Who Is a Candidate for Total Shoulder Replacement Surgery?

The initial treatment for shoulder arthritis includes non- or less-invasive treatments such as physical therapy, medications, and injections. If these treatments fail to provide relief, shoulder replacement surgery may be considered.

See Preparing for Shoulder Replacement Surgeries

Age and Weight Requirements

Advanced age or obesity alone does not rule out shoulder replacement surgery. Experts believe patients aged 85 or older who are in good general health can still have shoulder replacement surgery.¹Churchill RS. Elective shoulder arthroplasty in patients older than ninety years of age. J Shoulder Elbow Surg. 2008 May-Jun;17(3):376-9. doi: 10.1016/j.jse.2007.09.005. Epub 2008 Feb 14. PubMed PMID: 18276166. Likewise, there is no upper weight limit for those who can have the surgery.²Walch G, Boileau P, Noël E. Shoulder arthroplasty: evolving techniques and indications. Joint Bone Spine. 2010 Dec;77(6):501-5. doi: 10.1016/j.jbspin.2010.09.004. Epub 2010 Oct 18. PubMed PMID: 20961793.

While there are no age and weight limits, advanced age and obesity do tend to increase the risk for post-surgical complications such as infection.³Linberg CJ, Sperling JW, Schleck CD, Cofield RH. Shoulder arthroplasty in morbidly obese patients. J Shoulder Elbow Surg. 2009 Nov-Dec;18(6):903-6. doi: 10.1016/j.jse.2009.02.006. Epub 2009 May 22. PubMed PMID: 19464930.^,4Jain NB, Guller U, Pietrobon R, Bond TK, Higgins LD. Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop Relat Res. 2005 Jun;(435):232-8. PubMed PMID: 15930944. If appropriate, a doctor may encourage a patient to lose weight before surgery.

Who May Be Ineligible For Total Shoulder Replacement Surgery?

Not everyone who has shoulder arthritis is a candidate for total shoulder replacement. Factors that can affect patient eligibility include:

Nicotine use
Joint replacement patients who smoke or use other tobacco products face higher post-surgical complication rates. For example, a survey of more than 500 people who underwent knee replacement surgery found that smokers were about 10 times more likely to have had a revision surgery.⁵Kapadia BH, Johnson AJ, Naziri Q, Mont MA, Delanois RE, Bonutti PM. Increased Revision Rates After Total Knee Arthroplasty in Patients Who Smoke. J Arthroplasty. 2012 May 23. [Epub ahead of print] PubMed PMID: 22633104.

Tobacco users can lower their post-surgical risks by quitting or cutting back on use prior to surgery. For total shoulder replacements, the surgery involves cutting through the rotator cuff tendon and repairing it at the end of the procedure. Nicotine use has been shown to inhibit healing following rotator cuff repairs.

Infection
Doctors consider infection a serious complication. A patient may need to postpone surgery or consider non-surgical treatment options if he or she has:

• Systemic infections
• Predisposition to infection
• Skin problems that can limit wound healing or increase the risk of infection

Osteoporosis
Severe osteoporosis can cause bones to be too brittle to properly support and adhere to a prosthesis. On the other hand, mild to moderate osteoporosis may simply affect how a surgeon plans for surgery. For example:

• The surgeon may decide to use fast-acting bone cement to attach the new socket to the natural bone instead of using a cementless fixation method.
• The surgeon may ask the patient take steps to improve bone density before and after surgery to enhance the lifespan of the shoulder replacement.

Damaged shoulder socket
Sometimes the boney socket of the scapula, called the glenoid, is severely worn down and damaged from arthritis, making it difficult to attach a prosthesis.

Irreparable rotator cuff damage
Rotator cuff damage and shoulder arthritis often go hand in hand, a condition called rotator cuff tear arthropathy. If the rotator cuff is severely and irreparably damaged, then total shoulder replacement is not recommended. In this situation, reverse shoulder replacement may be possible.

See Who Gets Reverse Shoulder Replacement?

Irreparably damaged deltoid muscle
Damage to the shoulder’s large deltoid muscle limits the chances for successful rehabilitation and recovery for any shoulder replacements.

Nerve damage
A patient may not be eligible for surgery if the nerves traveling from the spinal cord to the affected shoulder, arm, and hand are damaged.

Other factors
Patients who are unable to follow pre- and post-surgical instructions may be ineligible for surgery. For example, people who suffer from dementia or alcoholism are more prone to dangerous falls, putting them at a higher risk of complications such as bone fractures and shoulder joint dislocations.

Risks for Patients Under Age 60

Patients under age 60 tend to have a higher rate of revision surgery than older patients.⁶Sperling JW, Cofield RH, Rowland CM. Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long-term results. J Bone Joint Surg Am. 1998 Apr;80(4):464-73. PubMed PMID: 9563375.^,7Dillon MT, Inacio MC, Burke MF, Navarro RA, Yian EH. Shoulder arthroplasty in patients 59 years of age and younger. J Shoulder Elbow Surg. 2013 Apr 6. doi:pii: S1058-2746(13)00086-4. 10.1016/j.jse.2013.01.029. [Epub ahead of print] PubMed PMID: 23571084. It may be that younger patients tend to be more active and therefore are harder on their new shoulders.

Because of the extra post-surgical risk, younger patients are sometimes encouraged to postpone shoulder replacement surgery and consider other less invasive treatment. However, arthroscopic surgery for shoulder arthritis has not been that successful.