Innovations transforming shoulder replacement surgery for optimal recovery

This story first appeared in Healthy You - July 2025, The Gazette’s quarterly health publication.

Arthritis in the shoulder can cause debilitating pain and limit your quality of life and ability to do everyday tasks. Luckily, improvements and innovations in total shoulder replacement surgery have made the procedure a reliable and effective way to relieve pain and improve function in patients.

Shoulder replacement surgery, known as total shoulder arthroplasty, has grown rapidly since 2000, thanks in part to improved techniques, better implant design, expanded indications and broader awareness of the procedure. Annual cases of primary total shoulder arthroplasty grew from 12,276 cases in 2000 to 110,208 in 2019, according to Cleveland Clinic, representing a nearly ninefold increase.

One major change that spurred this growth was the introduction of the reverse shoulder replacement surgery, originally designed for patients with damaged rotator cuffs. The older, anatomic replacement replaces the shoulder’s ball and socket joint in its original position. The reverse replacement flips the joint, placing the ball implant on the shoulder blade and the socket on the top of the humerus, which engages muscles outside the rotator cuff.

Dr. Blake Eyberg, an orthopedic surgeon at Physicians’ Clinic of Iowa in Cedar Rapids, said the reverse shoulder replacement surgery is far more common now than the traditional anatomic replacement.

Improvements in the functionality of reverse shoulder implants have led them to be the default option for many surgeons, even in patients without damaged rotator cuffs, said Dr. Derek Breder, an orthopedic surgeon at Steindler Orthopedic Clinic.

“In older patients where there’s concern for the rotator cuff failing, people just decide to go ahead and go with the reverse replacement, as a one and done surgery, in the hopes of avoiding a future revision,” he said.

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Technology guides surgery inside and outside the operating room

Shoulder replacement surgery is more precise these days thanks to technology that allows surgeons to plan out exactly where and how to set an implant in a patient’s bone.

Before surgery, the patient gets a CT scan to create a 3D model of the shoulder. Surgeons use computer software to see the 3D model of the patient’s shoulder and determine how best to perform the surgery.

“I actually will sort of perform the surgery virtually, and I can size the implants and see what sizes, look at the anatomy, see if there's anything funky going on,” Eyberg said. “So I would say that is something that I do that I think kind of takes the surgery to the next level.”

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Having more precision allows doctors to perform shoulder replacements with less bone loss and less risk of the implants becoming loose or dislocated. In some cases, surgeons can use the models to create custom 3D-printed implants for patients, Breder said.

“[For] the vast majority of patients, we can use standard implants,” Breder said. “But in the rare case that a patient has a significant amount of bone loss or some anatomic abnormality, we can much better manage that than we used to be able to by using customizable implants.”

Robotic devices are starting to be used for shoulder replacement surgeries. Neither Breder nor Eyberg are currently using robotics in shoulder replacements, but they do use them for knee and hip surgeries.

In the operating room, a robotic system is used to guide the drill to the exact spot where the surgeon planned to place the implant using the 3D model. In some models, the surgeon performs the cutting while the robot makes small adjustments and prevents cutting outside a planned boundary. Others can perform the cutting autonomously.

Robots can be especially helpful when someone needs shoulder implants replaced because of bone loss, Eyberg said. Often after having an implant for a long time, the bone around the implant will start to degrade, and a patient will need it replaced. Working around the bone loss can be difficult using only CT scans and manual operating, Eyberg said.

“Most of our brains can’t totally wrap our head around where the remaining bone might be. So the robot could allow us to place a guide pin in the remaining bone with much more precision than we can manually,” he said.

Another technology on the horizon is using augmented reality systems to assist surgeons in the operating room. While they’re not in widespread use, augmented reality headsets can allow a surgeon to see an overlay of the bone scan and the planned pin placements while operating on the bone.

“The entire goal of all of this is just to do a more accurate and more precise surgery that is tailored to the individual patient,” Breder said. “That's ultimately the goal of all of this technology that we're adding.”

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Breder and Eyberg said some combination of robotics and mixed reality will likely become standard practice within five to 10 years.

“Some sort of technology-based navigation will probably be the standard of care at some point,” Eyberg said. “Whether it's just navigation or the mixed reality or the robot, some form of that will probably become what everybody's using down the road.”

A big change in total shoulder replacement surgery came during the COVID-19 pandemic in 2020. Patients wanted to limit their time in the hospital, Eyberg said, which drove surgeons to schedule more outpatient surgeries that got the patients out of the clinic the same day as their operation. The practice has stuck around, even without the necessity of the pandemic.

“It was studied, sort of retrospectively, that if you do this in the outpatient setting, people can go home, even older patients who are healthy, and they do just fine,” Eyberg said.

Patients need to wear a sling for between four to six weeks and undergo physical therapy. Patients start receiving physical therapy soon after the surgery, Breder said.

Patients remain in physical therapy for about three months, Breder said, and people generally are back to full functionality of their shoulder after the first year. Breder said total shoulder arthroplasty used to have a worse reputation, but it’s improved significantly, and he’s seen a big increase in volume since he started performing them.

“It's a better surgery than what it used to be, and I think it's an excellent option for patients who have debilitating shoulder pain.” he said. “Outcomes are really good, and implant longevity and survivorship are better than they've ever been. It's a good option for folks, and it's something that I think they shouldn't be afraid of.”