By Angelica Bottaro 

 Medically reviewed by Jason DelCollo, DO

Roughly 18% to 26% of adults cope with shoulder pain.1 Some people will need to undergo surgeries like shoulder replacement or rotator cuff surgery to treat chronic shoulder pain.

This article discusses what goes into both procedures and why a person may choose one over the other.

Lacheev / Getty Images

What to Know About Shoulder Replacement

Shoulder replacement surgery can resolve damage from various problems such as osteoarthritis, rotator cuff injuries, and fractures.2

How Does It Work?

A shoulder replacement surgery involves removing damaged bone in the shoulder joint and rotator cuff and replacing it with implants. In some cases, the entire joint in the shoulder will be replaced.3

The procedure usually is highly successful at reducing pain and improving shoulder mobility.4

Can Anyone Get Shoulder Replacement Surgery?

Some people may be ineligible for shoulder replacement or are at a higher risk for complications. People who should not consider this type of surgery include:5

• Those under the age of 59

• Cigarette smokers

• People with osteoporosis (condition that causes weak, brittle bones)

• Someone with irreparable damage to their rotator cuff

• Damage in nerves that go from the shoulder to the spine

Treatment Delivery

There is more than one type of shoulder replacement surgery. The type you get will depend on the extent of the damage. The three types are:3

• Total replacement: Removes the entire "ball and socket" shoulder joint and rebuilds it with artificial implants made from plastic, metal, or cement

• Partial replacement: Only removes damaged areas

• Reverse replacement: Removes and replaces the entire shoulder joint by reversing positions of ball and socket to use deltoid muscles to move the shoulder (used in cases with a more damaged rotator cuff)6

All three types of shoulder replacements are done in a hospital.

How Long Will I Be in the Hospital?

Most people spend an average of three to five days in the hospital for this type of surgery. The length varies depending on how well a person responds to the surgery and their personal healing time.3

Side Effects

While this procedure is often considered safe and effective, there are some side effects, including:7

• Mild pain

• Swelling in the area

• Reduced strength and mobility

Shoulder Replacement Surgery Complications

In rare cases, serious complications can occur following this procedure, including:8

• Shoulder instability

• Infection

• Tears in the rotator cuff

• A loosening of the artificial implants in the shoulder

• Wearing down of part of the shoulder blade (the glenoid)

• Blood clots

• A fracture of bones surrounding the implants

Prices and Where to Get It

Shoulder replacement surgery is performed in a hospital by a surgical team, including an orthopedic surgeon. The cost of a shoulder replacement procedure can be $14,000 to $52,000.9 That cost may be reduced with medical insurance. However, not all insurance plans will cover it.

If you have Medicare insurance, you will pay between $805 and $1,473 for your shoulder replacement surgery.10

Other Costs Associated With Shoulder Replacement

Along with the surgery itself, people undergoing this procedure also have to consider aftercare costs, such as physical therapy and medications.

What to Know About Rotator Cuff Surgery

Rotator cuff surgery is used to help treat shoulder pain caused by shoulder injuries. The rotator cuff is the part of the shoulder that a person uses when they reach their arms up. The tendons and muscles that make up the cuff can become injured or tear, resulting in pain and limited mobility.

How Does It work?

The surgery is designed to restore mobility in the arms as well as reduce pain. For many people with injuries to the rotator cuff, surgery is a good option to restore the function and flexibility of the shoulder.11

Other Treatments for Rotator Cuff Injury

Typically, other treatments are explored prior to this surgery such as:12

• Nonsteroidal anti-inflammatories (NSAIDs) such as Advil or Tylenol to reduce pain and inflammation

• Physiotherapy to help strengthen and repair the rotator cuff

• Steroid injections

• Rest

Treatment Delivery

The two ways a surgeon can perform rotator cuff surgery are:13

• Arthroscopic surgery: This type of surgery involves the use of a small instrument with a light and camera on the end of it. It is inserted into the shoulder joint to guide the surgeon, who then enters from a separate small incision with the tools needed to fix the injury.

