Shoulder Replacement Surgery

Introduction

Shoulder replacement surgery is a procedure that replaces the damaged parts of the shoulder joint with artificial components, called prostheses. It is usually done to relieve pain and improve movement when other treatments haven’t worked. There are three main types of shoulder replacement: total shoulder arthroplasty (Figure 1), reverse shoulder arthroplasty (Figure 2), and shoulder hemiarthroplasty. The type of surgery chosen depends on the condition of the shoulder joint, the rotator cuff tendons, and the patient’s activity level. People who may benefit include those with severe arthritis, fractures, or rotator cuff damage causing persistent pain and stiffness. Specific details on each type of shoulder replacement are listed below:

• Total Shoulder Arthroplasty (Anatomic Shoulder Replacement)
• Reverse Shoulder Arthroplasty
• Shoulder Hemiarthroplasty

History and Materials

Shoulder replacement surgery has been performed since the 1950s. Early versions used simple metal implants, but modern designs have improved greatly. Today’s replacements are made from metal alloys such as titanium or cobalt-chromium for strength, combined with medical-grade plastic (polyethylene) for smooth movement. These materials are durable and compatible with the body. Over the years, better designs and surgical techniques have made shoulder replacements more reliable and long-lasting, helping many patients return to normal activities.

Total Shoulder Arthroplasty

Background

A total shoulder arthroplasty (TSA), also called a standard or anatomic shoulder replacement (Figure 1), is usually done for patients with severe osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis who still have a healthy rotator cuff. In these cases, both the ball (humeral head) and the socket (glenoid) of the shoulder joint are replaced. TSA is ideal for people with shoulder pain that limits daily activities but whose rotator cuff tendons remain strong enough to stabilize and move the joint.

How Total Shoulder Arthroplasty Surgery Is Performed

During a total shoulder replacement, the surgeon makes an incision at the front of the shoulder to access the joint. The damaged bone and cartilage from the top of the upper arm bone (humerus) and the shoulder socket (glenoid) are removed. The surgeon then inserts a metal ball attached to a stem into the upper arm bone and secures a plastic socket onto the shoulder blade. This design mimics the natural anatomy of the shoulder, allowing for smooth movement. The procedure typically takes one to two hours and is followed by physical therapy to restore motion.

Total Shoulder Arthroplasty Complications and Prognosis

Complications from total shoulder arthroplasty are uncommon but can include infection, stiffness, nerve injury, or implant loosening over time. Some patients may also experience wear of the plastic socket. With modern techniques, most people experience significant pain relief and improved shoulder function. The results are often long-lasting—over 90% of shoulder replacements still function well after 10–15 years. Proper rehabilitation and avoiding high-impact activities help ensure the best outcome.

Reverse Shoulder Arthroplasty

Background

A reverse shoulder arthroplasty (Figure 2) is designed for patients who have a torn or nonfunctional rotator cuff, severe arthritis, or complex fractures. In this design, the normal ball-and-socket structure is reversed: a metal ball is attached to the shoulder blade (glenoid), and a plastic socket is placed on the upper arm bone. This allows the deltoid muscle—rather than the damaged rotator cuff—to lift the arm. A reverse shoulder arthroplasty is often used in older adults who cannot have a standard shoulder replacement because of rotator cuff damage.

How Reverse Shoulder Arthroplasty Surgery is Performed

In a reverse shoulder replacement, the surgeon makes an incision over the shoulder and removes the damaged parts of the joint. The “reverse” design is created by fixing the metal ball to the shoulder blade (scapula) and the plastic socket to the upper arm bone (humerus). This reversed structure changes the way the shoulder moves, allowing the deltoid muscle to compensate for a weak rotator cuff. The surgery typically takes about two hours, and recovery involves several months of gradual rehabilitation.

Reverse Shoulder Arthroplasty Surgery: Complications and Prognosis

Reverse shoulder arthroplasty has specific risks, including dislocation, nerve injury, or fracture around the implant, though these are relatively uncommon. Some patients may experience decreased rotation strength, but most report excellent pain relief and improved arm function. This surgery is often life-changing for people with massive rotator cuff tears or severe joint damage. Most reverse replacements last 10–15 years, and outcomes are very good when patients follow their physical therapy program closely.

Shoulder Hemiarthroplasty

Background

A shoulder hemiarthroplasty replaces only the ball (humeral head) of the joint while leaving the socket intact. It is typically recommended for patients with a fracture of the upper arm bone, avascular necrosis, or arthritis limited to the ball side of the joint. It may also be used when the socket bone is too weak or damaged to support an artificial glenoid. Hemiarthroplasty can be an effective option for younger patients or those whose shoulder structure allows for good motion without replacing the socket.

How Shoulder Hemiarthroplasty Surgery is Performed

During this procedure, the surgeon removes the damaged humeral head and replaces it with a metal ball attached to a stem inserted into the upper arm bone. The natural socket of the shoulder blade is left unchanged. The surgery takes about one to two hours. Afterward, patients begin a rehabilitation program to restore range of motion and strength. Over time, the body adapts to the new implant, and most patients experience pain relief and improved function.

Shoulder Hemiarthroplasty: Complications and Prognosis

Complications can include stiffness, infection, nerve injury, or wear of the natural socket over time. Because the socket is not replaced, some patients may develop pain from ongoing cartilage wear. However, many people achieve good shoulder movement and reduced pain. For younger or less active patients, hemiarthroplasty can be a durable option that preserves bone and allows for future surgeries if needed. With proper care and physical therapy, most patients regain a comfortable range of motion and improved quality of life.

Edited by Stephen Pinney MD, November 3rd 2025