Shoulder joint replacement


Shoulder joint replacement surgery is performed to replace a shoulder joint with artificial components (prostheses) when the joint is severely damaged by such degenerative joint diseases as arthritis, or in complex cases of upper arm bone fracture.


The shoulder is a ball-and-socket joint that allows the arms to be raised, twisted, bent, and moved forward, to the side and backward. The head of the upper arm bone (humerus) is the ball, and a circular cavity (glenoid) in the shoulder blade (scapula) is the socket. A soft-tissue rim (labrum) surrounds and deepens the socket. The head of the humerus is also covered with a smooth, tough tissue (articular cartilage); and the joint, also called the acromioclavicular (AC) joint, has a thin inner lining (synovium) that facilitates movement while surrounding muscles and tendons provide stability and support.

The AC joint can be damaged by the following conditions to such an extent as to require replacement by artificial components:

During a total shoulder joint replacement, an incision is first made in the shoulder and upper arm (A). The head of the humerus is removed with a bone saw (B). The shaft of the humerus is reamed with a bone rasp to ready it for the prosthesis (C). After the shoulder joint, or glenoid cavity, is similarly prepared, bone cement is applied to areas to receive prostheses (D). The ball and socket prostheses are put in place, and the incision is closed (E). (Illustration by GGS Inc.)
During a total shoulder joint replacement, an incision is first made in the shoulder and upper arm (A). The head of the humerus is removed with a bone saw (B). The shaft of the humerus is reamed with a bone rasp to ready it for the prosthesis (C). After the shoulder joint, or glenoid cavity, is similarly prepared, bone cement is applied to areas to receive prostheses (D). The ball and socket prostheses are put in place, and the incision is closed (E). (
Illustration by GGS Inc.


Shoulder arthritis is among the most prevalent causes of shoulder pain and loss of function. In the United States, arthritis of the shoulder joint is less common than arthritis of the hip or knee. Individuals with arthritis in one joint are more likely to get it in another joint. Overall, arthritis is quite common in the United States, affecting about 16 million Americans. Osteoarthritis is also the most common joint disorder, extremely common by age 70. Men and women are equally affected, but onset is earlier in men.


Shoulder joint replacement surgery can either replace the entire AC joint, in which case it is referred to as total shoulder joint replacement or total shoulder arthroplasty ; or replace only the head of the humerus, in which case the procedure is called a hemiarthroplasty.


The two artificial components that can be implanted in the shoulder during shoulder joint replacment surgery are:

Shoulder joint replacement surgery is performed under either regional or general anesthesia, depending on the specifics of the case. The surgeon makes a 3–4 in (7.6–10.2 cm) incision on the front of the shoulder from the collarbone to the point where the shoulder muscle (deltoid) attaches to the humerus. The surgeon also inspects the muscles to see if any are damaged. He or she then proceeds to dislocate the humerus from the socket-like glenoid cavity to expose the head of the humerus. Only the portion of the head covered with articular cartilage is removed. The center cavity of the humerus (humeral shaft) is then cleaned and enlarged with reamers of gradually increasing size to create a cavity matching the shape of the implant stem. The top end of the bone is smoothed so that the stem can be inserted flush with the bone surface.

If the glenoid cavity of the AC joint is not damaged and the surrounding muscles are intact, the surgeon does not replace it, thus performing a simple hemiarthroplasty. However, if the glenoid cavity is damaged or diseased, the surgeon moves the humerus to the back and implants the artificial glenoid component as well. The surgeon prepares the surface by removing the cartilage and equalizes the glenoid bone to match the implant. Protrusions on the polyethylene glenoid implant are then fitted into holes drilled in the bone surface. Once a precise fit is achieved, the implant is cemented into position. The humerus, with its new implanted artificial head, is replaced in the glenoid socket. The surgeon reattaches the supporting tendons and closes the incision.


Damage to the AC joint is usually assessed using x rays of the joint and humerus. They provide information on the state of the joint space, the position of the humeral head in relation to the glenoid, the presence of bony defects or deformity, and the quality of the bone. If glenoid wear is observed, a computed tomography (CT) scan is usually performed to evaluate the degree of bone loss.

The treating physician usually performs a general medical evaluation several weeks before shoulder joint replacement surgery to assess the patient's general health condition and risk for anesthesia. The results of this examination are forwarded to the orthopedic surgeon, along with a surgical clearance. Patients are advised to eat properly and take a daily iron supplement some weeks before surgery. Several types of tests are usually required, including blood tests, a cardiogram, a urine sample, and a chest x ray . Patients may be required to stop taking certain medications until surgery is over.


Following surgery, the operated arm is placed in a sling, and a support pillow is placed under the elbow to protect the repair. A drainage tube is used to remove excess fluid and is usually removed on the day after surgery.

A careful and well-planned rehabilitation program is very important for the successful outcome of a shoulder joint replacement. It should start no later than the first postoperative day. A physical therapist usually starts the patient with gentle, passive-assisted range of motion exercises. Before the patient leaves the hospital (usually two or three days after surgery), the therapist provides instruction on the use of a pulley device to help bend and extend the operated arm.


Complications after shoulder replacement surgery occur less frequently than with other joint replacement surgeries. However, there are risks associated with the surgery such as infection; intra-operative fracture of the humerus or postoperative fractures; biceps tendon rupture; and postoperative instability and loosening of the glenoid implant. Advances in surgical techniques and prosthetic innovations are helping to significantly lower the occurrence of complications.

