A total shoulder replacement, also known as a total shoulder arthroplasty (TSA), is a well-established procedure for restoring mobility, function, and comfort to an arthritic shoulder. Non-operative treatments are highly recommended for younger athletes before considering a total shoulder replacement. Older patients tend to have more reliable outcomes with total shoulder replacements. Patients with arthritis who have failed to see improvements after non-operative treatments and minimally invasive arthroscopic surgery to clear debris from the joint are great candidates for a total shoulder replacement. In a total shoulder replacement, the head of the humerus (upper arm bone) is replaced with a metal implant. The smooth metal head resembles a sphere and the size is selected to replicate the original humeral head. In the procedure, the humeral head bone is removed, and the metal implant has a stem that is inserted into the shaft of the humerus. After securing the implant into the bone, only the smooth metal head is exposed. Next, the glenoid is resurfaced with a plastic insert that is made of a high-density polyethylene. The plastic implant is shaped and then secured with a bone cement over the original glenoid surface. The metal ball and resurfaced glenoid make up the revised ball-and-socket joint and provide rapid and complete improvement of the shoulder.
In certain instances, the rotator cuff can be completely torn in the setting of shoulder arthritis. When this occurs, a standard (or anatomic) shoulder replacement is not recommended, as function and motion will be suboptimal due to an incompetent rotator cuff. Instead a reverse total shoulder arthroplasty (rTSA) is recommended. This type of shoulder replacement reverses the position of the ball and socket, so the socket becomes the ball and the ball becomes the socket. This type of shoulder replacement does not depend on the rotator cuff for good motion and function.
After either operation, patients will wear a sling for 6-8 weeks, and will begin a therapy program to achieve the desired range of motion and strength with the new implant. After 3-4 months of therapy, patients will be able to return to most daily living activities.