Understanding the Different Types of Shoulder Replacement Surgery

Shoulder replacement is the third most common joint replacement surgery after knees and hips. The procedure is a reliable option for reducing pain and improving function in your shoulder.
You may be considering shoulder replacement surgery if you…
• Have severe arthritis pain that prevents you from participating in daily activities.
• Experience pain while resting, especially if it interferes with sleep.
• Have limited range of motion and/or hear a crunching, grinding or ratcheting sound with movement.
• Tried less invasive options such as medication, injections, physical therapy and/or adjusting your activities with little to no results.

Below, we look at three types of shoulder replacement surgeries and what makes them most effective.

The Anatomy of the Shoulder
First, it’s important to understand the parts that make up the shoulder, which is a ball-and-socket joint. The ball (head) at the end of your upper arm bone fits into the socket formed by your shoulder blade.
In a healthy shoulder, the areas where the ball and socket meet are covered with cartilage. This cartilage helps protect the bones and enables them to move smoothly. The shoulder bones are surrounded by muscles and tendons, which help promote stability and support your movement. This structure is important because the shoulder joint has the greatest range of motion of any joint in the body.
All shoulder replacement surgeries involve removing damaged areas of bone and resurfacing them with metal and plastic implants.

Partial Shoulder Replacement (Hemiarthrophsty)
In a partial shoulder replacement (hemi) surgery, only the ball side of the joint is resurfaced with an implant. While it’s the least common shoulder replacement performed today, a partial may be recommended if only the ball side of your shoulder joint is damaged or injured.
A partial replacement preserves more bone than other shoulder replacement surgeries, but it does not typically provide the same pain relief or last as long as other procedures.

Primary (Anatomic) Total Shoulder Replacement
Most shoulder replacement surgeries are primary total shoulder replacements, also known as anatomical total shoulder arthroplasty (TSA) replacements. Unlike a partial, both the ball and socket sides of the joint are resurfaced with implants. As the name suggests, these implants closely resemble the natural shapes of your bones.
In an anatomical TSA replacement, a surgeon fits your upper arm bone with a new metal ball, which will become one with the bone over a few months. A plastic liner is attached to the socket side of the joint. The implants are smooth and will not hurt when you move and use them.
You and your surgeon may discuss anatomic shoulder replacement if you have severe arthritis and your tendons remain intact.
“Prior to an anatomic replacement, we want to make sure your tendons and muscles are working properly and that you have plenty of healthy bone to work with,” says Dr. Michael Bender, a shoulder and elbow specialist at Forté. “Our goal is to restore your shoulder to as close to normal as possible.”

Reverse Total Shoulder Replacement
Patients with a torn or severely weakened rotator cuff tendon cannot have a primary total shoulder replacement. These patients may be better candidates for a reverse shoulder replacement.
A reverse procedure also involves resurfacing both sides of the joint, but the position of the implants is reversed. The ball is attached to your shoulder blade, and the plastic socket liner goes at the end of your upper arm bone.
This type of surgery is a good fit for patients with chronic or acute rotator cuff tears because they don’t need full use of their shoulder muscles and tendons for it to work long-term. You may also be a good candidate for a reverse procedure if you have arthritis with rotator cuff tears, a socket that is too worn /deformed, a severe shoulder fracture or as a revision of a prior shoulder replacement.
“The reverse procedure isn’t as good at restoring function as an anatomic replacement would be, but it’s a better range and quality of movement than the patient would have had,” says Dr. Dale Snead, an upper extremity injury specialist at Forté. “This procedure is designed for pain control, and a majority of patients have significantly less pain than they did before surgery.”

Deciding Which Surgery Is Right for You
Your surgeon can help you understand which type of shoulder replacement surgery would be most appropriate for you.
To schedule a consultation with one of our joint replacement specialists, call 317.817.1200.
You can also check out our many resources for shoulder replacements:
• How shoulder replacement is evolving with better implants and patient-specific surgical planning.
• Three steps that will help prepare you for shoulder replacement surgery.
• See how long it takes to recover from shoulder replacement surgery.
• Take a deeper dive into reverse shoulder replacement surgery.