Understanding Shoulder Replacement Surgery

Ryan LaCorte Kimberly Salvato, Publications

Total Shoulder Replacement (TSA):

The total shoulder arthroplasty (TSA) was first performed in the United States in the 1950’s. Now, the Agency for Healthcare Research and Quality states 53,000 people in the U.S. have shoulders replaced each year. The goal is to decrease pain, while increasing mobility, strength, and function.

Shoulder Anatomy

The shoulder is composed of three bones: the humerus (upper arm), scapula (shoulder blade), and clavicle (collar bone). Like a ball and socket joint, the head of the humerus (the ball) fits into the socket of the scapula (glenoid cavity). Next is the rotator cuff, made up of four muscles which hold the head of the humerus into the glenoid cavity.


Causes for a TSA include rheumatoid arthritis, disease of the rotator cuff, osteonecrosis, and humeral head fractures. The most common cause is advanced osteoarthritis meaning the joint’s smooth cartilage lining has deteriorated. Surgery is considered when conservative treatments (rehabilitation, injection, medication) have failed

Is this right for you?

This decision should be made between you, your family, and your orthopedic surgeon. If conservative treatment did not relieve symptoms, then TSA can be a great option to help increase your independence, and regain your quality of life.

TSA: Total v. Reverse

  • Total: Replaces the damaged joint with prosthetics. Typically, the head of the humerus, and the glenoid cavity are both replaced. A metal ball and stem replace damaged humeral head. The glenoid cavity is replaced with a smooth plastic surface.
  • Reverse: With severe damage or rotator cuff tears, Reverse TSA allows for less pain and increased function. The socket and ball are switched; ball replaces the shoulder socket, and the socket is attached where humerus had been. The deltoid muscle becomes the primary mover during elevation.

After surgery

Post-operative Physical therapy has a large success rate though results can vary. Restricted use of their hand, and wrist begins soon after, and their elbow and shoulder in approximately six weeks. Unrestricted use may begin as early as eight weeks. It is important to realize pain typically lasts until 6-12 months. After one year, 95% of patients enjoy pain-free function!

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