Shoulder Replacement
Background
Shoulder replacement removes damaged joint surfaces and replaces them with implants designed to relieve pain and restore function. Dr. Fliegel performs both anatomic and reverse total shoulder replacement. The best option depends on the condition of the rotator cuff, the shape and quality of the shoulder socket, and your goals for recovery.
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An anatomic shoulder replacement recreates the shoulder’s natural ball-and-socket arrangement and relies on a functioning rotator cuff to move the arm. A reverse shoulder replacement switches the position of the ball and socket, allowing the deltoid muscle to help lift the arm when the rotator cuff cannot function reliably. Reverse replacement may also be considered for certain complex fractures or after a prior shoulder replacement has failed.
The Surgical Procedure
Shoulder replacement is performed under general anesthesia, often with a nerve block to help manage pain after surgery. Dr. Fliegel removes the damaged joint surfaces and places implants chosen to fit your anatomy.
Anatomic Total Shoulder Replacement
The worn ball at the top of the upper arm bone is replaced with a new ball, and the socket is resurfaced. This procedure is generally considered when the shoulder has arthritis and the rotator cuff is functioning well. The rotator cuff tendon at the front of the shoulder may need to be moved and repaired to access the joint, so protecting it is an important part of early recovery.
Reverse Shoulder Replacement
A new ball is attached to the shoulder socket, and a socket-shaped implant is placed on the upper arm bone. This changes how the shoulder moves so the deltoid can compensate for a severely damaged rotator cuff. The procedure is often used for rotator cuff tear arthropathy, which combines arthritis with a large rotator cuff tear.
Planning Your Replacement
X-rays and, when needed, advanced imaging help Dr. Fliegel evaluate the rotator cuff and shoulder socket before surgery. Bone loss, deformity, prior surgery, and the condition of the remaining tendons can influence the implant and surgical plan.
Recovery Timeline
Recovery begins with protecting the shoulder and gradually progresses through motion, strengthening, and a return to daily activities. Your instructions will depend on the type of replacement and any additional procedures performed.
Early Recovery (Weeks 1 - 6)
​The first several weeks focus on protecting the new joint and allowing the surrounding tissues to heal while you begin gentle movement.
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Wear a sling as instructed to support and protect the shoulder.
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Move your hand, wrist, and elbow as permitted.
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Begin shoulder exercises or physical therapy according to your specific plan.
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Avoid lifting, pushing, pulling, or using the operative arm to support your body weight.
Intermediate Recovery (Weeks 6 - 12)
Shoulder motion increases, and you gradually use the arm for light daily tasks. Physical therapy focuses on restoring comfortable movement before progressing to more demanding strengthening.
Late Recovery (Months 3 - 6)
Many patients are able to perform most routine daily activities by about three months. Strength and endurance continue to improve, and recreational activities are introduced gradually.
Return to Sport (Months 6 - 12 and Beyond)
Depending on your procedure and progress, golf may begin with short chips around four months, followed by practice swings and a gradual return to full play around six months. Tennis and other activities are also resumed in stages rather than all at once. Dr. Fliegel will discuss the timing and any long-term activity limits based on your replacement and the demands of your sport. Shoulder strength and function can keep improving for more than a year.
What to Expect
Pain Management
We utilize a multimodal approach including a nerve block when appropriate, oral medications, and ice therapy to minimize the postoperative pain and to limit narcotic use. Swelling and discomfort are expected early on, but most patients find their pain very manageable with this comprehensive approach.
Sleeping
Sleep can be uncomfortable during the first several weeks after shoulder replacement. Many patients find it easier to rest in a recliner or with pillows supporting the upper body and operative arm. Comfort generally improves as pain decreases and shoulder motion returns.
Lifting Restrictions
Most patients can return to routine lifting as strength improves. Repetitive heavy lifting is generally discouraged, particularly after a reverse replacement. Dr. Fliegel will discuss any long-term limits based on your implant, shoulder function, and the activities you want to resume.