What Is Minimally Invasive Shoulder Replacement?

Despite its heavy use in everyday life, your shoulder is a complex system that balances flexibility with stability. An article in Harvard Health said that nearly 70% of people will have some shoulder pain in their lifetime. Some injuries can heal, and some pain can be managed. But what about those who need something more intense? Minimally invasive shoulder surgery, or shoulder arthroscopy, may be the answer. 

Minimally invasive shoulder surgery can treat various shoulder conditions, including:

• Rotator cuff tears
• Labral tears
• Shoulder impingement syndrome 
• Joint instability
• Early arthritis

What Happens During Minimally Invasive Shoulder Replacement Surgery?

A quick anatomy lesson on the shoulder may be helpful. 

Three bones meet here: the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone). The rounded head of the humerus sits in a shallow cup on the scapula — like a golf ball on a tee — held in place more by soft tissue than by bone structure.

That soft tissue includes the labrum (a ring of cartilage that deepens the cup), the rotator cuff (four muscles that keep the ball centered during movement), and the bursa (a fluid-filled cushion that prevents friction under the bony arch above). Each of these is a common source of pain and injury when something goes wrong.

The result is the most mobile joint in the body — capable of swinging, rotating and reaching in almost any direction — but one that demands a lot of its supporting structures to stay functional.

In a total shoulder replacement, a severely damaged joint is replaced with artificial components. A new plastic shoulder socket sits at the shoulder blade, and a metal ball fits into the head of the upper arm bone. This surgical procedure is used in patients with a working rotator cuff. 

A partial shoulder replacement, or hemiarthroplasty, involves replacing only the damaged ball at the top of the humerus bone, leaving the socket intact. This surgical procedure is used when the socket is either still in good shape, or is too damaged to accept an artificial one. 

A reverse shoulder replacement involves putting the socket on the head of the upper arm bone and attaching the ball to the shoulder blade. This “reversed” position means the deltoid muscle lifts the arm, which makes up for a rotator cuff that is too damaged to hold a traditional joint in place. 

A traditional shoulder replacement procedure typically includes larger incisions (cuts) and can affect more of the muscle and soft tissue around the shoulder joint. This type of surgery may be used for complex cases, such as a total shoulder replacement. In minimally invasive procedures, incisions are smaller, tools are narrower, and tiny cameras show the surgeon what is happening in real time. 

Robotic-assisted shoulder replacement surgery offers a high degree of precision that traditional shoulder procedures lack. This option lets patients have the most customized care possible — with real-time feedback that lets surgeons know exactly how they are doing.

What Conditions Can Benefit From Minimally Invasive Shoulder Replacement?

• Osteoarthritis: Arthritis where the cartilage is worn down but the rotator cuff remains intact and functional
• Avascular necrosis, also known as AVN: A condition where bone tissue dies due to lack of blood supply, often affecting the humeral head
• Proximal humerus fractures: Specific, complex fractures of the upper arm bone that do not involve significant displacement or damage to the rotator cuff
• Rheumatoid arthritis: An autoimmune disease affecting the joint lining, provided there is enough bone structure to support the implant
• Revision surgery: In certain cases, earlier failed, less-severe shoulder replacements

Who Is a candidate for Minimally Invasive Shoulder Replacement?

If you have the following issues, you may be a good candidate for minimally invasive procedures:

• Chronic shoulder pain that affects daily activities and quality of life
• Severe arthritis or joint damage
• A nonrepairable rotator cuff tear 
• Weakness, loss of mobility or shoulder instability 
• Previous conservative treatments that were not effective, including physical therapy, anti-inflammatory medication or steroid injections

Age, certain lifestyle choices and general health may impact the type of surgery recommended for you.

“Every patient is different,” said Caleb Davis, M.D., shoulder orthopedic surgeon with Norton Orthopedic Institute. “It is important to speak with your orthopedic surgeon about the best course of action for your specific case.”

