Total shoulder arthroplasty replaces the worn surfaces of the glenohumeral joint with metal and polyethylene components, restoring smooth motion and relieving the pain of advanced shoulder arthritis. It is the standard surgical treatment for glenohumeral arthritis in patients with an intact rotator cuff and reliable bone stock. Outcomes are durable, with most patients reporting near-complete pain relief and substantial improvement in function.
What Is Total Shoulder Arthroplasty?
Total shoulder arthroplasty (also called anatomic total shoulder replacement) replaces the diseased ball-and-socket surfaces of the shoulder while preserving the native anatomic relationship. The arthritic humeral head is replaced with a metal ball implant secured to a stem in the humeral canal. The arthritic glenoid surface is resurfaced with a polyethylene component anchored to the glenoid bone.
The rotator cuff remains intact and continues to function as the primary stabilizer of the joint. This is what distinguishes total shoulder arthroplasty from reverse total shoulder arthroplasty, which is reserved for patients whose rotator cuff is irreparable.
Who Is a Candidate?
Candidates for total shoulder arthroplasty typically have:
- Advanced glenohumeral arthritis with bone-on-bone narrowing on imaging
- Pain that interferes with daily activity, work, and sleep despite non-surgical treatment
- An intact rotator cuff with adequate function on examination and imaging
- Adequate glenoid bone stock for component fixation
- A medical profile that allows safe surgery
Patients with massive irreparable rotator cuff tears, severe glenoid bone loss, or rotator cuff arthropathy are typically better served by reverse total shoulder arthroplasty. Younger active patients may be considered for joint-preserving alternatives such as arthroscopic biologic resurfacing, a technique developed by Dr. Chudik.
How the Procedure Is Performed
Total shoulder arthroplasty is performed through an incision at the front of the shoulder, typically 4 to 6 inches long. The deltopectoral interval is opened to access the joint, with careful preservation of the deltoid origin. The subscapularis tendon is taken down to expose the glenohumeral joint and is repaired anatomically at the end of the procedure.
The arthritic humeral head is removed at the anatomic neck. A canal is prepared in the humerus and a stemmed humeral component is implanted with a head sized to match the patient’s anatomy. The glenoid is then exposed, the cartilage is removed, and a polyethylene glenoid component is implanted with cement or pegged fixation. Soft tissue tension and joint stability are tested before the subscapularis is repaired.
Modern implants offer improved bone preservation and longer durability than earlier generations. Implant choice and sizing are determined preoperatively using planning software in addition to intraoperative assessment.
Recovery and Rehabilitation
Recovery follows a protected protocol:
- Hospital stay of one to two days, occasionally same-day discharge in selected patients
- Sling protection for four to six weeks with passive range of motion exercises beginning within days
- Active motion at four to six weeks
- Strengthening at three months
- Return to daily activities by two to three months
- Return to low-impact sport (golf, swimming, doubles tennis) at four to six months
Heavy overhead work and high-impact sport are typically not recommended after total shoulder arthroplasty.
Risks and Outcomes
Major risks include infection, component loosening, glenoid wear, periprosthetic fracture, and stiffness. Long-term implant survivorship is excellent, with most modern implants functioning well at 10 to 15 years and many at 20 years.
Pain relief is reliable, with most patients reporting near-complete pain relief by three to six months. Motion recovery depends on preoperative range of motion and rotator cuff function. Most patients regain functional motion sufficient for daily activity, dressing, hair care, and reaching.
Why Dr. Chudik for Total Shoulder Arthroplasty
Dr. Chudik has performed shoulder arthroplasty for more than twenty years and treats the full spectrum of arthritic shoulder pathology, including primary arthritis, post-traumatic arthritis, and complex revision arthroplasty. His arthroscopic shoulder expertise informs his arthroplasty practice, with a focus on minimizing soft-tissue disruption and preserving the rotator cuff. For appropriate younger patients, Dr. Chudik also offers joint-preserving alternatives including the Arthroscopic Biologic Total Shoulder Resurfacing technique he developed.