Shoulder Reconstruction and Replacement Surgery

Recognized by U.S. News & World Report

UT Southwestern Medical Center has earned a "High Performing" rating from U.S. News & World Report for orthopaedic care, placing us among the nation’s leading hospitals in this area of care.

UT Southwestern orthopedic surgeons specialize in the latest procedures for shoulder reconstruction and shoulder replacement surgery. Our doctors and their teams provide compassionate care for people with severe shoulder pain and offer the most advanced surgical techniques and technology available.

Expertise in Orthopedic Shoulder Surgery

The shoulder joint is a “ball and socket” joint, with the end of the upper arm bone (humerus) forming the ball and the shoulder blade containing the socket. Ligaments hold the bones of the shoulder joint together, and tendons connect muscles to the bones. Soft tissue called cartilage cushions the bones to prevent them from rubbing together.

Pain, instability, or reduced mobility in the shoulder can result from injuries, falls, or conditions such as arthritis. Aging alone can cause degeneration of the ball and socket joint, resulting in arthritis. Aging can also be responsible for the degeneration of the tendons that help with shoulder mobility, or the rotator cuff, which can tear if left untreated.

When conservative treatments such as medication, physical therapy, and injections are no longer effective, patients might need rotator cuff repair surgery or shoulder reconstruction/replacement surgery.

Surgeons at UT Southwestern perform a high volume of shoulder replacement surgeries, and our expertise helps provide the best possible results for patients. Our orthopedic surgeons are leaders in the field of orthopedic medicine and have helped set national quality standards for joint replacement procedures. Michael Khazzam, M.D., is one of only a few active members of the American Shoulder and Elbow Surgeons in the Dallas-Fort Worth area.

Our Orthopedics team provides expert-level evaluation and treatment of severe shoulder injuries and conditions. We offer advanced diagnostic methods, the latest surgical techniques, and personalized rehabilitation programs to meet each patient’s needs.

Shoulder Conditions We Treat

We offer shoulder reconstruction and replacement surgery for patients with pain and damage that results from:

• Arthritis, including osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, and psoriatic arthritis, as well as other forms of shoulder degenerative joint disease
• Complete rotator cuff tears
• Shoulder dislocations and instability
• Failed prior shoulder surgery (including failed or re-torn rotator cuff repairs, recurrent dislocations after surgical shoulder stabilization, etc.)
• Osteonecrosis, a condition caused by inadequate blood supply to the bones of the shoulder joint
• Previous shoulder replacement surgery that failed because of wear and tear, infection, implant loosening, poor function, or a painful implant
• Severe fractures in the upper arm bone or the bones of the shoulder joint

Shoulder Injury Symptoms

Patients might need surgery to reconstruct or replace the shoulder joint because of symptoms such as:

• Severe pain
• Shoulder instability or tendency to dislocate
• Stiffness, swelling, and reduced range of motion

Diagnosing Shoulder Injuries

Our orthopedic specialists conduct a thorough evaluation, which includes a:

• Physical exam
• Discussion of personal and family medical history
• Discussion of symptoms

We use the latest diagnostic tests to understand the extent of damage or disease in the shoulder joint and view its location to determine if replacement surgery is the best course of action. We often order imaging tests such as:

• Computed tomography (CT) scans, specialized X-ray technology that takes cross-sectional images inside the body to produce 3D images
• Magnetic resonance imaging (MRI) scans, which use a large magnet and radio waves to produce detailed images of soft tissues such as ligaments, cartilage, and tendons
• X-rays to check for bone fractures and signs of wear or injury

Shoulder Injury and Pain Treatments

For people with shoulder injuries, pain, and other symptoms, we typically recommend conservative treatment first, such as medication and physical therapy. If these measures don’t relieve symptoms or if the condition is severe, we offer the latest surgical techniques for shoulder reconstruction or replacement.

For shoulder arthroplasty cases, our surgeons are also able to use a preoperative planning computer program that allows them to plan the surgery on a computer before going to the operating room. This shows them what implant and implant position would be best for an individual patient and enables them to predict the postoperative shoulder range of motion after the patient has gone through rehabilitation.

Surgical options include:

Shoulder reconstructive surgery

Our surgeons perform shoulder reconstruction for patients with moderate symptoms and conditions that don’t require joint replacement. In shoulder reconstructive surgery, we repair torn or stretched ligaments and other soft tissues to stabilize the shoulder joint and prevent future dislocations.

We use minimally invasive techniques whenever possible, but some patients need open surgery. Reconstructive surgical options include:

• Arthroscopy: Surgeons use a few tiny incisions to access the shoulder joint. We insert a small camera and instruments through the incisions to see inside the joint and repair tissues.
• Open surgery: We make one or sometimes more larger incisions to access the shoulder joint and make the repairs.

Total shoulder replacement surgery

People who have severe arthritis in the shoulder but whose rotator cuff tendons are intact (not torn) can benefit from total shoulder replacement surgery.

The shoulder replacement surgery replaces both the ball (head of the humerus) and socket (glenoid) parts of the shoulder joint. The new glenoid will be a plastic socket.

Reverse shoulder replacement surgery

We often recommend a different type of total replacement for people who have severe shoulder arthritis along with major rotator cuff tears or severe deformity with bone loss of the socket. A reverse shoulder replacement surgery also replaces both the ball and socket of the shoulder joint but switches their positions.

In this technique, our surgeons attach a metal ball to the shoulder socket and a plastic socket to the upper end of the humerus. A reverse shoulder replacement allows the patient to use an upper arm muscle rather than the rotator cuff to raise and move the arm.

Revision shoulder replacement surgery

In some people who have had previous shoulder replacement surgery, the artificial ball and socket components can wear down, become loose, or dislocate. In this situation, our surgeons perform a second shoulder replacement surgery to replace the artificial joint components.

Shoulder Rehabilitation

After shoulder reconstruction and replacement, we offer physical and occupational rehabilitation to help patients quickly and safely return to their everyday activities.

Our team of nurses and therapists customizes a rehabilitation program to meet each patient’s needs. Physical therapy helps strengthen muscles and improve range of motion, and occupational therapy helps patients regain the ability to use their shoulder and arm for work and home activities.

For more information about shoulder reconstruction and replacement surgery, visit orthinfo.org.

Support Services

If needed, a social worker can help make arrangements for attendants to help with daily living needs and home assistance services, such as in-home therapy and nursing services.

Family members are important in a patient’s rehabilitation. Our staff provides families with information about support groups and other resources that are an integral part of our rehabilitation program for all joint replacement patients.

Clinical Trials

UT Southwestern is involved in numerous clinical trials for shoulder replacement surgery. The team also collects outcomes data on every patient who undergoes surgery.

As part of the MOON (Multicenter Orthopaedic Outcomes Network) shoulder group, which is a group of shoulder surgeons from 12 academic sites across the country, Dr. Khazzam is currently enrolling patients in a prospective randomized trial comparing physical therapy for the treatment of atraumatic rotator cuff tears.

Other current and prospective trials include:

• A prospective randomized double-blind trial looking at the efficacy of subacromial injections comparing corticosteroids, ketorolac, and marcaine in patients with rotator cuff symptoms but intact tendons, as well as patients with rotator cuff tears
• The planning phases of a trial (soon to be enrolling patients) that will examine what is the best treatment of glenoid deformity in shoulder osteoarthritis
• Involvement in an FDA Investigational Device Exemption (IDE) trial evaluating an alternate bearing surface for shoulder arthroplasty