Shoulder Replacement Surgery
When shoulder arthritis, a severe fracture, or chronic rotator cuff disease has damaged the shoulder joint to the point where conservative treatments and arthroscopic procedures can no longer provide adequate pain relief or functional improvement, shoulder replacement surgery — also called shoulder arthroplasty — offers a definitive solution by resurfacing or replacing the damaged joint surfaces with prosthetic components. Modern shoulder replacement has become one of the most reliable and transformative procedures in orthopedic surgery, with the vast majority of patients experiencing dramatic pain relief and significantly improved shoulder function that restores their ability to perform daily activities, sleep comfortably, and in many cases return to recreational sports. The specific type of replacement — anatomic total shoulder, reverse total shoulder, partial replacement (hemiarthroplasty), or stemless resurfacing — depends on the condition of the rotator cuff, the pattern of bone loss, and the patient’s functional demands.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with a traveling shoulder fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins and fellowship training at the Southern California Orthopedic Institute/UCLA. Shoulder replacement is the endpoint of a treatment continuum — and Dr. Glashow’s extensive background in arthroscopic shoulder surgery, rotator cuff repair, instability repair, and biologic therapies means that when he recommends shoulder replacement, it is because every alternative has been considered or exhausted. This comprehensive perspective ensures that each patient receives the right procedure at the right time — not too early, and not so late that bone loss and muscle deterioration have compromised the surgical result. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers and a Castle Connolly Top Doctor every year since 2000, he performs shoulder replacement surgery at his Upper East Side practice in New York City.
Types of Shoulder Replacement
Anatomic Total Shoulder Replacement: The standard replacement for patients with glenohumeral arthritis and an intact, functioning rotator cuff. The arthritic humeral head (ball) is replaced with a polished metal component, and the worn glenoid socket is resurfaced with a polyethylene (plastic) component. This design preserves the shoulder’s natural biomechanics, with the rotator cuff continuing to power and stabilize the joint around the prosthesis.
Reverse Total Shoulder Replacement: Designed specifically for patients who have both arthritis and an irreparable rotator cuff tear — a condition called rotator cuff arthropathy. In a reverse replacement, the ball and socket are switched: a metal ball is placed on the socket side (glenoid) and a socket is placed on the humeral side. This reversed configuration allows the deltoid muscle to power the shoulder instead of the rotator cuff, providing both pain relief and restored overhead function in patients for whom an anatomic replacement would fail.
Hemiarthroplasty (Partial Replacement): Only the humeral head (ball) is replaced, while the natural glenoid socket is preserved. Hemiarthroplasty may be recommended for certain proximal humerus fractures in which the humeral head cannot be reconstructed, or for younger patients with isolated humeral head damage and a healthy glenoid.
Stemless Shoulder Resurfacing: A newer, bone-conserving option in which only the arthritic surface of the humeral head is capped with a small metal component, without inserting a stem into the humeral canal. This approach preserves maximum bone stock and may be appropriate for younger patients with early arthritis and good bone quality.
Conditions That May Require Shoulder Replacement
- Osteoarthritis: Age-related cartilage loss producing bone-on-bone contact in the glenohumeral joint
- Rotator Cuff Arthropathy: Arthritis combined with a massive, irreparable rotator cuff tear
- Post-Traumatic Arthritis: Arthritis that develops following a prior fracture, dislocation, or surgery
- Avascular Necrosis: Loss of blood supply to the humeral head causing bone collapse
- Severe Proximal Humerus Fractures: Complex fractures that cannot be reconstructed with plates and screws
- Rheumatoid Arthritis: Inflammatory arthritis that has destroyed the joint surfaces
- Failed Prior Surgery: Persistent pain and dysfunction after previous shoulder procedures
Recovery After Shoulder Replacement
Patients wear a sling for four to six weeks after surgery to protect the repair while the soft tissues heal around the prosthesis. Gentle passive range-of-motion exercises — performed by a physical therapist — begin within the first week to prevent stiffness. Active motion is introduced gradually, typically around six weeks, with progressive strengthening over the following months. Most patients experience significant pain relief within the first few weeks after surgery and continue to improve in range of motion and function over the first six to twelve months. Full recovery — including maximum range of motion and strength — typically occurs between three and six months for anatomic replacements and six to twelve months for reverse replacements.
