Shoulder hemiarthroplasty is an operation to replace the ball (humeral head) of the shoulder joint with a metal prosthesis, while preserving the native socket (glenoid). It is performed for complex proximal humerus fractures in elderly patients and certain types of arthritis.
An incision is made over the front of the shoulder. The fractured or arthritic humeral head is removed. A metal stem with an appropriately sized prosthetic head is cemented or press-fit into the humeral shaft. The tuberosities (with their attached rotator cuff tendons) are carefully repaired around the prosthesis using sutures. The operation takes one and a half to two hours.
Hemiarthroplasty is recommended for comminuted (shattered) proximal humerus fractures in elderly patients where fixation would fail, fracture-dislocations of the shoulder, and certain patterns of arthritis where the glenoid is well-preserved. In fracture cases, it provides immediate pain relief and stability.
Fracture fixation with plate and screws (if the fracture pattern allows), reverse shoulder replacement (increasingly preferred for fractures in the elderly), non-operative treatment in a sling (accepting limited function), and total shoulder replacement for arthritis.
CT scan to assess fracture pattern and tuberosity displacement. For fractures, surgery is ideally performed within two weeks.
Reliable pain relief. Functional outcomes depend heavily on tuberosity healing — if the tuberosities heal in position, good overhead function can be achieved. If they fail to heal, active elevation is limited.
The tuberosities may migrate or fail to heal, limiting active movement. Occurs in approximately 20–30% of fracture cases.
Limited range of motion, particularly overhead.
Some patients have ongoing discomfort.
The prosthesis may dislocate. Risk approximately 5%.
Prosthetic joint infection approximately 1–2%.
Fracture around the implant.
Over time, the metal head may wear the native glenoid.
Axillary or musculocutaneous nerve.
General anaesthesia with nerve block. Beach-chair position.
Sling for four to six weeks. Gentle pendular exercises from week one. Active assisted movement from four to six weeks. Strengthening from eight to twelve weeks. Full recovery six to twelve months. Tuberosity healing is monitored on X-rays.
X-rays at two weeks, six weeks, three months, and one year to monitor tuberosity healing and implant position.
Reverse replacement is increasingly used for fractures in elderly patients as it does not depend on tuberosity healing for function. Your surgeon will recommend the best option based on your specific fracture, bone quality, and activity level.
This depends on tuberosity healing. If the tuberosities heal well, good overhead function is achievable. If they do not heal, active elevation may be limited, though pain relief is usually maintained.