Total shoulder replacement is a surgical procedure that removes damaged bone and cartilage from the shoulder joint, including the humerus bone and glenoid cavity, and replaces them with prosthetic components, typically performed for advanced shoulder arthritis or joint damage that has not responded to conservative treatment such as physical therapy. As a total shoulder replacement surgeon, Michael J. Bercik Jr., MD, performs both anatomic total shoulder arthroplasty and reverse total shoulder replacement at his offices in Lancaster, Ephrata, and Mount Joy, Pennsylvania, tailoring the procedure to each patient’s anatomy, rotator cuff condition, and goals to relieve pain and restore mobility.
What Is Total Shoulder Replacement?
The shoulder is a ball-and-socket joint formed by the head of the upper arm bone (humerus) and the socket of the shoulder blade (glenoid). Total shoulder replacement removes the damaged joint surfaces and replaces them with prosthetic components designed to restore smoother, less painful movement and reduce pain.
Total shoulder replacement is generally considered for patients with severe shoulder pain caused by:
- Osteoarthritis, where cartilage in the joint has worn down over time, leading to bone-on-bone arthritis
- Rheumatoid arthritis or other inflammatory joint conditions
- Post-traumatic arthritis following a prior shoulder injury or severe fractures
- Avascular necrosis, a loss of blood supply to the bone
- Rotator cuff tear arthropathy, a form of arthritis linked to long-standing rotator cuff damage and rotator cuff injuries affecting the rotator cuff tendons and rotator cuff muscles
Surgery is typically considered after non-surgical treatments, such as activity modification, anti-inflammatory medication, physical therapy guided by a physical therapist, and corticosteroid injections, have not provided enough relief for the severe pain.
Anatomic Total Shoulder Replacement vs. Reverse Total Shoulder Replacement: Which Applies to You
There are two main types of total shoulder replacement, and the right one depends primarily on the condition of the rotator cuff.
Anatomic total shoulder replacement procedure recreates the joint in its normal orientation: a metal ball replaces the humeral head, and a plastic socket resurfaces the glenoid, typically using a metal stem for secure fixation. Because this design relies on the rotator cuff to center and power the joint, anatomic replacement is generally reserved for patients with a healthy, intact rotator cuff, most often those with glenohumeral osteoarthritis diagnosed through imaging tests such as X ray and magnetic resonance imaging (MRI).
This joint replacement surgery, which is minimally invasive with small incisions, aims to restore smooth movement and reduce pain caused by arthritis or joint damage affecting the affected shoulder. The procedure requires detailed review by their total shoulder replacement specialist of the patient’s medical history and imaging to ensure the joint capsule and surrounding structures are in good shape for optimal outcomes.
Reverse total shoulder replacement reverses this relationship: a ball-shaped component is attached to the glenoid, and a socket-shaped component is attached to the humerus. This configuration allows the deltoid muscle, rather than the rotator cuff, to power arm elevation, which makes reverse replacement the more common choice for patients with a torn or deficient rotator cuff. Reverse replacement is also frequently used for rotator cuff tear arthropathy, some complex proximal humerus fractures, fracture sequelae, and cases where a prior shoulder fracture has led to joint damage or an unreliable rotator cuff.
Because candidacy depends on rotator cuff integrity, bone quality, prior surgeries, age, and activity level, Michael J. Bercik Jr., MD, a total shoulder replacement doctor, determines which procedure applies to a specific patient only after a physical exam and imaging, not from symptoms alone.
How the Anatomy-Based Prosthesis Works
Modern shoulder replacement systems are designed to closely reproduce the geometry and mechanics of the native joint. In anatomic replacement, a metal humeral component, sometimes stemmed and sometimes a bone-preserving stemless design, replaces the humeral head, while a polyethylene (plastic) component resurfaces the glenoid to recreate a low-friction gliding surface, using an artificial shoulder implant.
