Shoulder Replacement

Before you consider surgery

Before you consider having surgery, there are several ways you can resume an active lifestyle. This first section will explain:

What is arthritis?

Did you know there are over 100 different types of arthritis?  

Arthritis is inflammation of the joints that can take several forms:  

Arthritis can also be caused by a prior injury, especially breaks in the bones of a joint, or it could have developed based on how your joints formed during childhood.  

Symptoms of arthritis can include:

Nonsurgical options

Explore nonsurgical ways to reduce your pain. Your pain can be dramatically decreased in several ways before you decide to have surgery. Discuss each nonsurgical option with your primary care doctor to determine which are best for your specific needs. 


There are a number of medications that can help with your pain. Discuss the risks and benefits of each pain medication with your doctor to determine which one is best for you.




Your doctor may recommend injections directly into your shoulder. The purpose of an injection is to reduce irritation and inflammation caused by your injury.

Corticosteroid Injections:

Physical therapy

Physical therapy is often the first option for treatment. It can help improve the flexibility and strength in your shoulder.

Lifestyle changes

To have the best outcome or results from your surgery, it is important that you are as healthy as possible. There are several lifestyle changes that will help.

Smoking cessation

The American Academy of Orthopaedic Surgeons (AAOS) lists these positive changes when you stop using tobacco products:

How to get started:

Smoking Cessation Resources: 

Phone Numbers:


Mobile Apps:

Group Counseling:

Weight loss

Being a healthy weight will benefit you in many ways, both in your daily living and related to your surgery.

Being overweight increases your risk for:

Weight loss can be difficult and takes both healthy eating and increased activity, which can be as easy as increasing the amount of walking that you do daily.

To get started:

Remember, safe weight loss is a slow, gradual process, of 1 to 1 ½ pounds of weight loss a week and takes changing long time habits and your lifestyle. It can be an up and down process but will be worth it as you begin to feel better and become more active.

When should I consider having surgery?

The decision to have surgery is typically made based on your answers to the following questions:

Understanding the risks

As with any surgical procedure, there are risks and complications. Your surgeon will discuss each potential complication of shoulder replacement surgery in detail.


Although uncommon, infections are one of the most severe complications. This can occur around the time of surgery or later in your recovery. The treatment is complex, but the incidence is quite low.

Nerve Injury

Nerve injuries to the shoulder, arm, and hand are uncommon. This injury is usually temporary but can be permanent.

Blood Clots

Blood clots are also known as deep vein thrombosis (DVT) and pulmonary embolism (PE). The formation of a blood clot is uncommon. Some patients are instructed to take medications (such as aspirin or a blood thinner) around the time of their surgery to decrease this risk. Your surgeon will let you know if this is necessary.

Stiffness and weakness

Stiffness can be a problem after your rotator cuff repair surgery. This can be minimized by fully participating in therapy after surgery.


Dislocation is when the bone joint comes out of the socket. Typically this does not require an incision or an extensive surgical procedure to correct.  However, if a dislocation occurs multiple times, additional surgery may be required. The risk of dislocation can be minimized by wearing your sling as directed and following therapy exercises as instructed. 

Prosthesis wearing or loosening

Over time your shoulder prosthesis can wear down or the components may loosen. This is rare but can be caused by infection, poor bone quality, or wear over time.  Excessive wear or loosening may require additional surgery. 

Discuss with your doctor if surgery is right for you.

Once you have chosen surgery

If you and your doctor choose surgical repair, review this section to: 

Female patient consulting with female doctor next to computer screen with x-ray displayed.

Meet your surgical team

You are in good hands.

All of our surgeons are board certified and have completed orthopaedic subspecialty fellowships in the area of shoulder and elbow surgery.  

We work as a team.

An integrated, multidisciplinary approach combines a team of dedicated physicians, advance practice providers, orthopaedic nurses, clinical case managers, anesthesia teams, residents and medical students, and physical and occupational therapists dedicated to providing our patients with the highest quality care. 

This team is led by your surgeon and also includes advance practice providers. They communicate daily about your progress both before and after surgery. During your preoperative and postoperative period,  our advance practice providers, which consist of physician assistants (PA) and/or nurse practitioners (NP), will be involved in your care. They are licensed by the state and engage in ongoing education in the specialty of orthopaedics. They have advanced academic and clinical training that allows them to provide health care services including: 

Learn more about the Orthopaedic services we provide.

What will happen during your total shoulder replacement surgery?

Joint replacement surgery, also called arthroplasty, is surgery performed to relieve pain and restore your range of motion by realigning or reconstructing a joint.

I wanted to talk to you about what it means to have a total shoulder replacement. So, we’re going to talk about an anatomic total replacement, and what that means is we are replacing the ball and the socket of your shoulder because of your arthritis. So this is what it looks like on an x-ray. This is a typical picture for osteoarthritis (gestures to x-ray images on the computer screen). Your should is made up of a ball as well as a socket. In arthritis, you lose the cartilage between the ball and the socket. So we normally should see a space between these two and as you can see they’re riding bone-on-bone. That’s what’s causing your pain. So when it’s time to have the should replacement, what we do is replace that ball and socket. This is what it looks like. (Holds up a metal ball replacement piece and plastic socket replacement piece.) The two of them together make your new joint, and they articulate so that you don’t have that pain anymore. You don’t have the bone-on-bone. And then this is what it looks like when it’s in your shoulder. (Holds up a model of the pieces set in bone.) So now the ball is in the bone, and the plastic-looking piece is deep inside there, resurfacing the socket. Essentially, you have a new joint, and you shouldn’t have your pain anymore.

