Common Anatomic Shoulder Replacement Symptoms & Causes
Candidates for anatomic total shoulder replacement experience severe shoulder pain that limits daily activities and disrupts sleep, progressive loss of motion and function, grinding or catching sensations with movement, weakness performing overhead activities or lifting, and pain unrelieved by conservative treatments including medications, injections, and physical therapy. The primary cause is glenohumeral osteoarthritis—wearing away of cartilage resulting in bone-on-bone contact. Other causes include rheumatoid arthritis, post-traumatic arthritis following fractures or dislocations, avascular necrosis (bone death), and severe cartilage loss from chronic rotator cuff tears. Key requirement: intact, functional rotator cuff tendons to stabilize the prosthetic joint.
Schedule Your ConsultationWho's a Candidate for Anatomic Shoulder Replacement?
Not everyone with shoulder arthritis requires joint replacement. Understanding candidacy criteria ensures optimal outcomes and patient satisfaction:
Intact Rotator Cuff Function
+The critical requirement for anatomic shoulder replacement is a functioning rotator cuff. Unlike reverse replacement, anatomic implants rely on rotator cuff muscles to stabilize and move the shoulder. Patients with massive irreparable rotator cuff tears are not candidates for anatomic replacement and should consider reverse replacement instead.
Failed Conservative Treatment
+Surgery is considered after exhausting conservative options including physical therapy, activity modification, anti-inflammatory medications, corticosteroid injections, and viscosupplementation over 6-12 months. Candidates experience persistent pain and functional limitations despite appropriate non-surgical management.
Age and Activity Expectations
+While age alone isn't a contraindication, most candidates are over 50-55 years old. Younger, active patients face difficult decisions as implants have 15-20 year expected lifespans and may require revision. Activity expectations must be realistic—no heavy lifting over 50 pounds, no contact sports, no high-impact activities to maximize implant longevity.
Overall Health and Bone Quality
+Candidates must be healthy enough for major surgery and anesthesia. Adequate glenoid and humeral bone stock is essential for implant fixation. Active infections, severe osteoporosis, inadequate soft tissue, or significant medical comorbidities may disqualify candidates. Realistic expectations and commitment to activity modifications are essential for satisfaction.
Preparing for Anatomic Shoulder Replacement
Thorough preparation optimizes surgical outcomes and recovery. Complete comprehensive pre-operative medical clearance including cardiac evaluation, chest x-ray, and laboratory testing. Optimize management of diabetes, blood pressure, and other chronic conditions. Dental examination ensures no infections that could seed the implant. Stop smoking at least 6-8 weeks before surgery—smoking significantly increases infection risk and impairs healing. Discontinue blood thinners as directed. Lose weight if overweight to reduce surgical risks and implant stress. Arrange transportation and full-time assistance for at least one week post-operatively. Prepare your home for one-armed activities—move frequently used items to accessible locations, arrange sleeping in a recliner initially. Complete pre-operative physical therapy to maximize rotator cuff strength and shoulder motion. Mental preparation for rehabilitation commitment and permanent activity restrictions is critical.
How is Anatomic Shoulder Replacement Performed?
The procedure requires general anesthesia combined with nerve block and typically takes 1.5-2.5 hours. You're positioned in beach chair position. A deltopectoral incision (4-6 inches) is made over the front of the shoulder. The deltoid muscle is carefully mobilized. The subscapularis tendon is released to access the glenohumeral joint—this tendon will be meticulously repaired at surgery's conclusion.
The arthritic humeral head is removed using specialized cutting guides. The humeral canal is prepared with reamers, and a metal stem is inserted into the humerus. A metal or ceramic ball (humeral head component) matching your anatomy is attached to the stem. Attention turns to the glenoid where remaining cartilage is removed and bone prepared. The plastic glenoid component is secured with pegs, screws, or cement depending on bone quality and implant design. Components are reduced together and shoulder motion, stability, and tension are assessed. The subscapularis tendon is repaired with strong sutures. Wound is closed in layers. Drains may be placed. Arm is placed in immobilization sling. Hospital stay is typically 1-2 nights.
What to Expect After Anatomic Shoulder Replacement?
Recovery requires patience and commitment to rehabilitation. Protecting the subscapularis repair is critical during initial healing. Most patients achieve maximum improvement at 6-12 months post-surgery with pain relief occurring much earlier than functional gains.
Hospital Stay and Early Recovery (Weeks 0-6)
+Hospital stay is 1-2 nights with pain management and early mobilization. Arm remains immobilized in sling for 4-6 weeks protecting subscapularis repair. Gentle passive motion exercises begin immediately but no active motion or muscle activation. Hand, wrist, and elbow exercises prevent stiffness. Ice and pain medication manage discomfort. Wound care and infection monitoring are critical. No driving during this phase.
Active Motion Phase (Weeks 6-12)
+Sling discontinued once subscapularis healing confirmed, typically 6 weeks. Physical therapy progresses to active-assisted then active motion exercises. Gradual rotator cuff strengthening begins. Light activities of daily living resume. Driving resumes once off narcotics with surgeon clearance. No lifting, pushing, or pulling yet.