In reverse replacement, a metal glenosphere is secured to the glenoid with screws, and a polyethylene cup is fitted to the humeral component. This reversed geometry lowers and medializes the joint’s center of rotation, which is what allows the deltoid to substitute for a damaged rotator cuff, preventing nerve damage and causing less pain. Component size, positioning, and fixation are planned individually by your total shoulder replacement surgeon using preoperative imaging to match each patient’s bone anatomy, which helps prevent infection and ensures a full recovery.
The Surgical Procedure: What Happens Step by Step
Total shoulder replacement is typically performed by your total shoulder replacement specialist under a combination of regional nerve block anesthesia, which numbs the shoulder and arm using local anesthetic, and general anesthesia. While details vary by patient and by anatomic versus reverse replacement, the procedure generally takes about 1 to 3 hours and follows these steps:
- An incision is made at the front of the shoulder, following a path between two muscles to reach the joint without detaching them
- A portion of the subscapularis tendon is carefully released or, in some cases, the bone it attaches to is temporarily removed, to allow access to the joint
- The damaged humeral head is removed and the bone is prepared to receive the new component
- The glenoid surface is prepared and the glenoid component (a plastic socket for anatomic replacement, or a metal glenosphere for reverse replacement) is secured in place
- The humeral component is placed, either press-fit or secured with bone cement depending on bone quality and implant design
- Trial components are used to check stability, motion, and tension before the final implants are secured
- The subscapularis is repaired, and the incision is closed
Total shoulder replacements require high technical precision and understanding of joint biomechanics; that’s why it’s important to choose total shoulder replacement surgeons who have completed a fellowship specifically in shoulder and elbow surgery and should inquire about a surgeon’s annual shoulder replacement case volumes. Done right, shoulder replacement surgery can last approximately 15 to 20 years.
Hospital Stay and Discharge Criteria
Most patients stay in the hospital for one to two nights after total shoulder replacement, though some patients may be candidates for a shorter stay depending on their overall health, the complexity of the procedure, and how they are recovering.
Before discharge, patients generally need to show that pain is reasonably controlled with oral medication, that they can move safely with the arm in a sling, and that they understand their home exercise program and activity precautions. The surgical team also confirms that the incision looks appropriate and that the patient is medically stable. The exact discharge timeline depends on the individual patient and procedure, and Dr. Bercik and the care team determine readiness on a case-by-case basis, communicating clearly about risks, recovery timelines, and rehabilitation to ensure a smooth transition. Infection risk is low due to antibiotic use, and nerve or artery damage is very rare after surgery (less than 5% of patients experience complications after surgery). Facility quality and surgical team experience impact shoulder replacement success rates, so choose wisely.
Physical Therapy: From Sling Immobilization to Full Strength
Rehabilitation after total shoulder replacement generally progresses through several phases, with the pace guided by healing, pain, and strength rather than a fixed calendar.
- Protection phase: Most patients wear a sling for several weeks after surgery. Only passive motion, movement performed by the therapist rather than the patient’s own muscles, is typically allowed during this early period to protect the repair and healing tissue.
- Motion phase: As healing progresses, therapy advances to active-assisted and then active range-of-motion exercises to gradually restore movement.
- Strengthening phase: Once adequate motion is regained, progressive strengthening exercises begin to rebuild strength in the shoulder muscles that support the new joint.
- Return-to-activity phase: Patients work toward the specific demands of daily activities, work, or recreational interests, with clearance based on strength, motion, and symptom benchmarks.
This full process commonly spans several months. Most patients feel less pain within 12 weeks after surgery. Reverse replacement rehabilitation is often paced somewhat differently than anatomic replacement, since it relies on the deltoid rather than the rotator cuff, and Dr. Bercik tailors the therapy protocol to the procedure performed and each patient’s progress.
Driving and Work Return Timelines
Most patients are able to resume driving once they are out of the sling, are no longer taking pain medication that could impair reaction time, and have regained enough motion and comfort to control a vehicle safely. This is often several weeks after surgery, though the right timing depends on the arm involved, the type of vehicle, and the patient’s recovery, and should be confirmed with Dr. Bercik before resuming.
