Total Shoulder Replacement

What this procedure is

Total shoulder replacement is a surgery that replaces a damaged shoulder joint with artificial parts, known as prostheses. The shoulder is naturally a ball-and-socket joint. During this procedure, a surgeon replaces the rounded end of the arm bone (the ball) with a metal part and covers the surface of the shoulder blade (the socket) with a smooth plastic liner.

The main goal of the surgery is to help the joint glide easily again. By replacing the rough, damaged surfaces of the joint with smooth artificial ones, the procedure aims to reduce pain and help you move your arm more comfortably during daily tasks.

What it treats or fixes

This procedure is most often used to treat severe pain and stiffness caused by various forms of arthritis. This includes osteoarthritis, which is wear-and-tear that happens over time, and rheumatoid arthritis, a condition where the immune system affects the joints. It may also be used to treat severe bone fractures or a condition called avascular necrosis, which occurs when bone tissue dies because it loses its blood supply.

Your clinician may recommend this surgery if your shoulder pain is so severe that it interferes with sleep or makes it hard to do simple things like washing your hair or getting dressed. It is usually considered after other treatments have not helped enough, such as:

• Physical therapy and exercise.
• Anti-inflammatory medications.
• Cortisone injections to manage swelling.

How common it is & where it's done

While hip and knee replacements are more frequent, shoulder replacement is a common and successful surgery. Thousands of people in the U.S. and Canada undergo this procedure every year. Modern techniques and materials have made it a reliable option for improving a person's quality of life and range of motion.

The surgery is typically performed in a hospital or a specialized outpatient surgery center. Depending on your health and your clinician's advice, you may stay in the hospital for a day or two to recover. In some specific cases, certain patients may be able to return home on the same day as the procedure.

Recovery: What to Expect

After surgery, you will likely stay in the hospital for one to three days. Your arm will be placed in a sling (a supportive strap) to keep your shoulder still while it heals. Your clinician may ask you to wear this for four to six weeks. You will likely begin gentle physical therapy—exercises to help you move and strengthen your joint—shortly after the procedure.

At home, you may need help with daily tasks like bathing, dressing, and cooking for several weeks. It is important to follow your exercise plan carefully. Most people can return to light activities within a few weeks, but full recovery often takes several months.

Risks & Possible Complications

While most shoulder replacements are successful, every surgery has some risks. These may include infection, blood clots, or the new joint loosening over time. In some cases, the replacement joint could move out of place, which is called dislocation.

Your care team will give you specific instructions on how to stay safe. You should contact your clinician if you notice any of the following:

• A fever or chills.
• Redness, warmth, or unusual drainage around your incision.
• Sudden, severe swelling in your arm or hand.
• Pain that is not helped by your prescribed medication.

Outcomes & Long-Term Results

The primary goal of this surgery is to relieve the chronic pain caused by arthritis or injury. Most patients experience significant pain relief and a better range of motion, allowing them to return to daily activities and low-impact hobbies like swimming or golf.

Modern shoulder implants are designed to be very durable. Many last for 15 to 20 years. To help your new shoulder last as long as possible, your clinician may suggest avoiding heavy lifting or high-impact sports that put a lot of stress on the joint.

Emotional Support & Reassurance

It is completely normal to feel nervous about having a joint replacement. Preparing your home ahead of time and having a support system of family or friends can help you feel more confident. Focus on the progress you make each week during physical therapy rather than rushing the process.

This procedure is a well-established way to help people regain their independence. Your healthcare team is dedicated to your comfort and will work with you to manage pain and guide you through every step of your healing journey.

Why doctors recommend it

Clinicians typically recommend total shoulder replacement when the joint is severely damaged and causes constant discomfort. The most common cause is osteoarthritis, a "wear-and-tear" condition where the smooth cartilage that cushions the bones wears away. Other reasons include rheumatoid arthritis or severe injuries to the rotator cuff, which is the group of muscles and tendons that hold the shoulder in place.

This procedure is usually considered after other treatments have not worked well enough. Your clinician may first suggest options such as:

• Physical therapy to strengthen the surrounding muscles.
• Anti-inflammatory medications to reduce swelling and pain.
• Injections, such as cortisone, to help manage symptoms temporarily.