Strengthening Phase (Months 3-6)
+Progressive strengthening with resistance bands and light weights. Emphasis on rotator cuff, deltoid, and scapular stabilizers. Functional activities expand to most daily tasks. Lifting restrictions begin at 5 pounds, gradually increasing to permanent maximum of 40-50 pounds. Most patients achieve pain relief and functional plateau by 6 months.
Long-Term Recovery (Months 6-12+)
+Continued strength gains occur up to 12 months. Patients reach maximum functional capability with permanent activity modifications. No lifting over 40-50 pounds repetitively. No contact sports, no high-impact activities. Golf, swimming, doubles tennis, and light recreation permitted. Home exercise program maintains strength and motion. Annual follow-up monitors implant integrity and function.
Anatomic Shoulder Replacement Surgery in Cleveland, Ohio
Cleveland Shoulder Institute is a regional center of excellence for anatomic total shoulder replacement. Our surgeons perform over 150 shoulder replacements annually, utilizing the latest implant technology including stemless designs, augmented glenoids for bone deficiency, and patient-specific instrumentation. We participate in national shoulder arthroplasty registries tracking long-term outcomes.
Our comprehensive approach includes detailed pre-operative planning with 3D CT imaging and computer templating, expert surgical technique with meticulous subscapularis repair, multidisciplinary care with specialized orthopedic nurses, and structured rehabilitation programs. We emphasize infection prevention with protocols exceeding national standards. Surgery is performed at hospitals equipped for complex joint replacement with experienced surgical teams. Located in Cleveland, we provide thorough pre-operative consultations ensuring patients understand this procedure's life-changing benefits and permanent activity restrictions.
Schedule Your ConsultationMeet our Shoulder Replacement Team
Dr. Gobezie is a fellowship-trained shoulder and elbow surgeon who completed advanced training in complex shoulder reconstruction and arthroplasty. He performs high volumes of anatomic shoulder replacements annually, maintaining expertise in the latest surgical techniques and implant technologies. Dr. Gobezie stays current through active participation in shoulder arthroplasty research, teaching, and professional societies dedicated to advancing shoulder replacement outcomes.
Supporting Dr. Gobezie are orthopedic-specialized anesthesiologists, experienced surgical nurses and technicians trained in joint replacement protocols, specialized physical therapists understanding anatomic replacement biomechanics, and case managers coordinating care. Our infection prevention protocols exceed national standards. Social workers assist with discharge planning and home health coordination. This comprehensive team approach ensures optimal surgical outcomes, complication prevention, and structured rehabilitation. We provide extensive patient education, realistic expectation setting, and long-term follow-up monitoring implant performance.
What Our Patients Say About Anatomic Shoulder Replacement
Real experiences from patients who eliminated shoulder arthritis pain through surgery:
"I lived with shoulder arthritis for five years before finally having the replacement. The pain relief was immediate after surgery. Six months later I have excellent range of motion and can do activities I gave up years ago. Life-changing procedure."
— Richard Palmer
"Dr. Gobezie took time to explain everything and set realistic expectations. The surgery went smoothly and recovery progressed exactly as described. One year later my shoulder feels great—no pain, good strength, back to golf. Couldn't be happier."
— Carol Jensen
"After trying everything else for my arthritis, shoulder replacement was the answer. The surgical team was outstanding and physical therapy was crucial to my recovery. My only regret is not doing it sooner. The constant pain is completely gone."
— Thomas Wright
Anatomic Shoulder Replacement Frequently Asked Questions
What is the difference between anatomic and reverse shoulder replacement?
+Anatomic replacement preserves normal shoulder anatomy with a ball on the humerus and socket on the glenoid, requiring intact rotator cuff function. Reverse replacement reverses this anatomy (ball on glenoid, socket on humerus) for patients with massive irreparable rotator cuff tears. Your surgeon determines which type is appropriate based on rotator cuff condition.
How long do shoulder replacements last?
+Modern anatomic shoulder replacements show excellent longevity with 90-95% lasting 15-20 years. Many last even longer. Factors affecting longevity include patient age, activity level, bone quality, implant design, surgical technique, and adherence to activity restrictions. Younger, more active patients may require revision surgery eventually.
What are permanent restrictions after shoulder replacement?
+Permanent activity restrictions protect implant longevity: no repetitive lifting over 40-50 pounds, no contact sports, no high-impact activities. Golf, swimming, doubles tennis, cycling, and light recreation are encouraged. These restrictions help ensure your implant lasts as long as possible while allowing most desired activities.
How painful is recovery from shoulder replacement?
+Post-operative pain is managed with nerve blocks providing 12-24 hours of numbness, followed by prescription pain medication. Most patients describe moderate discomfort for 1-2 weeks, significantly improving by 4-6 weeks. Pain relief from arthritis is often dramatic and immediate, though surgical pain requires several weeks to resolve completely.
When can I return to activities after shoulder replacement?
+Timeline varies by activity: driving at 6-8 weeks, light work at 8-12 weeks, golf at 4-6 months, swimming at 3-4 months. Full unrestricted activities (within permanent limitations) typically by 6 months. Your surgeon provides specific guidance based on your healing progress and desired activities.