The shoulder is the joint with the greatest mobility in the body — and precisely for this reason, when it no longer functions correctly, the impact is immense. Simple gestures like dressing, combing your hair, or lifting a glass become painful or impossible. Sleeping on the affected side is a distant memory.
Shoulder arthroplasty — replacing the joint — is indicated when the pain is severe, mobility is severely compromised, and conservative treatments no longer provide relief. It is a less known procedure than knee or hip replacement, but with equally good results in correctly selected patients.
The procedure typically lasts between 90 and 120 minutes, but can be longer depending on the complexity of the case and anatomical particularities.
When is shoulder replacement indicated?
Shoulder replacement is considered when other treatments have been exhausted:
Severe Glenohumeral Osteoarthritis
Wear and tear of the cartilage between the humeral head and the glenoid cavity, which causes chronic pain and progressive stiffness. It is the most common reason for shoulder replacement.
Rotator Cuff Tear Arthropathy
When a massive and irreparable rotator cuff tear leads to secondary osteoarthritis and a complete loss of shoulder function. This requires a special type of prosthesis (reverse).
Avascular Necrosis of the Humeral Head
Loss of blood supply to the bone, which leads to its collapse.
Complex Fractures of the Proximal Humerus
Especially in the elderly, where bone reconstruction is no longer viable.
Failure of Other Interventions
When previous surgeries (cuff repair, debridement) have not provided relief.
Alternatives Before Replacement
As with the knee or hip, shoulder replacement is the last step, not the first. The conservative options I explore first are:
Injections with hyaluronic acid or cortisone
They can relieve pain in the early-to-moderate stages of shoulder osteoarthritis.
→ Learn morePhysiotherapy
Mobility and periarticular muscle strengthening exercises remain fundamental, especially in adhesive capsulitis (frozen shoulder) or tendinopathies.
Medication
Anti-inflammatory drugs, analgesics, and activity modification.
When these options no longer work and the pain becomes constant and disabling, replacement surgery is discussed as a realistic option.
Types of Shoulder Prosthesis
Anatomic Prosthesis
This respects the natural anatomy of the shoulder: a spherical metal head replaces the humeral head, and a component fixed to the glenoid (the socket of the scapula) replaces the joint surface of the shoulder blade. It is indicated when the rotator cuff is intact or functional.
Reverse Shoulder Prosthesis
This reverses the joint's geometry: the sphere is fixed to the glenoid, and the concave component to the humerus. This design allows the deltoid muscle to take over the function of lifting the arm, compensating for the absence of the rotator cuff. It is indicated in cuff tear arthropathy, complex fractures, and the failure of other interventions.
The reverse prosthesis fundamentally changed shoulder surgery—it offered a functional solution to patients who, in the past, had no viable surgical options.
Choosing the Type of Prosthesis
The decision between an anatomic and a reverse prosthesis depends on the condition of the rotator cuff, bone quality, age, and the patient's activity level. This is decided during the consultation, based on the clinical examination and imaging studies.
Risks and limits
Like any major surgery, shoulder replacement carries real risks: infection, nerve injury (usually transient, rarely persistent), prosthesis instability or dislocation, residual pain. We discuss them in detail, tailored to your case, before deciding together on surgery.
Training in Shoulder Surgery
Dedicated training: the SECEC/ESSSE Shoulder and Elbow Curriculum and the practical courses in shoulder arthroscopy and arthroplasty, University Medical Center Utrecht, 2022.
What Results to Expect
Shoulder replacement offers significant pain relief and improved mobility, but expectations must be realistically calibrated.
What the prosthesis can do
- Significant improvement in pain for most patients — published studies report satisfaction of over 90% at 10 years
- Improved mobility — lifting the arm, daily activities (dressing, combing, driving) become possible again
- Return to light activities: swimming, golf, hiking
What you should know
- • The range of motion will not be identical to that before the disease — a replaced shoulder has certain limitations
- • Recovery is slower than for knee or hip — active physiotherapy lasts 3-6 months, and the final result is achieved at 6-12 months
- • Lifting heavy weights remains inadvisable long-term
- • Immobilization with a sling for the first 4-6 weeks is necessary to protect tissue healing