Shoulder Replacement

(Arthroplasty)

Shoulder replacement reliably relieves pain and restores function when the joint surface is destroyed by arthritis, failed previous repair, or complex fracture. It is one of the fastest-growing orthopaedic procedures worldwide, with patient satisfaction rates comparable to hip and knee replacement.

Indications

Osteoarthritis

The most common indication. Gradual cartilage loss causing progressive pain and stiffness in older adults.

Rotator cuff arthropathy

Arthritis combined with a massive, irreparable rotator cuff tear, the primary indication for reverse shoulder replacement.

Complex fracture

Severely comminuted fractures in elderly patients where fixation is not feasible, particularly 3- and 4-part proximal humerus fractures.

Rheumatoid arthritis

Inflammatory destruction of the joint surface, often affecting both shoulders and occurring at a younger age.

Types of Replacement

Total Anatomic (TSR)

Replaces the humeral head with a metal ball on a stem and resurfaces the glenoid with polyethylene. Often humeral side can be stemless. Mirrors natural anatomy. Requires an intact rotator cuff. Excellent long-term track record >20 years.

Reverse Total (rTSR)

Ball and socket positions are reversed, glenosphere fixed to glenoid, cup on humeral side. Recruits deltoid to lift the arm, bypassing the need for a cuff. Now the most commonly performed shoulder replacement worldwide.

Resurfacing

A cap is placed over the existing humeral head without a stem, preserving bone stock. Can also be stemless if the humeral head needs to be removed. Best suited to younger patients with early arthritis and intact humeral bone quality.

Hemiarthroplasty

Only the humeral head is replaced; native glenoid retained. Used for complex fractures and avascular necrosis. Increasingly replaced by reverse TSR for rotator cuff deficient shoulders.

The reverse total shoulder replacement now accounts for over 50% of all shoulder replacements performed. It works without a functioning rotator cuff and produces highly reliable pain relief and function.

Key Difference: Anatomic vs Reverse

In an anatomic replacement, the ball (metal) is on the humerus and the socket (polyethylene) is on the scapula - as in nature. The rotator cuff controls movement. In a reverse replacement, the geometry is flipped: the ball (glenosphere) is on the scapula and the socket (cup) is on the humerus. This shifts the centre of rotation medially and inferiorly, allowing the deltoid muscle to lift the arm without needing a functioning rotator cuff.

Pre-Operative Preparation

Pre-operative assessment

Blood tests, ECG, and anaesthetic review. CT scan to plan implant sizing and assess glenoid morphology (Walch classification for anatomic TSR).

1

Medication review

Blood thinners paused before surgery. Disease-modifying drugs for rheumatoid arthritis reviewed with rheumatologist. Iron prescribed if anaemia identified.

2

Prehabilitation physiotherapy

Pre-operative exercises strengthen the deltoid and remaining cuff. Patients who are stronger before surgery recover faster. Post-operative exercises are taught in advance.

3

4

Home preparation

Arrange support for 2-4 weeks. Prepare a semi-upright sleeping area. Front-opening clothing, easy-to-prepare meals, no trip hazards.

RECOVERY AFTER SURGERY

  • Pain managed with nerve block and regular analgesia. Arm in sling. Physiotherapy begins on day one with gentle pendulum exercises.

  • Sling worn at all times except exercises. Wound care and suture removal at 2 weeks. No driving.

  • Sling discontinued by 4-6 weeks. Active shoulder movement begins. Light daily tasks resumable.

  • Progressive deltoid and cuff strengthening. Driving resumes at 6-8 weeks. Return to desk work within 4-6 weeks.

  • Ongoing improvement. Low-impact leisure (swimming, golf) from 3-6 months. Maximum benefit typically seen at 12 months.

Expected Outcomes

90%

of patients report significant pain relief after shoulder replacement.

15-20+ years

implant survival in most patients with modern implants.

1-2%

serious infection rate, comparable to other major joint replacements.

FREQUENTLY ASKED QUESTIONS

  • Most patients return to everyday activities, driving, swimming, golf, and cycling. High-impact activities and heavy overhead lifting are discouraged to protect the implant. 

  • Modern implants have around 85-90% survivorship at 15-20 years for anatomic TSR. Glenoid component loosening is the most common long-term concern. Younger, more active patients have higher revision rates due to greater demands on the implant.

  • Major complications are uncommon but include infection (<2%), nerve injury, instability or dislocation, implant loosening, and fracture. Your surgeon will discuss your individual risk profile at your pre-operative consultation.

This guide is intended for patient education purposes and does not replace a formal surgical consultation. Treatment decisions are always individualised based on your specific history, examination findings, and imaging. Please discuss your symptoms and management plan directly with your orthopaedic surgeon.