When is shoulder replacement considered?
Shoulder replacement is considered when arthritis or irreparable rotator cuff damage causes pain and loss of function that no longer respond to non-surgical care — night pain, difficulty dressing, reaching and lifting, despite medication, physiotherapy and injections.
Types of shoulder replacement
There are three main options, and the state of your rotator cuff — more than your age — usually decides between them.
Anatomic total shoulder replacement
The worn ball and socket surfaces are replaced, reproducing normal anatomy. Most appropriate for osteoarthritis with an intact rotator cuff, where it gives the most natural shoulder mechanics and the best rotation.
Reverse total shoulder replacement
The ball and socket positions are switched, allowing the deltoid muscle to power the arm when the rotator cuff is deficient. The preferred option for cuff tear arthropathy, irreparable cuff tears, and many complex fractures in older patients.
Pyrocarbon hemiarthroplasty
Only the ball is replaced, with a pyrocarbon head, and your own socket is preserved. Aimed at active patients with a working rotator cuff, avoiding the plastic socket that is the usual long-term weak point. Suitability rests on activity level and bone quality rather than age alone.
Dr Melsom will recommend the design that fits your anatomy, cuff status and goals.
The surgery and hospital stay
- Performed under general anaesthesia, usually with a nerve block for comfort
- Hospital stay is typically 1–2 nights
- A sling is worn for comfort and protection for the early weeks
Recovery
- Everyday light tasks (eating, writing, keyboard) resume within the first weeks
- Physiotherapy progresses motion and then strength
- Most patients are substantially comfortable by 6–12 weeks, with improvement continuing to 12 months
- Driving is usually possible at around 6 weeks
Outcomes
Modern shoulder replacement is a well-established treatment for shoulder arthritis; for most patients it reduces pain and improves everyday function, with implant survivorship now comparable to hip and knee replacement. Risks — infection, instability, nerve injury and the need for revision over time — are uncommon and will be discussed in detail at your consultation.
Mako robotic-assisted shoulder surgery
Following the initial trial at the Wesley Hospital, Dr Melsom plans to offer Mako-assisted reverse shoulder replacement to suitable patients. Robotic assistance adds guidance during socket preparation to the existing 3D planning process. Read how Mako compares with planning and patient-specific guides, and what the evidence can tell us.