Anatomic Total Shoulder Replacement

What is anatomic shoulder replacement?

Anatomic total shoulder replacement removes the arthritic humeral head and resurfaces the glenoid with a polyethylene component. The metal ball remains on the humeral side and the socket remains on the shoulder-blade side, preserving the native orientation of the joint. The operation may be considered for primary osteoarthritis and selected cases of post-traumatic or inflammatory arthritis, osteonecrosis, or other cartilage damage when the rotator cuff and surrounding soft tissues can support an anatomic reconstruction.

Who is a candidate?

Typical candidates have pain, stiffness, grinding, sleep disruption, and loss of function that remain unacceptable despite reasonable nonsurgical care. A functioning rotator cuff is important because it centers the humeral head on the glenoid and helps maintain stable mechanics. Glenoid deformity does not automatically exclude an anatomic replacement, but the amount and pattern of wear affect implant choice and fixation. Severe cuff dysfunction, instability, bone loss, or other complex anatomy may make a reverse replacement more reliable.

Patient-specific CT and 3D planning

Dr. Knudsen plans every anatomic replacement with a CT scan and three-dimensional computer templating. The CT defines the shape, orientation, and wear of the glenoid and the anatomy of the humerus. Digital templating allows comparison of implant sizes, glenoid correction strategies, augmented components, humeral reconstruction, and fixation before surgery. Augmented- and mixed-reality applications can provide intraoperative access to the plan and help guide accurate execution. The goal is to restore the joint line, alignment, sizing, and soft-tissue balance while preserving as much healthy bone as possible.

Surgery and recovery

The damaged joint surfaces are replaced through an incision at the front of the shoulder. The subscapularis tendon or its bony attachment is managed to reach the joint and must be protected while it heals. The arm is therefore placed in a sling during the early recovery period. Rehabilitation progresses from protected motion to active use and strengthening. Daily activities return gradually during the first several months. Gains in comfort, motion, and strength may continue for a year or longer. Return to work and sports depends on healing, strength, implant stability, and the demands of the activity.

Risks and limitations

Potential risks include infection, bleeding, stiffness, nerve or blood-vessel injury, fracture, instability, subscapularis or rotator cuff failure, glenoid component wear or loosening, persistent pain, and revision surgery. Anatomic replacement can provide substantial pain relief and useful motion, but it does not create a normal shoulder or guarantee unrestricted lifting and athletics. The expected result is discussed in the context of the patient's preoperative stiffness, muscle quality, anatomy, health, and rehabilitation.

Selected References

1. American Academy of Orthopaedic Surgeons. Management of Glenohumeral Joint Osteoarthritis: Evidence-Based Clinical Practice Guideline. AAOS; 2020.
2. Knudsen ML, Levine WN. The Lesser Tuberosity Osteotomy Exposure for Total Shoulder Arthroplasty. JBJS Essent Surg Tech. 2021;11(1):e19.00031.
3. Gannon NP, Wise KL, Knudsen ML. Advanced Templating for Total Shoulder Arthroplasty. JBJS Rev. 2021;9(3).
4. Piper C, Neviaser A. Survivorship of Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Surg. 2022;30(10):457-465.
5. Aleisawi H, et al. Outcomes of anatomic versus reverse shoulder arthroplasty for B2 & B3 glenoids with an intact rotator cuff: an updated systematic review and proportional meta-analysis. Shoulder Elbow. 2026;18(3):425-436.

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