Why this matters:
After medical school and orthopedic residency, surgeons can do additional fellowship training. Not all fellowships focus on the same things. Some emphasize sports injuries, some trauma, some general orthopedics. Patients should listen for a fellowship that is in shoulder and elbow surgery. Shoulder replacement is a highly specialized procedure with unique anatomy, implants, and complication patterns.

A surgeon with dedicated shoulder and elbow training has spent an entire extra year focused on complex shoulder problems — including replacements, revisions, and complications.

What patients should listen for:
Your surgeon should clearly explain where they trained and what their fellowship focused on, not just say they are “fellowship trained.” Would also recommend a dedicated ASES fellowship completed in the United States.

Why this matters:
Shoulder replacement outcomes improve with repetition. Surgeons who perform a high volume each year tend to:

• Be more efficient in the operating room

• Recognize problems earlier

• Have lower complication rates

• Be more comfortable managing complex anatomy

Just like pilots or musicians, surgeons improve with experience — especially for technically demanding procedures.

What patients should listen for:
A confident answer with a real number. Vague responses like “I do a fair amount” aren’t as reassuring as specific experience.

Dr. Dubiel performs over 200 shoulder replacements each year. Shoulder replacement is a central focus of his practice, allowing for consistent technique, efficient surgery, and familiarity with both routine and complex cases.

Why this matters:
There are two main types of shoulder replacement, and the correct one depends on the patient’s anatomy, especially the rotator cuff.

If a surgeon only performs one type, there’s a risk that the recommendation is influenced by the surgeon’s comfort — not the patient’s needs.

A surgeon who routinely performs both procedures can choose the best option for you, not force a one-size-fits-all solution.

What patients should listen for:
An explanation that the decision is based on imaging, tendon function, bone quality, and long-term goals — not surgeon preference.

Why this matters:
Many patients worry they may be “too old” or “too medically complex” for shoulder replacement. In reality, chronological age alone is rarely the deciding factor.

Experienced shoulder replacement surgeons evaluate the whole patient — including pain, function, goals, and overall health — rather than using age or appearance as a cutoff. Modern techniques allow many older patients to safely regain function and independence.

What a reassuring answer sounds like:
A discussion focused on individual health and goals, not a blanket age limit or quick dismissal.

Why this matters:
CT-based preoperative planning allows the surgeon to evaluate your shoulder anatomy in three dimensions before surgery.

This advanced planning helps:

• Optimize implant size and positioning

• Account for bone wear or deformity

• Reduce surprises during surgery

• Improve accuracy and reproducibility

Small differences in implant positioning can significantly affect long-term function and durability.

What a reassuring answer sounds like:
An explanation of how CT imaging and planning software are used to tailor the surgery to your anatomy.

How Dr. Dubiel approaches this
Dr. Dubiel routinely uses CT-based preoperative planning to customize implant selection and positioning for each patient’s anatomy.

Why this matters:
Sling time has a major impact on comfort, independence, and recovery. Longer sling use can lead to stiffness, muscle weakness, and frustration for patients.

Sling duration varies based on:

• The type of shoulder replacement

• The stability of the implant

• The surgeon’s technique and philosophy

Many surgeons keep patients in a sling for six weeks after reverse shoulder replacement. In experienced hands, some patients can safely discontinue the sling earlier, allowing earlier motion and a more comfortable recovery.

What a reassuring answer sounds like:
A clear explanation of sling duration — and why that timeline is chosen — rather than a blanket rule applied to all patients.

How Dr. Dubiel approaches this
Dr. Dubiel keeps most reverse shoulder replacement patients in a sling for three weeks, rather than six. With modern implants and stable fixation, earlier motion can be safe and more comfortable for many patients.

Why this matters:
Some orthopedic surgeons perform a wide variety of procedures, while others focus their practice on a smaller set of conditions. Shoulder replacement is a complex operation with unique anatomy, implants, and long-term considerations.

Surgeons who make shoulder replacement a core part of their practice tend to be more current with techniques, more comfortable managing complications, and more consistent in their outcomes than surgeons who perform these procedures only occasionally.

What a reassuring answer sounds like:
An explanation that shoulder replacement is a regular, routine part of the surgeon’s practice — not something done only from time to time.

Why this matters:
Pain is one of the most common concerns before surgery. Modern shoulder replacement uses multiple strategies to control pain safely and effectively.

Good pain control helps patients:

• Sleep better

• Move earlier

• Participate in physical therapy

• Avoid excessive narcotic use

What a reassuring answer sounds like:
Discussion of nerve blocks, anti-inflammatory medications, ice, and a structured plan — not just “pain medicine.” Dr Dubiel’s team utilized a multimodal pain approach including steroids, anti-inflammatories and regional anesthesia. Most patients take less than 10 pain pills after surgery.

Why this matters:
Many patients assume physical therapy is mandatory after shoulder replacement, but modern reverse shoulder replacement techniques and implants have changed this.

For many patients undergoing reverse shoulder replacement, formal physical therapy is optional, not required. With stable implants and thoughtful surgical technique, many patients regain function safely through guided home motion and normal daily activities.

Avoiding routine physical therapy can:

• Save significant driving time and appointments

• Reduce out-of-pocket costs

• Simplify recovery

• Make the process less stressful

Physical therapy is still helpful for some patients — especially those with stiffness, weakness, or specific functional goals — but it is no longer automatically required for everyone.

What a reassuring answer sounds like:
An explanation that therapy is individualized, with many patients recovering well without formal PT, while still having access to it if needed.

How Dr. Dubiel approaches this
For many reverse shoulder replacement patients, Dr. Dubiel does not require formal physical therapy. Many patients recover well with guided home motion, saving time, travel, and out-of-pocket cost. Physical therapy remains available when needed.

Why this matters:
Shoulder replacement is a major operation. While some orthopedic procedures can be safely performed in ambulatory surgery centers (ASCs), a full hospital is the safest setting for shoulder replacement, particularly reverse shoulder replacement.

Hospitals provide:

• Advanced anesthesia support

• Immediate access to medical specialists

• Blood bank and ICU backup if needed

• The ability to monitor patients overnight

These resources matter, especially for older patients, medically complex patients, or technically demanding cases.

In some practices, surgeons perform shoulder replacements primarily at ASCs. However, the safest location for surgery should be chosen based on patient safety and surgical complexity — not efficiency or profit.

What a reassuring answer sounds like:
A clear explanation that the surgeon prioritizes safety and chooses a hospital setting for shoulder replacement when it offers the greatest margin of safety for the patient.

How Dr. Dubiel approaches this
Dr. Dubiel performs reverse shoulder replacement at a full hospital to provide the highest margin of safety, access to advanced anesthesia support, and overnight monitoring when needed.