If these treatments no longer help you perform daily tasks or get a good night's sleep, a replacement may be the next step to improve your quality of life.

Urgent vs planned treatment

In most cases, shoulder replacement is a planned, or elective, surgery. This means you and your care team have time to discuss the benefits and prepare your home for recovery. It is often the result of a long-term conversation about managing chronic pain that has gradually worsened over several years.

Sometimes, the surgery may be needed more quickly. This can happen if you experience a severe fracture, which is a complex break in the shoulder bones. If the bone is broken in a way that cannot be repaired with screws or plates, a clinician may recommend replacing the joint to help the arm heal and function properly.

Goals of treatment

The primary goal of this surgery is to provide significant relief from chronic pain. By replacing the damaged bone and cartilage with smooth metal and plastic parts, the "bone-on-bone" friction that causes discomfort is removed. Many patients find they can sleep more comfortably and feel less stiffness after they have recovered.

Another important goal is to improve range of motion, which is the ability to move your arm freely in different directions. Success in this area often means being able to perform everyday activities again, such as:

• Reaching for items on a shelf.
• Grooming and getting dressed without assistance.
• Lifting light objects more easily.

While the surgery aims to make the shoulder feel much better, the ultimate goal is to help you return to a more active and independent lifestyle with a joint that feels more stable.

Who may benefit

Total shoulder replacement is often considered for people with severe shoulder pain that makes daily life difficult. This includes trouble reaching into a cupboard, getting dressed, or washing. If your pain is so constant that it keeps you awake at night, your clinician may suggest this procedure to help you find relief.

This surgery is usually for those who have tried other treatments first. These might include physical therapy, anti-inflammatory medicines, or cortisone injections (medicine shots that reduce swelling). If these options no longer provide enough relief, replacing the damaged joint may help restore comfort and movement.

Common reasons for the surgery include osteoarthritis, which is "wear and tear" of the joint cartilage. Other reasons include rheumatoid arthritis (a condition where the immune system attacks the joints) or severe shoulder fractures. It may also be used for osteonecrosis, a condition where the bone tissue dies because it does not get enough blood flow.

When it may not be the right option

While many people find relief through surgery, it is not the right choice for everyone. If you have an active infection in your body, your care team will likely wait until it is cleared before considering surgery. This helps prevent complications during the healing process.

The surgery also requires healthy bone and muscle to support the new joint. If the bones in the shoulder are too weak or if the rotator cuff—the group of muscles and tendons that hold the shoulder in place—is severely damaged, a standard total shoulder replacement might not be the best fit. In those cases, your clinician may discuss other types of procedures, such as a reverse shoulder replacement.

Finally, surgery may not be recommended if your symptoms are mild or if they can still be managed with non-surgical methods. Your care team will look at your overall health and activity level to decide if the procedure is the safest path forward for you.

Questions to ask your care team

Deciding on surgery is a big step. It is helpful to talk openly with your healthcare providers about what to expect. You may want to bring a list of questions to your next appointment to help you feel more confident in your choice:

• What are the specific risks and benefits for my health history?
• How long will the recovery process take, and when can I return to my daily activities?
• What kind of physical therapy will I need after the surgery?
• How long do shoulder implants typically last?
• What activities should I avoid once I have fully healed?
• Are there any other non-surgical options we should try first?

In the procedure room

When you are moved into the procedure room, the surgical team will help you get into a comfortable and stable position. You may be placed in a sitting position (similar to a beach chair) or lying on your side. This allows the surgeon to have the best access to your shoulder joint.

The team will clean the skin around your shoulder with a special soap to help prevent infection. They will also place sterile drapes around the area to keep the site clean during the process. You will have several small sensors placed on your body to track your vitals throughout the surgery.

High-level steps

The surgeon begins by making an incision (a surgical cut) over the shoulder to reach the joint. They carefully remove the damaged "ball" at the top of your humerus (upper arm bone) and the worn-out surface of the "socket" in your shoulder blade. These damaged areas are often the cause of pain and stiffness.

Once the damaged bone is removed, the surgeon replaces it with artificial parts called prosthetics:

• A metal ball is attached to a stem that fits inside your upper arm bone.
• A smooth, durable plastic surface is placed into the socket of your shoulder blade.