What happens during reverse shoulder replacement surgery?

I’d like to tell you about a reverse ball and socket implant. Typically, we do this implant for someone who has a massive rotator cuff tear as well as arthritis. So I’m going to go over some x-rays (gestures toward the computer).

The shoulder is made up of a ball (gestures in a circular motion on the x-ray image of a shoulder joint), as well as a socket (gestures in a curved motion to the right of the ball area on x-ray). When someone has a massive rotator cuff tear as well as arthritis we start seeing that the ball rides high on this socket here (pointing to the x-ray). So normally, the ball should be down here, but you can see in this picture that the ball has ridden up and is riding high. And so what we get is cartilage loss at the top of the ball as well as the socket, and we also get cartilage loss where it articulates with the acromion. That’s the bone on the top of your shoulder. So what happens in a normal should is the ball rides and is contained within the socket normally, because you have normal tendons that hold it there. But in a massive cuff tear what we start to see is that the ball starts to ride high on the socket and we get edge loading on that socket which creates arthritis, and then you get that new articulation with that bone on the top of your shoulder.

So for the implant, what we do is we put a ball on the socket and a socket on the ball. What that allows us to do is to bring this ball all the way back down so that it’s in its normal position. It also allows the deltoid to start moving the shoulder. So this is the big muscle on the outside part of the shoulder you can feel so we don’t have to rely on the internal tendons anymore in the shoulder. So for the implant, this is what it looks like. So this is the socket that we put on the ball, and this is the ball we put in the socket. We bring that back down and you have a new articulation in your shoulder. This is what it looks like at the time of surgery in the bone. So you can see here that we’ve got a new ball in the socket and the socket is now in that previous ball. That creates the new joint and you don’t have pain anymore.

How your pain will be controlled

Pain control is one of the most important considerations for our patients around the time of surgery. 

When can I go home after surgery?

Patients that are in good health with good strength and have a strong support system at home may be eligible for outpatient shoulder replacement surgery. This means that the patient can expect to return to their home the same day as surgery. Some patients do stay overnight in the hospital. Discuss this option with your surgeon to see if you are a candidate.

Pain Medication 

You will receive a prescription for pain medication for you to have at home after your surgery. 

Medication for Constipation 

Constipation is a side effect of pain medication. Use the medications you typically use to help prevent constipation (fiber, Metamucil, stool softeners such as Colace or Senokot, and Milk of Magnesia). If you have not had a bowel movement after 4 days following your surgery, contact the Bone and Joint Institute.

How to prepare for your surgery

Once you have made the decision to proceed with surgery, there is still much to do. Please review the following sections in detail. 

Preoperative checklist

Medical Optimization/Surgical Risk Assessment

Your surgeon will let you know if you need a surgical risk assessment from your family doctor and/or specialist. 

Schedule other exams and procedures

Dental exams

Invasive procedures


Preoperative appointments

Plan on spending 2-4 hours at the Milton S. Hershey Medical Center for your preoperative appointments.

The following will occur during the preoperative appointment with your surgeon and their team:

Not all patients will require an appointment with the anesthesia clinic, however, if necessary, the following will occur during this appointment:

Prepare your home for recovery

Prior to surgery, it is recommended that you make the following preparations:

We recommend that you spend time doing your routine activities in your home without using your operative arm.  This will help you plan for your recovery period.

Pick up medications

You will want to have your medications on hand before having surgery:

Arrange for care and transportation 

Discharge usually occurs the same day as your surgery.

Physical therapy

When you start therapy will depend on what your physician finds during your surgery. Do not begin formal therapy until you are instructed to do so by your surgical team.

Shoulder Replacement Guidebook

Read your Shoulder Replacement Guidebook and contact our team with any questions. 

What to bring the day of surgery

Bring the following with you to the hospital: 

Do not bring:

The day before your surgery

Nurse on the telephone.

In the afternoon

An admissions nurse will call and tell you:

In the evening

It is important to prepare your skin before surgery to reduce the risk of infection at the surgical site. It is also crucial to follow proper diet restrictions. Please be sure to do the following the evening before your surgery: 

Dietary restrictions: 

Clear liquids include:

Clear liquids are NOT:

No smoking sign.

Tobacco restrictions (after midnight)

The morning of your surgery

Image of the admissions desk at the Penn State Health Milton S. Hershey Medical Center.

In the operating room

Once your surgery is complete, your surgeon will speak with your family and review the procedure.

In the recovery room - Post Anesthesia Care Unit (PACU)

Orthopaedic unit

Recovery after surgery

Rehabilitation begins almost immediately after shoulder replacement surgery and there are certain things you need to watch out for. This section will discuss:

When should I call the doctor?