What to Expect During Surgery

During the Procedure

• Anesthesia: You will receive either general anesthesia or a regional nerve block to keep you comfortable.
• Positioning: You likely will be placed in a “beach chair” (sitting/reclining) position.
• Technique: The surgeon makes a small incision, usually on the front of the shoulder, and navigates between muscles to spare the rotator cuff, avoiding major muscle detachment.
• Replacement: The damaged ball (humeral head) is removed and replaced with a metal implant, and if necessary, the socket is resurfaced.
• Duration: The procedure often lasts between one to two hours, or sometimes less. 

Immediately After Surgery

• Recovery room: You will wake up in a recovery area while the anesthesia wears off.
• Outpatient discharge: Because this is frequently an outpatient procedure, many patients go home the same day.
• Pain management: A nerve block ensures significant pain relief immediately following the surgery.

Recovery Expectations

• Reduced restrictions: Because the rotator cuff often is spared, patients may have fewer movement restrictions compared with traditional, open surgery.
• Physical therapy: Rehabilitation will start early to help you regain range of motion.
• Daily activities: Many patients can perform light activities, like eating and dressing, shortly after surgery.

Recovery After Minimally Invasive Shoulder Replacement

It may take a few months to recover completely from surgery. You may need to wear a sling to keep the arm as stable as possible while the shoulder heals. 

Your orthopedic surgeon probably will give you exercises to do at home. Do them as prescribed, because this keeps the joint mobile and flexible right after surgery. 

You will go to physical therapy, where a therapist will test your range of motion, then assign you exercises meant to regain lost mobility and strengthen shoulder muscles. 

Pain management is key after any surgery. Your healthcare provider will prescribe medications based on what is safe for you personally to take. 

After two or three weeks, you should be able to resume light activity with your shoulder, such as getting dressed. You will need to avoid heavy lifting, playing sports or any activity that could put too much stress on the healing shoulder. Your surgeon will explain what the timeline is for your return to any activity.

While recovering, you should try to:

• Walk a little each day. This may help prevent blood clots, boost your mood and speed healing.
• Stay hydrated and eat a balanced diet.
• Rest as much as you need to. 
• Avoid any activity that may hurt your recovering arm.

Benefits of Minimally Invasive Shoulder Replacement

• Faster recovery: Many patients heal more quickly and can start physical rehabilitation sooner, which helps prevent initial stiffness.
• Reduced pain and trauma: Smaller incisions result in significantly less damage to surrounding muscles and soft tissue, leading to lower postoperative discomfort.
• Lower risk of complications: There is a reduced risk of infection, less blood loss during the procedure and fewer difficulties with wound healing compared with open surgery techniques.
• Outpatient eligibility: Many procedures can be performed in an outpatient setting, allowing patients to return home the same day.
• Minimal scarring: The tiny incision results in much smaller permanent scars.
• Greater precision: Advanced 4K video technology and magnification provide surgeons with a better view of joint structures, including areas previously hard to see.
• Improved long-term function: Because the procedure preserves healthy tissue and reduces scar tissue formation, patients often regain better range of motion and strength. 

Risks and Potential Complications

This surgery is considered very safe, but all surgery may have complications. Those may include:

• Infection
• Blood clots
• Implant loosening
• Nerve injury
• Shoulder instability
• Need for revision surgery

Choose Norton Orthopedic Institute for Your Shoulder, Hip or Knee Replacement

• Same-day appointments are available with no referral required. When you’re ready to take care of the pain, you want to get started.
• Our fellowship-trained and board-certified orthopedic surgeons have the experience you can trust. They perform more than 800 hip replacements, 1,000 knee replacements and hundreds of shoulder replacements every year.
• Lower-cost, nonsurgical options, such as physical therapy, are considered and tried before we recommend surgery.
• Robotic-assisted surgeries provide added precision when placing your new joint and, with advanced, minimally invasive techniques, often allow you to go home the same day.
• Choose from 30 locations in Louisville and Southern Indiana for follow-up care.
• Norton Healthcare is the first health system in the nation to be recognized as an Advanced Orthopedic & Spine Center of Excellence by DNV.
• We help you get ready for surgery and support your recovery with educational programs available online and in person.
• Medicare, Medicaid and most major commercial insurance plans are accepted. Financial assistance also is available.
• Your free Norton MyChart account allows you to communicate with your provider, manage appointments, refill prescriptions and more from a mobile device or computer.