Return to work follows a similar individualized pattern. Patients with desk-based or light-duty jobs often return within a few weeks, sometimes with temporary modifications. Patients with physically demanding jobs involving lifting, overhead work, or repetitive shoulder use typically need a longer recovery, often several months, before returning to full duty. Dr. Bercik provides guidance based on the specific job demands and how recovery is progressing.
Implant Longevity and Revision Rates
Total shoulder replacement implants are designed for long-term use, but like other joint replacements, they do not necessarily last a lifetime, and some patients eventually need revision surgery, a secondary procedure to replace or adjust part of the implant. National joint registries and long-term studies have reported 10-year implant survival, meaning the percentage of implants still functioning without need for revision, commonly in the range of 90% for both anatomic and reverse total shoulder replacement, though reported rates vary by diagnosis, implant design, and patient age.
Research following reverse shoulder replacement over time has found that younger age at the time of surgery and revision procedures (as opposed to a first-time replacement) are associated with lower long-term survival, while replacements performed for rotator cuff tear arthropathy and massive cuff tears have tended to show higher survival at 10 years. These patterns come from published research and registry data rather than a prediction for any individual patient, and the likelihood that applies to a specific case depends on diagnosis, age, activity level, and other factors Dr. Bercik reviews as part of surgical planning.
Risks, Limits, and Treatment Alternatives
Like any major surgery, total shoulder replacement carries risks that are worth understanding before moving forward with a plan.
Surgical risks can include infection, instability or dislocation of the implant (more often a concern with reverse replacement), nerve or blood vessel injury, fracture during or after surgery, blood clots, implant loosening or wear over time, and the general risks associated with anesthesia. Reverse replacement carries a specific risk called scapular notching, a form of bone wear near the implant that is monitored on follow-up imaging.
Non-surgical alternatives, including activity modification, anti-inflammatory medication, physical therapy, and corticosteroid injections, can be reasonable options for patients who are not ready for surgery or whose symptoms are still manageable with conservative care, though these approaches do not reverse joint damage that has already occurred. For select younger patients with arthritis limited to one part of the joint, partial shoulder replacement (also known as hemiarthroplasty) or resurfacing procedures may also be an option worth discussing.
Total Shoulder Replacement Care in Lancaster, Ephrata, and Mount Joy
Michael J. Bercik Jr., MD, is a board-certified orthopedic surgeon with sub-specialty training in shoulder surgery and orthopedic trauma, including fellowship training focused specifically on shoulder conditions.
As a board-certified, a total shoulder replacement specialist whose practice is limited to shoulder conditions, Dr. Bercik’s caseload is built around this one joint rather than general orthopedics. He also treats other shoulder conditions, including shoulder separation, frozen shoulder, and shoulder dislocations, giving patients with a history of shoulder injury ongoing care from the same practice as their needs change over time. Patients are offered detailed consultations with time to review imaging, ask questions, and understand the reasoning behind a recommended plan before deciding how to proceed.
Frequently Asked Questions
Schedule a Consultation with a Total Shoulder Replacement Surgeon
Shoulder pain and stiffness that have not improved with conservative treatment are worth having evaluated by a specialist, especially if they are limiting sleep, strength, or daily activities. Michael J. Bercik Jr., MD, sees patients for total shoulder replacement consultations at his offices in Lancaster, Ephrata, and Mount Joy, Pennsylvania. Call 717-560-4200 or request an appointment to review your imaging, symptoms, and treatment options with Dr. Bercik directly.
Medically Reviewed By Michael J. Bercik Jr., MD
Michael J. Bercik Jr., MD, is a board-certified orthopedic surgeon with sub-specialty training in shoulder surgery and orthopedic trauma. He completed his orthopedic surgery residency at the Rothman Institute in Philadelphia and two international fellowships focused specifically on shoulder conditions. He has treated shoulder patients throughout Lancaster County for more than a decade, with offices in Lancaster, Ephrata, and Mount Joy, Pennsylvania.
