Total shoulder replacement is kind of the end of the game for the shoulder. So, a shoulder thatŐs gone on and gotten bone on bone arthritis, typically, is why we do a shoulder replacement. The symptoms of shoulder arthritis are similar to other symptoms that patients will present with in their shoulders with other injuries, but they are increasing pain in the shoulder, particularly at night, decreasing function in the shoulder, and then stiffness in the shoulder. ThereŐs a number of other conditions that can also present that way, but the way to diagnose shoulder arthritis is usually just simply with an x-ray. In addition to a physical exam, an x-ray can show the bone on bone nature of the arthritis. When patients present with arthritis in their shoulder, we donŐt jump straight to a shoulder replacement.  We try things to put off shoulder replacement if possible. These include things like physical therapy, over the counter anti-inflammatories, and then things like steroid injections can be helpful in delaying the need for shoulder replacement. ThereŐs actually two different types of shoulder replacements. You have regular replacements where you replace the ball with the ball and the socket with the socket, and you also have whatŐs called a reverse shoulder replacement where we do the surgery backwards. We put a ball in the socket side, and a socket on the ball side. While that sounds a little bit confusing, the reason for doing that is for a specific subset of patients who have shoulder arthritis without a rotator cuff. If you do a regular shoulder replacement in that patient, theyŐre not able to lift their arm up and actually use their arm. So, a reverse shoulder replacement was developed specifically for patients with arthritis due to not having a rotator cuff. And we found that it works very very well in those patients. Shoulder replacement is something thatŐs very challenging. ItŐs something that, across the United States, most surgeons donŐt do it frequently. So at UVA, we have the benefit of having myself and one of my partners who do a high volume of shoulder replacement. We both did specific fellowship training in shoulder replacement. And, collectively, we do over 200 shoulder replacements a year, which is a very high number across the United States. So, itŐs something we have a lot of experience in, and that definitely helps produce good outcomes after them.