Normal results

Pain relief is expected after shoulder joint replacement because the diseased joint surfaces have been replaced with smooth gliding surfaces. Improved motion, however, is variable and depends on the following:

Morbidity and mortality rates

Good to excellent outcomes usually follow shoulder joint replacement surgery, including pain relief and a functional range of motion that provides the ability to dress and perform the normal activities of daily living. In the hands of experienced orthopedic surgeons, such outcomes occur 90% of the time. Shoulders with artificial joints are reported to function well for more than 20 years. No death has ever been reported for shoulder joint replacement procedures.


Arthritis treatment is very complex, as it depends on the type of arthritis and the severity of symptoms. Alternatives to joint replacement may include medications and therapy. It is known that arthritis is characterized by an increased rate of cartilage degradation and a decreased rate of cartilage production. An experimental therapy featuring the use of such joint supplements as glucosamine and chondroitin is being investigated for its effectiveness to repair cartilage. The pain and inflammation resulting from arthritis are also commonly treated with nonsteroidal anti-inflammatory pain medication (NSAIDs) or cortisone injections (steroidal).

See also Shoulder resection arthroplasty .



Wallace, W. A., ed. Joint Replacement in the Shoulder and Elbow. London: Edward Arnold Pub., 1998.


Godeneche, A., et al. "Prosthetic Replacement in the Treatment of Osteoarthritis of the Shoulder: Early Results of 268 Cases." Journal of Shoulder and Elbow Surgery 11 (January–February 2002): 11–18.

Miller, S. L., Y. Hazrati, S. Klepps, A. Chiang, and E. L. Flatow. "Loss of Subscapularis Function after Total Shoulder Replacement: A Seldom Recognized Problem." Journal of Shoulder and Elbow Surgery 12 (January–February 2003): 517–521.

Roos, E. M. "Effectiveness and Practice Variation of Rehabilitation after Joint Replacement." Current Opinions in Rheumatology 15 (March 2003): 160–162.

Steinmann, S. P., and R. H. Cofield. "Bone Grafting for Glenoid Deficiency in Total Shoulder Replacement." Journal of Shoulder and Elbow Surgery, 9 (September–October 2000): 361–367.

Vitale, M. G., et al. "Geographic Variations in the Rates of Operative Procedures Involving the Shoulder, Including Total Shoulder Replacement, Humeral Head Replacement, and Rotator Cuff Repair." Journal of Bone and Joint Surgery, 81 (June 1999): 763–772.


American Academy of Orthopaedic Surgeons (AAOS). 6300 North River Road, Rosemont, Illinois 60018-4262. (847) 823-7186. .

American Shoulder and Elbow Surgeons (ASES). 6300 North River Road, Suite 727, Rosemont, IL, 60018-4226. (847) 698-1629. .


Getting a Shoulder Replacement. .

"A Patient's Guide to Artificial Shoulder Replacement." Medical MultiMedia. .

Monique Laberge, PhD


Shoulder replacement surgery is performed in a hospital by orthopedic surgeons with specialized training in shoulder joint replacement surgery.


User Contributions:

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I have a cement spacer in my upper arm including the ball that goes into the socket. It is from a fractured are with severe staff infection twice. I will not get a shoulder replacement down the road because my doctor tell me that the muscles & nerves will not work againg anyways. I will keep the cement spacer for as long as it lasts, then have it taken out if something happens to it. My question is; I live in pain every day. My doctor tell me that even with the spacer out, he can not guarentee me that I will not live with pain. Could this be true. I go to see a pain management doctor March 25th. I do not want to live on codiene and valium the rest of my life. Do you have any suggestions for me. I am kind of wondering if I am being used to see how long a cement spacer will last in an arm. I am the first patient that he has done in the arm at my age. I am 47 years old, and have two grandchildren that I would love to have a normal life with them. I have another grandchild on the way, and will not be able to pick any of them up. Please do not ignore my e-mail, I am desperate not to have any more pain. Thank you for your time. Tanya Grimes (from upstate NY, near Albany)
my concern is I have already had my shoulder joint replaced and something else needs to be done on that shoulder I want to know the odds of infecting the joint
Where can I find rating/or number of surgeries orthopaedic surgeons preform annually?
This is the best site ever! It's a wealth of information that regular people like me can understand. I'm getting ready to have shoulder replacement surgery and you completely explained, step by step, information on what to expect from the first time I walk into the Doctor's office to what to when I go home! This has quickly become my favorite medical site on the web! I will for sure suggest your site to all my friends! Thanks and blessings to all! Donna
I had shoulder joint replacement a couple of weeks ago and experienced an unexpected complication: when I awoke from surgery, I had no feeling in my right foot, and my right leg and ankle were numb. My doctor thinks that there was some impingement of the sciatic nerve during my 4-hour surgery, due to my positioning on the table. I have begun recovering some of the feeling in my foot, but my leg and ankle are weak and my foot is still partially paralyzed. I am receiving PT and have to use a hemi walker to get around. I can't find any specific information regarding such a complication from this surgery.
I agree with Trish, I live in central Penna., where can I find ratings on surgens who do shoulder's and the number of surgeries they do yearly?
I need a Shoulder replacement and am looking for a well qualified surgeon
that is in the Pheonix Arizona area. From what I read it sounds like
my best option would be a reverse shoulder operation I am 85 years
young and would like it repaired Our home is in Sun City West Az.
Please advise H.F. Friele
mrs. brooks
My fiance is a war veteran he had to have surgery on his shoulder for a gun shot wound. Now his shoulder joint is deteriorating he is afraid that he will have to lose his whole arm now. Could he be a good candidate for a shoulder replacement?
i had a replacement ball in my left shoulder 11 years ago and a replacement ball in my right shoulder 6 years ago,i am now 63 and both my shoulders are so painful and my hands go to sleep regularly.Doe,s anyone have the same problem,or does anyone know the reasons for my agonies?

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