When Is It Time to Consider Shoulder Replacement?

Severe arthritis on an X-ray does not automatically mean that a patient needs surgery. Similarly, patients do not need to wait until their shoulder becomes completely unusable before discussing replacement.

Patients considering shoulder replacement often report:

Pain and functional limitation are both important. Some patients retain reasonable motion but experience substantial pain, while others are most troubled by stiffness and an inability to use the arm effectively.

Shoulder replacement becomes a reasonable consideration when these problems meaningfully affect quality of life and the expected benefits of surgery outweigh its risks and recovery demands.

Most patients will try some form of nonsurgical management before undergoing shoulder replacement. Treatment commonly includes a combination of:

Patients do not necessarily need to exhaust every option before considering surgery. Treatment should be matched to the patient's symptoms, imaging findings, medical health, and goals.

Physical therapy may improve motion, strength, and shoulder mechanics in some patients. However, when arthritis is severe, therapy can sometimes aggravate pain rather than provide meaningful relief. In that setting, repeatedly pursuing an ineffective treatment may not be helpful.

The decision to proceed with replacement is individualized rather than based on a mandatory number of injections, therapy visits, or months of symptoms.

Shoulder X-rays are an important part of the initial evaluation. They allow Dr. Horner to examine joint-space loss, changes in the shape of the joint, bone spurs, and other findings associated with osteoarthritis.

The amount of arthritis can generally be classified as mild, moderate, or severe. These findings are then compared with the patient's pain, motion, strength, examination, and functional limitations.

Imaging and symptoms do not always match perfectly. Some patients have severe arthritis on X-rays but manageable symptoms, while others experience significant limitations. For this reason, the decision to consider shoulder replacement is not made from imaging alone.

An MRI may be obtained when additional information about the rotator cuff or other soft tissues is needed.

Rotator cuff integrity is important when choosing between an anatomic and reverse shoulder replacement. An anatomic replacement generally depends more heavily on a functioning rotator cuff, while a reverse replacement may be preferred when the rotator cuff is compromised or in other selected situations.

Not every patient requires an MRI. The need for one depends on the examination, X-rays, surgical history, and the type of replacement being considered.

Dr. Horner uses a preoperative CT scan for nearly all shoulder replacements. The scan provides a three-dimensional assessment of the patient's anatomy and allows the operation to be planned before entering the operating room.

CT-based planning can help:

This planning is intended to optimize component sizing and positioning for the individual patient.

For particularly complex shoulder replacements, the CT scan may also be used to create patient-specific 3D-printed surgical guides. In selected cases with substantial anatomical deformity or bone loss, a custom implant may be designed to match the patient's anatomy.

These technologies are not necessary for every shoulder replacement. Their use depends on the complexity of the shoulder and the surgical plan.

Both anatomic and reverse shoulder replacements can provide excellent outcomes in appropriately selected patients. The choice depends on factors such as rotator cuff function, bone quality, the amount and pattern of socket wear, age, activity demands, and surgical history.

Dr. Horner reviews these factors with each patient and recommends the implant design that best matches their anatomy and goals. Read more about the shoulder replacement procedure and recovery.

If persistent shoulder pain, sleep disturbance, stiffness, or loss of function continues despite reasonable nonsurgical treatment, an orthopedic evaluation can help determine whether shoulder replacement should be considered.

The consultation includes a review of symptoms, examination, and X-rays. Additional imaging is ordered when needed to clarify the diagnosis or plan treatment.

Dr. Nolan Horner evaluates patients with shoulder arthritis at his Oak Brook, St. Charles, and Little Village offices.