• Open surgery: Open surgery is the traditional approach. It involves cutting into the skin to expose the rotator cuff so that it's easier to repair. In some cases, a graft using tendons from elsewhere in the body is used.

If these two options are unsuccessful, a shoulder replacement may be required.

Why Else Would a Rotator Cuff Surgery Be Necessary?

In some cases, age-related degeneration can damage the rotator cuff. In this instance, surgery is necessary if the symptoms are difficult to cope with.

8 Types of Shoulder Surgeries

Side Effects

Following the surgery, you may experience many side effects, including:14

• A swollen arm and hand

• Swelling in the shoulder

• Skin color changes around the incision

• Fatigue

These side effects shouldn’t last longer than a week. Other side effects, such as immobility in the shoulder, will last longer. It could be a few months before you have full use of both your shoulder and your arm after rotator cuff surgery.

Rotator Cuff Surgery Risks

Although rare, there are certain risks associated with rotator cuff surgery, including:15

• Infection

• Nerve injury

• Stiffness

• Deltoid (shoulder muscle) detachment

• Re-tearing the tendon

Prices and Where to Get It

The surgery is performed in a hospital or ambulatory surgical center by an orthopedic surgeon. It is typically considered an outpatient procedure, which means that patients leave the hospital on the same day the surgery is performed.

The average cost to have rotator cuff surgery sits at roughly $22,894 without insurance.16 In many cases, this procedure is considered elective since it does not directly treat any disease. Because of this, many insurance providers will not cover the cost.

Medicare will cover the surgery in some cases, but it has to be deemed medically necessary by your healthcare provider before they consider covering it. They are unlikely to pay for it as it affects only quality of life.17

What Can I Do to Make Sure I’m Covered?

Aside from getting an insurance plan that specifically states that this procedure is covered, you can speak to your healthcare provider about the medical and health implications of your injury. If they can provide the appropriate documentation, you are more likely to be covered for the procedure. 

Which Treatment Is Right for You?

Your healthcare provider is tasked with determining which surgery is best for your current situation. In many cases, both procedures are done only if completely necessary. If your shoulder joint is not damaged at all, rotator cuff surgery is a better option. However, if there is damage to the joint, shoulder replacement is likely the best procedure to go with.

In some cases, shoulder replacement surgery may be done following a rotator cuff surgery if it does not fix the issue.11

Meeting With a Healthcare Provider

When you meet with your healthcare provider, they will give you the options that would be the most effective in treating your specific type of shoulder pain or injury.  

Can Shoulder Replacement or Rotator Cuff Surgery Be Used Together?

A shoulder replacement surgery may be done at the same time as rotator cuff repair. This is because shoulder replacement surgery requires the tendons and muscles in the rotator cuff to help hold the implants in place.18 Joint damage and tears in the rotator cuff may also occur simultaneously.

That said, the extent of the rotator cuff injury matters when considering both surgeries at the same time. Research has shown that smaller tears in the rotator cuff equate to a better overall outcome than larger ones.

The type of shoulder replacement also matters. Smaller tears in the rotator cuff can be repaired during total shoulder replacement, however, the repair of medium and large tears is better suited for people undergoing reverse shoulder replacement surgery.18

Benefits of Combined Surgeries

If you are undergoing a rotator cuff repair at the same time as a shoulder replacement surgery, it eliminates the need for two surgeries.

Coping With Side Effects

The side effects of both a rotator cuff surgery and shoulder replacement are similar and include swelling, pain, and limited shoulder function. Shoulder function will be restored over time using specialized exercises and movements. The pain and swelling can be alleviated through the use of over-the-counter or prescribed pain medications and icing the affected area.11

After surgery, your arm will be kept in a sling so that your shoulder moves as little as possible to help in the healing process. While recovery can take a while, it’s important to follow all of your healthcare provider’s advice following surgery to help reduce the chance of complications.

How Long Is Recovery?