These new parts are designed to glide together smoothly. Once the parts are in place, the surgeon tests the movement of the joint before closing the incision with stitches or staples.

Anesthesia and pain control

Your care team will use anesthesia to make sure you are comfortable and do not feel pain during the surgery. Most patients receive general anesthesia, which puts you into a deep sleep. Your clinician may also suggest a regional nerve block, which is an injection that numbs the nerves in your arm and shoulder for several hours.

Using a nerve block can help you feel more comfortable immediately after you wake up. Your anesthesia provider will discuss the best options for you based on your health history and the type of surgery being performed.

Monitoring and safety steps

Safety is a top priority during the procedure. A dedicated specialist will monitor your heart rate, blood pressure, and oxygen levels every few minutes. This constant monitoring ensures that your body is reacting safely to the anesthesia and the surgery.

To further protect you, the team may give you antibiotics through an IV (a small tube in your vein) before and during the procedure. This is a standard step to help lower the risk of infection in the new joint.

Immediately after the procedure

After the surgery is finished, you will be moved to a recovery room. Nurses will check on you frequently as you wake up from the anesthesia. It is normal to feel groggy, thirsty, or slightly chilly during this time. You may also notice some numbness or a heavy feeling in your arm if a nerve block was used.

Your arm will typically be placed in a sling or a special brace to keep the new joint stable and protected. Your clinician may encourage you to do simple breathing exercises or gently move your wrist and fingers to help with blood flow while you rest.

Typical procedure length

A total shoulder replacement usually takes between one and three hours to complete. The exact time can vary depending on the condition of your bone and the specific type of prosthetic parts being used. Your surgical team will keep your family or loved ones updated on your progress during this time.

Common approaches (open vs minimally invasive)

To perform a shoulder replacement, your surgeon needs to access the damaged joint. According to standard procedures, the surgeon typically makes an incision (cut) over the shoulder joint. This incision is often about 4 to 6 inches long. This approach allows the surgical team to clearly see the bones and muscles, ensuring the new parts are placed accurately.

The specific technique used can vary based on your anatomy and the surgeon’s preference. While the goal is always to be as gentle as possible with the surrounding tissues, a standard incision is common to ensure the artificial joint fits correctly. Your clinician will discuss which surgical approach is safest and most effective for your specific needs.

Partial vs total

There are different ways to replace the shoulder joint depending on how much of the bone and tissue is damaged. Your doctor will recommend the option that best fits your condition.

• Total Shoulder Replacement: This is the most common procedure for arthritis. The surgeon replaces the damaged ball at the top of the arm bone with a metal ball. The damaged socket is replaced with a smooth plastic cup.
• Partial Replacement (Hemiarthroplasty): If the socket is still healthy, your surgeon may replace only the ball. This preserves your natural bone in the socket while providing a smooth surface for the arm to move.
• Reverse Shoulder Replacement: This approach is often used for patients with torn rotator cuff muscles. In this surgery, the positions of the ball and socket are switched. The metal ball is attached to the shoulder blade, and the socket is attached to the arm bone. This design relies on different muscles to move the arm.

Revision or repeat procedures

Artificial shoulder joints are designed to be durable, but they may not last forever. Over many years of use, the implant can wear down or become loose. If the artificial joint loosens or becomes painful, a second surgery—called a revision procedure—may be necessary.

Revision surgery involves removing some or all of the original artificial parts and replacing them with new ones. Because this procedure can be more complex than the first surgery, doctors carefully evaluate when it is truly needed. Regular check-ups help your care team monitor the joint for any signs of wear.

Tests and imaging that may be done

Before surgery, your healthcare team needs to understand the exact shape and condition of your shoulder. You will likely undergo a physical exam to check your range of motion and strength. Your surgeon will also order imaging tests to plan the procedure.

• X-rays: These provide pictures of your bones to show the extent of arthritis or damage.
• CT scan: This test uses computers to create a detailed image of your shoulder bones. It helps the surgeon choose the right size and type of implant.
• MRI: This scan uses magnetic fields to create images of soft tissues. It is often used to check the condition of the rotator cuff muscles and tendons.

