a shoulder replacement surgery does not work as expected, a revision surgery replaces the old implants with new ones. This may be necessary due to instability, infection, fractures, rotator cuff tears or loosening implants. The procedures vary and depend on a patient's needs and previous replacement or surgery. Revisions often involve anatomic or reverse total shoulder replacements.

With each shoulder replacement surgery, more bone is removed, leaving orthopedic surgeons with less material to use. Repeated surgeries also increase the risk of infection.

Recovery after revision shoulder surgery can vary depending on the type of surgery performed. However, existing scar tissue or prolonged damage can lead to a longer recovery.

“It’s difficult to predict the functional outcomes or recovery time for these revision surgeries because you are redoing work on the bone,” Dr. Dillon said. “There are many more factors to consider in these complicated cases.”

There are various surgical options for shoulder repair. Speak to your doctor to identify what is most important to you. To continue learning about these options, visit the American Academy of Orthopaedic Surgeons.