Total (Anatomic) Shoulder Replacement
Anatomic Total Shoulder Replacement (TSA) in Houston
Anatomic total shoulder replacement is one of the most reliable operations in orthopaedic surgery for relieving the pain of advanced shoulder arthritis and restoring function. When performed in appropriate candidates, the procedure provides durable pain relief that allows most patients to return to the activities they enjoy.
Who Is a Candidate
Anatomic total shoulder replacement is most often considered for patients with:
- Advanced glenohumeral arthritis confirmed on X-ray
- Persistent pain that interferes with sleep, work, or daily activities
- An intact and functional rotator cuff
- Failure of non-operative treatment (medications, physical therapy, injections)
The decision is highly individualized. Patients with significant rotator cuff deficiency, irreparable tears, or cuff tear arthropathy are usually better served by reverse shoulder replacement.
Implant Design
Modern anatomic shoulder replacement systems are designed to recreate each patient's individual anatomy as closely as possible.
- Humeral component. A metal ball replaces the worn humeral head. It may be fixed with a stem (extending down the humerus), a short stem, or as a stemless implant secured directly to the upper humerus, depending on bone quality and the surgeon's judgment.
- Glenoid component. A polyethylene (plastic) component resurfaces the worn socket. Different designs—pegged, keeled, all-polyethylene, or hybrid metal-backed—are used based on the patient's anatomy and the bone available for fixation.
Implant selection is part of the pre-operative discussion and is tailored to each patient.
How the Procedure Works
Anatomic shoulder replacement is performed under general anesthesia, often combined with a regional nerve block for pain control after surgery.
- Surgical approach. An incision is made on the front of the shoulder, and the deltopectoral interval (between the deltoid and pectoralis major muscles) is developed to expose the joint.
- Subscapularis management. The subscapularis tendon (the front part of the rotator cuff) is carefully released and repaired anatomically at the end of the case.
- Humeral head resection. The worn humeral head is removed using a guide that recreates the patient's original anatomy.
- Glenoid preparation. The arthritic socket is reshaped to receive the glenoid component, which is fixed with bone cement and/or biologic ingrowth fixation depending on the implant design.
- Humeral component placement. The humeral component is placed, either with a stem or as a stemless design.
- Trial and balance. The shoulder is trialed to confirm proper soft-tissue tension, stability, and motion.
- Final implants and closure. Final implants are placed, the subscapularis is repaired, and the incision is closed.
The procedure typically takes approximately two hours.
Outpatient Shoulder Replacement
For appropriate candidates, anatomic shoulder replacement can be safely performed as outpatient surgery, with the patient going home the same evening. Modern protocols make this possible through:
- Regional anesthesia (interscalene nerve block) for several hours of dense pain control
- Multimodal pain management combining non-narcotic medications
- Pre-operative education so patients know what to expect at every step
- Same-day physical therapy to confirm safety with motion before discharge
- Structured at-home follow-up to monitor early recovery
Dr. Gregory has been involved in developing and publishing national standards for outpatient shoulder arthroplasty. Whether outpatient surgery is appropriate is determined in consultation with each patient.
Recovery Timeline
The subscapularis tendon at the front of the shoulder is taken down during anatomic shoulder replacement and repaired at the end of the case. It takes about 4–6 weeks for that tendon to heal back, which drives the early motion restrictions.
Weeks 0–2: Early recovery
- Sling for comfort, typically discontinued between 1 and 2 weeks
- Light use of the arm for daily activities; avoid lifting more than 1 lb
- Gentle motion exercises
Weeks 2–6: Protected motion
- Continued protected motion to allow the tendon repair to heal
- Specific motion restrictions to protect the repair
- No resisted shoulder motions yet
Weeks 6–12: Motion restrictions lift
- Motion restrictions are lifted
- Light strengthening begins
Months 3–6: Strengthening and recreation
- Progressive strengthening
- Return to most recreational activities
After 6 months
- Continued strength gains through the first year
- Heavy overhead lifting is generally avoided long-term to protect implant longevity
Longevity and Outcomes
Modern anatomic shoulder replacements typically provide reliable pain relief and durable function for fifteen to twenty years or longer in most patients. Long-term outcomes depend on bone quality, activity level, implant design, and surgical technique.
Further patient education is available in this handout.
Houston Locations and Scheduling
Anatomic total shoulder replacement is performed at hospitals and outpatient surgery centers in Houston affiliated with UTHealth Houston and Memorial Hermann. Office consultations are available at Memorial Villages and Texas Medical Center locations.
Appointments are scheduled through UTHealth Houston at 713-486-1700.
Frequently asked questions
What is anatomic total shoulder replacement?
Anatomic total shoulder replacement (TSA) is a surgery in which the worn ball and socket of the shoulder are replaced with prosthetic components that recreate the normal anatomy of the joint. The metal humeral head is fixed to the upper arm bone and a polyethylene component resurfaces the socket. It is used when the rotator cuff is intact and arthritis pain is severe.
Who is a candidate for anatomic shoulder replacement?
Candidates typically have advanced shoulder arthritis confirmed on X-ray, persistent pain despite non-operative treatment, and an intact and functional rotator cuff. Patients with a deficient rotator cuff usually require reverse shoulder replacement rather than anatomic replacement.
How long does a shoulder replacement last?
Most modern anatomic shoulder replacements function well for fifteen to twenty years or longer, depending on activity level, implant type, and bone quality. Registry data continue to track long-term durability across implant designs.
Is anatomic shoulder replacement performed as outpatient surgery?
For appropriate candidates, yes. Modern anesthesia, regional nerve blocks, and structured recovery protocols allow many shoulder replacements to be performed as same-day surgery, with the patient returning home the same evening.
How long is the recovery after shoulder replacement?
The sling is typically discontinued within the first 1 to 2 weeks. The first 6 weeks involve protected motion to allow the tendon repair to heal. Strengthening begins around 6 weeks. Most patients return to most recreational activities within several months and continue to gain strength through the first year.
Will I have full range of motion after shoulder replacement?
Most patients regain functional range of motion sufficient for daily activities and most recreational pursuits. Final motion depends on pre-operative motion, rotator cuff function, and adherence to rehabilitation.