It's really too bad that you got the change news through the office paperwork and not by a discussion with him. He may have reviewed the scans and xrays again, and noticed areas of concern that he thought would be better served by a TSR? Osteoarthritis and cartilage loss will continue with age, I'm not sure what an "arthritic clean up" involves, as you mentioned in the previous post. Any shoulder surgery can take many months to heal from and perhaps he was trying to save you from having yet another inevitable surgery and recovery phase in a year. I know it's hard to get answers now, all of the surgeons are pre-booked months in advance for appointments. If you decide to go through with it, I would say the positive view is that you will have the whole area fixed at one time, rather than keep picking away at each separate new problem.