Shoulder Replacement: Regain Strength, Stop The Pain

If shoulder pain keeps you up at night or forces you to quit the activities you enjoy, it may be time to consider shoulder replacement surgery. For many, shoulder replacement offers long-term relief and a smoother recovery than expected.

“Shoulder replacements usually have the smoothest recovery of any shoulder procedure I perform,” said Ryan Nixon, MD, an independent shoulder and knee surgeon who chooses to practice at Franciscan Health. “Patients often say it was easier than their rotator cuff surgery.”

What Is Shoulder Replacement Surgery?

During shoulder replacement, your orthopedic surgeon removes the damaged part of your joint and replaces it with metal and plastic parts. The goal is simple: relieve pain and restore motion.

“Surgeons recommend this option when arthritis, rotator cuff damage or long-term joint wear makes everyday use difficult,” said Dr. Nixon.

The right procedure depends on your shoulder structure and tendon health. There are two main options for shoulder replacement surgery.

• Anatomic shoulder replacement keeps the natural ball-and-socket joint. It works best when the rotator cuff is healthy.
• Reverse shoulder replacement swaps the ball and socket, which allows the deltoid muscle to take over lifting the arm if the rotator cuff is damaged.

“The reverse replacement changes how the shoulder works, so the deltoid muscle can do more of the lifting,” said Dr. Nixon. “It gives that muscle more strength and helps keep the joint stable.”

Today, reverse shoulder replacements are more common. They make up most shoulder replacements in the U.S.

“About 70 percent of shoulder replacements, we do are reverses,” said Dr. Nixon. “They work well even with a torn rotator cuff.”

When To Consider Shoulder Replacement

Shoulder replacement is your choice. You don’t need to wait for the “perfect” age. You do it when the time feels right.

“I tell people, don’t live in pain because you think you’re too young,” Dr. Nixon said. “Would you rather be miserable for 20 years, or enjoy life now and have a revision down the road when the techniques have only improved?”

You might benefit from shoulder replacement if:

• A torn rotator cuff causes constant pain or weakness
• Arthritis damages the joint
• Shoulder pain makes your daily routines hard
• Therapy and injections don’t help

What Happens During Surgery

At Franciscan Health, our orthopedic surgeons perform most shoulder replacements as outpatient procedures. Most patients go home on the same day.

“Ninety-five percent of my patients leave the surgery center in about six hours,” Dr. Nixon said. “That shocks people.”

During the procedure, surgeons make a small cut in the front of the shoulder and work between major muscles. Only one tendon, the subscapularis, gets detached, which the surgeon repairs during the procedure.

“We avoid major muscles, which helps speed up recovery,” Dr. Nixon said.

“We go through the front, between the deltoid and pectoral muscles, not through them. We use dissolvable stitches and waterproof dressings,” Dr. Nixon said. “The incision is small, and you can usually shower after three days.”

Recovery After Shoulder Replacement

Recovery from shoulder replacement surgery is often easier than people expect.

“It’s not a tough rehab,” said Dr. Nixon. “My average patient is off pain meds quickly. By six weeks, they’re back to a normal routine.”

Here’s a typical recovery timeline after shoulder replacement:

• Weeks 1–3:Wear a sling for comfort; start gentle range-of-motion movements
• Week 4: Start physical therapy and active range of motion
• Week 6: Resume daily activities, including driving
• Months 4–5: Return to sports and full activity with no restrictions

“You can play golf, tennis or pickleball again,” he said. “I don’t put lifetime restrictions on people. Treat the shoulder like it’s normal. You don’t need to live in fear of dislocation.”

Does Age Matter?

Age should not be the sole factor in deciding if you are a good candidate for a shoulder replacement.

Some patients are told that they are too young to consider shoulder replacement despite severe arthritis, but I often disagree," Dr. Nixon said. "Age is one factor in many when considering if shoulder replacement is appropriate. This decision is tailored to the individual. Often if the arthritis is severe and the patient has failed conservative measures, then I think replacement can be an appropriate option despite being younger than what is average. I would rather have improved pain and function for 20-30 years and accept the possibility of a revision if the alternative is living with it until a more typical age is reached."

For older adults, reverse total shoulder may be a better option even with a healthy rotator cuff. 

"Patients over 70 often have less functional demands and can achieve a satisfactory result with less risk of revision with a reverse shoulder placement," Dr. Nixon said. "This is a shared decision tailored to the individual patient."

Talk To A Shoulder Specialist

Shoulder replacement surgery has improved over the years. Better technology, stronger implants and advanced training have all improved the experience and outcomes.