The entire recovery process for a shoulder replacement, including physical therapy, can take as long as six months.3 For rotator cuff surgery, recovery time is typically four to six months.13

Summary

Rotator cuff surgery and shoulder replacement surgery are viable options for shoulder injuries and pain. Shoulder replacement removes part or all of the shoulder joint to replace it with artificial implants, whereas rotator cuff surgery repairs tears or injuries.

If the rotator cuff is damaged beyond repair, shoulder replacement surgery is not an option because the cuff is required to help hold the new joint in place. If the damage can be fixed, medical providers may opt for rotator cuff surgery before sending you for a total shoulder replacement. The procedures can also be combined to tackle damage to the shoulder joint and a rotator cuff injury.

As with other surgeries, there are side effects associated with both procedures. They can include pain and swelling in the area and limited movement capabilities. To ensure that recovery goes smoothly, people are advised to take pain medications as instructed and avoid movement as much as possible.

 Sources

Linaker CH, Walker-Bone K. Shoulder disorders and occupation. Best Pract Res Clin Rheumatol. 2015 Jun;29(3):405-423. doi:10.1016/j.berh.2015.04.001

Wand RJ, Dear KE, Bigsby E, Wand JS. A review of shoulder replacement surgery. J Perioper Pract. 2012 Nov;22(11):354-359. doi:10.1177/175045891602201102

Johns Hopkins Medicine. Total shoulder replacement.

Fevang BT, Lygre SH, Bertelsen G, Skredderstuen A, Havelin LI, Furnes O. Good function after shoulder arthroplasty. Acta Orthop. 2012 Oct;83(5):467-473. doi:10.3109/17453674.2012.720118

The Centers for Advanced Orthopaedics: Maryland Orthopedic Specialists Division. How to know if you are a good candidate for shoulder replacement surgery.

American Academy of Orthopedic Surgeons. Reverse total shoulder replacement.

University of California San Fransisco. Recovering from shoulder replacement surgery.

Bohsali KI, Bois AJ, Wirth MA. Complications of shoulder arthroplasty. J Bone Joint Surg Am. 2017 Feb 1;99(3):256-269. doi:10.2106/JBJS.16.00935

Steinhaus ME, Shim SS, Lamba N, Makhni EC, Kadiyala RK. Outpatient total shoulder arthroplasty: a cost-identification analysis. Journal of Orthopaedics. 2018;15(2):581-585. doi:10.1016/j.jor.2018.05.038

Medicare. Arthroscopy, shoulder, surgical; with rotator cuff repair.

Johns Hopkins Medicine. Rotator cuff repair.

John M. Eisenberg Center for Clinical Decisions and Communications Science. Treatment options for rotator cuff tears: a guide for adults. In: Comparative Effectiveness Review Summary Guides for Consumers. AHRQ Comparative Effectiveness Reviews. Agency for Healthcare Research and Quality (US); 2005.

Hospital for Special Surgery. Rotator cuff surgery: arthroscopic repair of a torn rotator cuff.

My Health Alberta. Rotator cuff repair: what to expect at home.

American Academy of Orthopedic Surgeons. Rotator cuff tears: surgical treatment options.

MD Save. Rotator cuff repair surgery.

Medicare. Does medicare cover rotator cuff surgery?

Simone JP, Streubel PH, Sperling JW, Schleck CD, Cofield RH, Athwal GS. Anatomical total shoulder replacement with rotator cuff repair for osteoarthritis of the shoulder. Bone Joint J. 2014 Feb;96-B(2):224-228. doi:10.1302/0301-620X.96B.32890

Calvo E, Torres MD, Morcillo D, Leal V. Rotator cuff repair is more painful than other arthroscopic shoulder procedures. Arch Orthop Trauma Surg. 2019 May;139(5):669-674. doi:10.1007/s00402-018-3100-0

By Angelica Bottaro
Bottaro has a Bachelor of Science in Psychology and an Advanced Diploma in Journalism. She is based in Canada.