Shoulder Replacement Surgery in New York City
If shoulder pain and stiffness are limiting your daily activities, disrupting your sleep, and no longer responding to conservative treatment, shoulder replacement surgery may be the solution that restores your quality of life. Dr. Glashow offers comprehensive evaluation with same-day imaging at his Upper East Side practice to determine which type of replacement is most appropriate for your shoulder. Contact our office to schedule your consultation.
Frequently Asked Questions About Shoulder Replacement Surgery
How do I know if I need a shoulder replacement?
Shoulder replacement is typically considered when you have significant shoulder arthritis confirmed on X-rays, your pain and functional limitation are affecting your daily quality of life, and an adequate course of non-surgical treatment — including physical therapy, anti-inflammatory medications, corticosteroid injections, and activity modification — has not provided sufficient relief. Dr. Glashow evaluates each patient’s imaging, rotator cuff status, bone quality, and functional goals before recommending replacement as the best option.
What is the difference between anatomic and reverse shoulder replacement?
An anatomic total shoulder replacement preserves the shoulder’s natural ball-and-socket configuration and works well when the rotator cuff is intact and can power the joint. A reverse total shoulder replacement switches the ball and socket — placing the ball on the glenoid side — which allows the deltoid muscle to power the shoulder instead of the rotator cuff. Reverse replacement is designed for patients with combined arthritis and irreparable rotator cuff tears, where an anatomic replacement would not function properly. The condition of the rotator cuff is the primary factor that determines which type of replacement Dr. Glashow recommends.
How long does shoulder replacement surgery take?
Shoulder replacement surgery typically takes one and a half to two hours, depending on the complexity of the case and the type of replacement being performed. The procedure is performed under general anesthesia with a regional nerve block for post-operative pain control. Most patients spend one night in the hospital and go home the following day.
How long does a shoulder replacement last?
Modern shoulder replacement implants are designed to last 15 to 20 years or longer with normal use. Published long-term studies show that more than 90 percent of anatomic total shoulder replacements are functioning well at 15 years. Implant longevity depends on factors including the patient’s activity level, bone quality, compliance with post-operative guidelines, and overall health. Low-impact activities such as swimming, golf, and doubles tennis are generally encouraged after recovery, while high-impact activities and heavy overhead lifting are typically discouraged to protect the implant long-term.
What activities can I do after shoulder replacement?
Most patients are able to return to daily activities — including dressing, grooming, cooking, driving, and light household tasks — within four to eight weeks after surgery. Low-impact recreational activities such as swimming, golf, cycling, and walking are encouraged after full recovery. Many patients also return to gardening, light fitness training, and doubles tennis. Activities that place heavy repetitive loads on the shoulder — such as heavy weightlifting, competitive overhead sports, and manual labor involving sustained overhead reaching — are generally discouraged to maximize implant longevity. Dr. Glashow discusses realistic activity expectations with each patient during the pre-operative planning process.
What are the risks of shoulder replacement surgery?
Shoulder replacement is a highly successful procedure, but like all surgery, it carries some risks. These include infection, nerve or blood vessel injury, implant loosening over time, instability or dislocation of the prosthesis, stiffness, and the possibility of fracture around the implant. Serious complications are uncommon — published complication rates are generally below 5 percent — and Dr. Glashow discusses the specific risks and benefits with each patient individually before surgery. Performing the procedure at Midtown Surgery Center — which maintains one of the lowest infection rates in New York — helps minimize surgical risk.