To ensure you are healthy enough for anesthesia, you may also need standard health checks. These often include blood tests, a urine test, and an electrocardiogram (EKG) to check your heart rhythm.

Medication adjustments

It is important to tell your surgeon about every medicine you take. This includes prescription drugs, over-the-counter pain relievers, vitamins, and herbal supplements. Some substances can increase the risk of bleeding or interact with anesthesia.

Your surgeon may ask you to stop taking certain medications one or two weeks before the procedure. These commonly include:

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen.
• Blood thinners, such as warfarin.
• Certain arthritis medications.

Only stop medicines if your clinician instructs you. If you are told to continue certain daily medications (like those for heart or blood pressure), you may be instructed to take them with a small sip of water on the morning of surgery.

Day-before and day-of instructions

As your surgery date approaches, your hospital or surgery center will give you specific rules to follow. Following these instructions helps prevent infection and complications.

• Fasting: You will likely be told not to eat or drink anything after midnight the night before surgery. This keeps your stomach empty for anesthesia safety.
• Hygiene: You may need to shower with a special antiseptic soap the night before or the morning of surgery to reduce bacteria on your skin.
• Clothing: Wear loose-fitting clothes to the hospital. A button-down shirt is often best because it is easier to put on over a bandaged shoulder than a pullover shirt.
• What to bring: Bring your insurance card and a list of your medications. Leave jewelry, watches, and other valuables at home.

General surgical risks

As with any major surgery, total shoulder replacement carries some general risks. Your care team takes many steps to lower these risks and monitor your health closely during and after the procedure.

Common general risks associated with surgery and anesthesia include:

• Reactions to anesthesia: Some patients may have trouble breathing or allergic reactions to the medicines used to put them to sleep.
• Infection: Bacteria can enter the surgical wound. This can happen near the skin surface or deeper around the new implant.
• Bleeding: Excessive bleeding can occur during or after the operation.
• Blood clots: Clots can form in the leg veins due to decreased movement after surgery. If a clot travels to the lungs, it can be serious.

Procedure-specific complications

In addition to general risks, there are complications specific to the shoulder joint and the artificial parts used. While most surgeries are successful, it is helpful to be aware of these possibilities.

• Implant issues: Over time, the artificial shoulder components (prosthesis) may wear out or loosen from the bone. In some cases, the ball can slip out of the socket, known as dislocation.
• Nerve or blood vessel injury: Nerves and blood vessels near the shoulder joint can be stretched or injured during the surgery. This is often temporary but can sometimes cause lasting weakness or numbness.
• Stiffness or limited motion: Some patients may not regain full range of motion or may experience stiffness in the shoulder after recovery.
• Fracture: Rarely, the bone around the shoulder implant may break during surgery or afterward if you fall.

How complications are treated

If complications do occur, your medical team has specific ways to manage them. Many issues can be treated without additional surgery.

• Medication: Infections are often treated with antibiotics. Your doctor may also prescribe blood thinners or support stockings to prevent blood clots.
• Physical therapy: If you experience stiffness or weakness, your physical therapist can adjust your exercise plan to help improve flexibility and strength.
• Revision surgery: If the artificial joint becomes loose, wears out, or becomes infected deeply, a second surgery may be needed to replace the components. This is known as revision surgery.

Pain control medicines

Managing pain is a top priority after shoulder surgery. Your care team often uses a "multimodal" approach, which means using different types of medicine together to provide better relief with fewer side effects. Your clinician will tailor this plan to your specific needs and health history.

• Acetaminophen: This common medicine helps reduce pain.
• NSAIDs: Non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen, help lower both pain and swelling (inflammation).
• Opioids: These are stronger pain relievers used for a short time to manage severe pain. Because they can be habit-forming and cause side effects like sleepiness or constipation, they are used only when necessary.

Before surgery, your clinician may also use a nerve block. This is an injection of local anesthetic (numbing medicine) near the nerves in your shoulder to help block pain signals for several hours after the procedure.

Antibiotics

Antibiotics are medicines used to prevent infections caused by bacteria. To help keep your new shoulder joint safe, your surgical team will likely give you antibiotics through an IV (intravenous, or into a vein) shortly before the surgery begins.

