An incision is made over the front of the shoulder. The damaged ball (humeral head) is removed and replaced with a metal ball on a stem, which is inserted into the upper arm bone. The socket (glenoid) is resurfaced with a plastic component. In a reverse shoulder replacement, the ball and socket are switched — the ball is placed on the socket side and the socket on the arm bone — which allows the deltoid muscle to power the arm when the rotator cuff is deficient. The operation typically takes one and a half to two hours.
Shoulder replacement is considered for severe shoulder arthritis causing persistent pain and loss of function that has not responded to non-operative treatment. A reverse replacement is used when there is both arthritis and a large, irreparable rotator cuff tear, or for certain complex fractures in older patients.
Pain medication, physiotherapy, activity modification, and corticosteroid injections can manage symptoms in the earlier stages. However, when arthritis is severe and these measures are no longer effective, joint replacement may be the most reliable option for pain relief and functional improvement.
A thorough pre-operative assessment is required, including blood tests, a heart tracing, and imaging. You may need to adjust or stop certain medications. Dental problems should be addressed before surgery to reduce infection risk. Plan for being in a sling and one-handed for several weeks after surgery.
The primary goal is pain relief. Most patients experience a significant reduction in pain and improvement in function. Conventional replacement can provide very good range of movement. Reverse replacement is particularly effective at restoring the ability to lift the arm in patients with rotator cuff deficiency. Modern shoulder replacements typically last 15–20 years or more.
StiffnessCommon
Some limitation of movement is expected, particularly in the early months. Physiotherapy helps restore function.
Bruising and swellingExpected
Expected around the shoulder and may extend down the arm.
Nerve block effectsExpected
Temporary arm numbness from the nerve block lasting up to 24 hours.
InfectionUncommon
Deep infection occurs in approximately 1–2% of cases and may require further surgery and prolonged antibiotics.
Instability or dislocationUncommon
More common with reverse replacement. Precautions in the early weeks reduce this risk.
Nerve injuryRare
Stretching or damage to nerves around the shoulder. Usually temporary.
Periprosthetic fractureRare
Fracture of the bone around the implant during or after surgery.
Component looseningLong-term
The implant may loosen over time, eventually requiring revision surgery.
Blood clotsRare
DVT or pulmonary embolism, though less common with upper limb surgery.
Usually performed under general anaesthesia with a nerve block for pain relief. The nerve block provides numbness to the shoulder and arm for up to 24 hours. Your anaesthetist will discuss the best approach for you.
Your arm will be in a sling for four to six weeks. Gentle passive exercises begin within the first few days. Active movement starts gradually from six weeks. Strengthening exercises begin at around three months. Most patients notice significant improvement by three to six months, with continued gains for up to a year. Driving is typically possible at six to eight weeks. Return to light activities such as swimming and golf is usually achievable.
Wound review at two weeks, then clinic appointments at six weeks, three months, and one year. Long-term follow-up with imaging may be arranged to monitor the implant.
What is the difference between a conventional and reverse replacement?
In a conventional replacement, the ball stays on the arm side and the socket on the shoulder blade. In a reverse, these are switched. The reverse is used when the rotator cuff is severely damaged and cannot power a conventional replacement.
How long does a shoulder replacement last?
Modern shoulder replacements typically last 15–20 years or more. Longevity depends on activity level, implant type, and individual factors.
What activities can I do afterwards?
Most patients return to gentle activities including swimming, golf, and gardening. High-impact or heavy overhead activities are generally discouraged.