About This Procedure
Anatomic total shoulder replacement — also called anatomic total shoulder arthroplasty — replaces the damaged humeral head with a metal ball and the worn socket with a plastic component. It restores natural anatomy. The rotator cuff muscles control motion, strength, and stability.
Dr. Jay Levin performs anatomic shoulder replacement at Duke Health facilities in Durham, bringing expertise in implant selection, surgical technique, and the nuanced decision-making required for excellent long-term outcomes. Patients from Durham, Cary, Chapel Hill, and across North Carolina seek his care for end-stage shoulder arthritis.
Candidates include those with shoulder arthritis, post-traumatic arthritis, or inflammatory arthritis who have pain, stiffness, or loss of function despite nonsurgical treatment. An anatomic replacement requires a functioning rotator cuff.
The Procedure
Anatomic shoulder replacement is performed under nerve block and general anesthesia. The surgery typically takes 1–2 hours. Dr. Levin makes an incision along the front of the shoulder, carefully protecting the surrounding muscles and nerves — with special attention to the subscapularis tendon, which must be protected early after surgery.
The damaged humeral head is removed and replaced with a metal stem and ball component. The worn glenoid surface is resurfaced with a high-density polyethylene socket component. Dr. Levin uses advanced preoperative planning tools — including 3D CT-based templating — to optimize component sizing and positioning for each patient's unique anatomy.
Most patients go home the same day. Soft-tissue balancing ensures the shoulder functions smoothly and the repair is durable.
Recovery at Duke Health
Anatomic shoulder replacement is routinely performed as an outpatient procedure at Duke Health, with most patients returning home the same day. The nerve block typically controls pain for 1–3 days; most patients need little or no opioids. Non-opioid medications such as Tylenol and Ibuprofen are routine.
Your arm will be in a sling full-time for 2 weeks. After that, the sling is removed at home but worn while sleeping and in public. The sling is discontinued completely around 6 weeks. Early therapy is passive motion only and begins approximately 5 days after surgery.
Do: Wear the sling as instructed. Perform your home exercise program 3–5 times daily. Use your legs to push up from chairs.
Don't: Actively reach, lift, push, or pull for the first 6 weeks. Reach behind your back early. Support your body weight through the operated arm. Do heavy repetitive lifting long-term.
Follow-up visits are typically scheduled at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and yearly thereafter. Dr. Levin provides close follow-up to monitor healing and guide your rehabilitation throughout the process.
Risks
As with any surgery, anatomic shoulder replacement carries risks, including infection, bleeding, nerve or vessel injury, stiffness, rotator cuff or subscapularis failure, implant loosening or wear, and fracture. Dr. Levin discusses these and any patient-specific concerns during your consultation.
Dental Care
Per AAOS/ADA guidelines, antibiotics are generally not required before dental procedures. Avoid non-urgent dental work for 3 months after surgery.