In some cases, you may continue taking these medicines for a short time after the procedure. It is important to tell your clinician about any known drug allergies, especially to common antibiotics like penicillin, to ensure the safest choice is made for you.

Blood thinners and clot prevention

After surgery, your activity level may be lower than usual, which can increase the risk of blood clots. To help prevent this, your clinician may prescribe blood thinners, also called anticoagulants. These medicines help keep your blood from forming dangerous clots in your veins.

Common options include:

• Aspirin: Often used for patients at a lower risk for clots.
• Prescription thinners: These may include pills or small injections under the skin, such as warfarin or heparin.

Your care team will decide which medicine is right for you based on your medical history. Be sure to discuss any other supplements or medications you take, as these can sometimes interact with blood thinners and increase the risk of bruising or bleeding.

Emergency warning signs

While serious complications are rare, it is important to act quickly if they occur. Call 911 or go to the nearest emergency room if you experience:

• Sudden chest pain
• Shortness of breath or trouble breathing

These symptoms may indicate a blood clot in the lung, which requires immediate treatment.

Call your surgeon or clinic if…

Contact your healthcare provider if you notice changes in your incision (the cut made during surgery) or how your arm feels. Your care team needs to know if you have:

• Signs of infection: A fever over 101°F (38.3°C), shaking chills, or increased redness, heat, and tenderness around the wound.
• Drainage: Yellow or green fluid leaking from the incision.
• Bleeding: Blood that soaks through your dressing or bandage.
• Nerve or circulation changes: Numbness or tingling in your fingers or hand. Call if your hand feels cool to the touch or looks pale or blue.
• Pain issues: Pain that is not relieved by your prescribed medicine.

Expected vs concerning symptoms

Knowing what is normal during recovery can help you stay calm.

Expected symptomsMost people experience some pain and swelling in the shoulder and arm after surgery. You may also see bruising around the area. These symptoms usually improve gradually as you heal and follow your rehabilitation plan.

Concerning symptomsSymptoms that get worse instead of better need attention. While some swelling is normal, swelling that increases in the arm or hand is a concern. Likewise, pain should generally decrease over time; sudden, sharp increases in pain or pain that prevents you from sleeping despite medication should be discussed with your clinician.

Non-surgical treatments

Before suggesting surgery, your clinician may recommend several non-surgical options to manage shoulder pain and stiffness. These treatments focus on reducing inflammation (swelling) and keeping the joint moving as well as possible.

• Physical therapy: A therapist can teach you specific exercises to strengthen the muscles around your shoulder and improve your flexibility.
• Medications: Over-the-counter medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may help reduce pain and swelling.
• Injections: Corticosteroid injections, often called steroid shots, can be placed directly into the joint to provide temporary relief from severe inflammation.

Watchful waiting

Watchful waiting is a period where you and your clinician monitor your shoulder health without starting new major treatments. During this time, you might make lifestyle changes, such as avoiding heavy lifting or overhead reaching, to see if the pain stays at a manageable level.

This approach allows you to see how quickly your condition is changing. If your symptoms are mild and do not stop you from doing what you love, your clinician may suggest continuing with gentle exercise and regular check-ups rather than moving straight to surgery.

When surgery becomes the best option

Surgery is typically considered when non-surgical treatments no longer provide enough relief. Your clinician may suggest a total shoulder replacement if your pain is so severe that it interferes with daily activities like dressing, washing, or reaching into a cabinet.

Other signs that surgery might be the right choice include:

• Pain that is present even when you are resting or trying to sleep.
• A significant loss of motion in your shoulder that makes it hard to use your arm.
• Weakness in the shoulder that does not improve with physical therapy.

The main goal of the procedure is to help you return to your daily routine with less discomfort and better movement (range of motion).

Hospital services that commonly perform this surgery

Total shoulder replacement is usually performed in hospitals or specialized surgical centers that have a dedicated orthopedic department. Orthopedics is the branch of medicine focused on bones, joints, and muscles. These facilities are equipped with specialized operating rooms and recovery areas designed for joint replacement patients.

Your care team often includes orthopedic surgeons, anesthesiologists (doctors who manage pain and sleep during surgery), and specialized nurses. Many hospitals also have dedicated physical therapy departments where staff help you begin moving your arm shortly after the procedure.

