Shoulder Replacement - What is it and are you a candidate?
Dr. Brian Hill explains the essentials of shoulder replacement surgery, covering shoulder joint anatomy, how arthritis damages the joint, and the difference between traditional Anatomic and Reverse shoulder replacements.
Basic Shoulder Anatomy & Arthritis
- The shoulder is a flexible ball-and-socket joint where the head of the humerus (upper arm bone) meets the glenoid (socket of the shoulder blade).
- Smooth cartilage allows friction-free movement, while the four rotator cuff muscles hold the ball in the socket.
- As cartilage wears away (osteoarthritis), bone rubs on bone, resulting in bone spurs, pain, loss of range of motion, stiffness, and cracking/crepitus.
Anatomic vs. Reverse Shoulder Replacement
| Type | How It Works | Key Candidate Criteria |
|---|---|---|
| Anatomic Replacement | Replaces the natural ball with a metal ball and socket with plastic, retaining normal anatomy. | Patients with an intact rotator cuff, which serves as the "motor." ~80% last at least 20 years. |
| Reverse Replacement | Reverses the orientation: places a socket on the humerus and a ball on the glenoid. | Patients with irreparable rotator cuff tears, failed prior replacements, severe socket wear, or complex fractures. ~90% last at least 10 years. |
Benefits & Potential Risks
- Expected Outcomes: Pain relief (50% report 0/10 pain; 50% report 1–2/10 pain) and improved range of motion and function.
- Risks & Complications:
- Infection: ~1% national risk (higher in males under 60, unmanaged diabetes, or immunocompromised state).
- Other Risks: Nerve stretching (~1 in 300), joint dislocation, general medical/cardiovascular issues, and acromion stress fractures (specific to reverse replacements if overdone early).
Patient Testimonials
- Paul: Suffered severe pain and loss of arm function while fishing. After receiving a reverse shoulder replacement, he successfully returned to weightlifting and cycling pain-free.
- Paul S: A long-term rotator cuff injury aggravated by playing pickleball forced him to play non-dominant left-handed. Post-surgery, he resumed right-handed pickleball, golf, and lifting his grandchildren.