Some patients do have complications after surgery. Call us if you experience any of the following:

Emergency department entrance of the Penn State Health Milton S. Hershey Medical Center

What are the do's and don'ts after your surgery?

You have an important role in caring for your “new” shoulder. To have the best surgical outcome, follow the Do's and Don'ts listed below:


Certain movements place stress on your new shoulder and should be avoided until your surgeon instructs you to do otherwise.


When and how to wear your sling

You must wear your sling at all times, including night time (6 to 8 weeks in the sling depending on the type of replacement surgery you have had). The only times you may take it off are:

There are two ways you can learn to put on and take off the sling:  

Option 1:

  1. Place the sling on a high table or countertop with the trough open.
  2. Place your surgery arm into the trough and fasten the two trough straps to secure your arm in trough
  3. Fasten the waist belt.
  4. Reach behind with nonsurgical arm and move arm through loop in the remaining strap. (This will be a similar motion to putting on a backpack).
  5. Fasten the buckle in front to secure the strap.
  6. Fasten the thumb strap.
  7. Ensure the sling is positioning the operative arm directly in front of you.
  8. When removing the sling, be sure to just release the quick-clip buckles at the waist and shoulder straps and the short straps over the trough and thumb - Do not remove the Velcro from the long straps.

Option 2:

  1. Place the sling on a high table or countertop with the trough open.
  2. Insert your non-operative arm through the only “loop” in the straps
  3. Rotate your body to allow you to place your surgery arm into the trough of the sling.
  4. Use the hand of the non-operative side to fasten the two straps over trough, and fasten the waist and shoulder buckles. Fasten the thumb strap.
  5. Ensure the sling is positioning the operative arm directly in front of you
  6. When removing the sling, be sure to just release the quick-clip buckles at the waist and shoulder straps and the short straps over the trough and thumb - Do not remove the Velcro from the long straps.

Bathing instructions

You may take the neutral wedge brace off once a day to bathe. Please make sure you have someone to assist you with transfers into the shower or tub. If you feel unsteady, a shower seat for bathing will increase safety. When bathing your upper body try leaning forward, allowing some space between your body and operated arm to wash under your armpit and upper arm. The operated arm should only be extended out by 10-15 degrees. Dry yourself in this position. Drying under your armpit is important to prevent skin breakdown or rash.

How to dress

Man reaching non-operated arm behind back to pull the other sleeve of a button-down shirt on.

Wear a loose t-shirt or button-down shirt.


  1. Put your operated arm into your sleeve.
  2. Pull your t-shirt up as far as possible to your upper arm without moving your elbow away from your body. You may need assistance with positioning your operated arm away from your body by bending toward your operated side or forward, making sure you do not put weight on your operated arm. The operated arm should only be extended out by 10-15 degrees to assist with putting your arm into your sleeve.
  3. Position your t-shirt so that you can put your non-operated arm into your sleeve.
  4. Put your head through the opening for your neck.
  5. Put the sling on as per the instructions in the guidebook or from your therapist.

Button-Down Shirt

  1. Insert your operated arm into your sleeve.
  2. You will need to walk the collar over to your non-operated arm.
  3. Put your non-operated arm through your sleeve.
  4. You may need assistance with your buttons.
  5. Adjust your shirt at the back and front with your non-operated arm.
  6. Put on your sling as per the instructions in the guidebook or from your therapist.


Wear pants or shorts with an elastic waist. To dress while wearing the sling, follow these instructions:

  1. While sitting on a chair or the edge of a bed, use your non-operated arm to hold the waistband of your pants.
  2. Place your leg into your pants by crossing your leg and bringing your ankle up to knee height.
  3. Pull your pants up to upper thigh height.
  4. Using your non-operated arm, push up from your chair/bed and pull your pants up.


  1. While sitting on a chair or the edge of a bed, cross your leg and bring your ankle up to knee height.
  2. Bend slightly forward with the sock in your non-operated hand, and place the sock over your toes.
  3. Pull up your sock while bending your knee toward you.


Try to wear slip-on shoes or use elastic shoelaces or velcro closures so you do not have to tie your shoes.

  1. While sitting in a chair, slip your feet into your shoes.
  2. Use your non-operated hand to secure the velcro closures, if applicable.

Exercises to do after surgery

It is important to do the exercises recommended by your therapist after your shoulder replacement surgery.

You can begin with hand, wrist, and elbow exercises immediately after surgery.  Your therapist, as directed by your surgeon, will instruct you on which exercises to do, and when to begin, as you progress after surgery. 

Click each image for a video demonstration of the exercise.

Exercises to be done immediately after surgery: 

Exercises to perform only when directed by your surgeon, with instructions from your physical therapist: 

Thank you for visiting

Thank you for taking the time to view this resource! We hope you, your family, and your caregivers find this resource convenient and helpful in making informed decisions about your course of care.

If you have other questions or would like to discuss shoulder replacement surgery further, we would be happy to meet with you. 

Best wishes from the Shoulder and Elbow Division at Penn State Health! 

Aerial photograph of the Penn State Health Milton S. Hershey Medical Center