Patient resources and support services

Many hospitals offer educational classes or materials before your surgery. These sessions help you understand what to expect, how to prepare your home, and what exercises you will need to do. You may also receive written guides or videos to help you through the recovery process.

Support services often include:

• Discharge Planning: Social workers or case managers help arrange for any equipment you need at home, such as slings or reaching tools.
• Physical Therapy: Therapists work with you to regain strength and motion in your shoulder. This may start in the hospital and continue at an outpatient clinic.
• Home Health Care: If needed, your clinician may arrange for a nurse or therapist to visit you at home during the first few weeks of recovery.

Questions for choosing where to have surgery

Choosing the right facility is an important step in your recovery. You may want to ask your clinician or the hospital staff the following questions to help you feel more prepared:

• How many total shoulder replacements does this hospital perform each year?
• Does the hospital have a dedicated team that specializes in orthopedic surgery and recovery?
• What kind of physical therapy services are available on-site or nearby?
• What is the typical length of stay for this procedure?
• Who should I contact if I have questions or concerns once I am back at home?

Conditions commonly treated by this procedure

Total shoulder replacement is often recommended when the shoulder joint has significant damage that makes daily life difficult. Your clinician may discuss this procedure if you have certain types of arthritis or joint issues that have not improved with other treatments.

• Osteoarthritis: This is a common "wear-and-tear" condition where the cartilage—the smooth cushion on the ends of your bones—wears away over time.
• Rheumatoid arthritis: This is a condition where the body's immune system causes the lining of the joint to become thick and inflamed, which can damage the bone and cartilage.
• Post-traumatic arthritis: This can happen after a serious shoulder injury, such as a fracture or a bad dislocation, that causes the joint surface to wear down.
• Avascular necrosis (osteonecrosis): This occurs when the blood supply to the bone is limited, which can cause the bone to collapse and damage the joint.
• Rotator cuff tear arthropathy: This may occur if a person has a very large, long-term tear in the rotator cuff muscles that eventually leads to severe arthritis in the joint.

Related symptoms people search for

People considering shoulder surgery often experience symptoms that interfere with their quality of life. These symptoms can vary, and your clinician can help determine if they are related to joint damage.

• Persistent pain: You may feel a deep ache in the shoulder that often gets worse when you use your arm or try to lift objects.
• Sleep disruption: Many people find that shoulder pain makes it hard to fall asleep or causes them to wake up during the night.
• Loss of motion: The shoulder may feel stiff, making it hard to reach behind your back, wash your hair, or put on a coat.
• Grinding or clicking: You might notice a "grating" sensation or hear clicking sounds when you move your shoulder joint.
• Weakness: The arm may feel weak, making it difficult to perform simple tasks like reaching into a cupboard or carrying groceries.

Evidence overview

Total shoulder replacement is a widely accepted surgical procedure designed to relieve severe pain and stiffness in the shoulder. It is most often recommended for patients with osteoarthritis, rheumatoid arthritis, or severe fractures who have not found relief through non-surgical treatments like physical therapy or medication.

Medical evidence supports shoulder replacement as an effective option for restoring comfort and function. While this surgery is performed less frequently than knee or hip replacements, it is considered a standard and successful treatment for advanced joint damage. Most patients report significant pain relief and an improved ability to perform daily activities after they have fully recovered.

Safety notes and individualized care

As with any major surgery, total shoulder replacement involves certain risks. Your surgical team will take specific precautions to help keep you safe. Common safety measures include using antibiotics to prevent infection and using medications or compression devices to lower the risk of blood clots.

Potential complications can include infection, bleeding, nerve injury, or reaction to anesthesia. There are also risks related to the artificial joint itself. Over time, the replacement parts may wear out, loosen, or become dislocated. If the implant wears out after many years, a second surgery might be required to replace it.

Your care plan will be tailored to your specific needs. Your clinician will evaluate the quality of your bone and the health of your rotator cuff (the muscles and tendons surrounding the shoulder) to decide which type of replacement is safest for you. Following your doctor's instructions regarding physical therapy and activity restrictions is essential for a safe recovery.

Sources used

• Mayo Clinic
• Johns Hopkins Medicine
• MedlinePlus (U.S. National Library of Medicine)