Your implant will be immediately stable after surgery. If we use cement to affix your implant to bone, there is no time needed for “ongrowth.” However, if we use cementless implants, there is a 6-8 week period which the body needs to allow for “ongrowth” fixation of the bone affixing to the implant. However, during this time, there is no change in outcomes, recovery, or treatment plan. Cementless fixation offers the ability to have longer lasting fixation of the implant to bone, whereas theoretically, the cement bone interface can loosen over time. Both implants have the same outcomes overall, and will be monitored with X-rays for a period of time after placement.

We use cementless components. This allows for long-term biologic fixation to decrease the risk of loosening in the future.

The anatomic implant is based “anatomically” how the native shoulder exists with a ball on the humerus and a cup on the scapula. This allows the shoulder to function like a native shoulder. However, a reverse implant has the ball on the scapula and the socket on the humerus. The reverse implant removes the rotator cuff from the equation and relies on the deltoid for shoulder range of motion and function.

AAOS article about reverse shoulder arthroplasty (Link)

AAOS article about anatomic vs reverse shoulder arthroplasty (Link)

AAOS video about reverse shoulder arthroplasty (Link) and animation about anatomic shoulder arthroplasty (Link)

This is largely determined on your age and your rotator cuff quality. The key with the anatomic replacement, is that you have to have a functioning rotator cuff with all tendons intact for this to be successful. However, regarding the reverse, while we prefer to keep all current rotator cuff tendons intact or repaired, this is not as imperative, since the reverse arthroplasty is made to function in patients without a functional rotator cuff. The anatomic arthroplasty will give you marginally better range of motion than the reverse, but that is not clinically significant.

We will limit shoulder range of motion for about 6 weeks. After that time, we will begin working on shoulder range of motion between 6-12 weeks after surgery. Following that, we will begin strengthening starting at 12 weeks. You will have a simple sling in place for 4-6 weeks. However, in the interim, we recommend working on hand and elbow range of motion daily after surgery.

The articulation is polyethylene (plastic) on cobalt chrome.

Our goal is for you to perform every activity you desire after surgery, except heavy weightlifting activities. Everyday activities such as carrying groceries, bathing, showering, light to moderate work outs, cycling, etc. should not be an issue. 

This is variable, but between 12-25cm (4-8in) is the average–running from the bottom of the clavicle to the junction of the proximal and middle thirds of the humerus. Some patients will need larger incisions to prevent wound complications, promote appropriate component placement, etc.

Historically there was concern that the plastic in these shoulders would wear out. That is very uncommon at this time. We have this generation of plastic with 20 year results showing no wear and biomechanical studies suggesting this up to 40 years of wear. Ultimately, we can confidently say that the plastic will not wear out within 20 years, but there are other areas of possible failure within the shoulder that we will continue to monitor over the years. The most likely reason for it “wearing out” is that the rotator cuff fails in an anatomic replacement, requiring conversion to a reverse.

If you get a joint infection, we will first have to obtain blood and fluid from the knee to confirm the infection. We will then discuss different options for treatment. All patients will need at least 1 more surgery, a period of IV antibiotics, then long term oral antibiotics.  This will be a long road, but we will be here together. 

We recommend working to maximize your physical fitness, shoulder strength, shoulder range of motion, optimizing nutrition, and setting up your home for a safe healing environment–limiting fall risks and setting up social assistance for a week or so after surgery.

Yes, neck pain can cause lateral shoulder pain. Also, rotator cuff injury can cause pain in the lateral aspect of the elbow.

This is a long process. After the first few weeks the pain will be better. Our hope is by 4-6 weeks your range of motion has improved. Then after 8-12 weeks we can begin strengthening the shoulder.

Ultimately, no. The surgical positioning and procedure of the surgery is not amenable for both sides at once. We will always do 1 side, then proceed with the second side after 3 months. 

Not at this time. We are working to evaluate robotic options at this time.

The entire goal of having shoulder replacement surgery being performed is to improve your quality of life, and to be able to perform the activities that you desire. With that said, our goal is to impose minimal or no restrictions upon you. However, patients with shoulder replacements should limit heavy weightlifting activity moving forward. We will impose some restrictions on you for 3-4 months, but then remove essentially all restrictions for you at that point. The key will be to listen to your body and slowly increase your activities to your desired level.

The most common complications are broke down into surgical and medical complications. The most common medical complications are: nausea/vomiting from medication intolerance, uncontrolled pain, constipation from narcotics, uncontrolled glucose levels after surgery, insomnia, and fatigue. The most common surgical complications are pain, stiffness, dislocation, nerve injury, wound drainage, hypertrophic scarring, and infection.