Shoulder replacement

Expert reviewer, Mr Roger M Tillman, Consultant Orthopaedic Surgeon
Next review due February 2022

Shoulder replacement is a surgical procedure to treat your shoulder joint if it’s been damaged or worn away, usually by arthritis or injury. Your surgeon replaces some or all of your shoulder joint with artificial parts.

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About shoulder replacement

Your shoulder is a ball-and-socket joint. The ball at the top of your upper arm moves smoothly in the socket of your shoulder blade on a lining of cartilage. The cartilage prevents your bones from rubbing together. If your cartilage is damaged by injury or arthritis, this can make your joint painful and stiff.

A new shoulder joint can help to improve your shoulder movement and reduce your pain there. Artificial shoulder parts are usually made of metal or plastic or a combination of these.

The average age for people having a shoulder replacement is around 70 years, with many people being well over this age. An artificial shoulder joint will usually last for at least 10 years, often for much longer.

Types of shoulder replacement

There are several different types of shoulder replacement. Your surgeon will discuss with you what would be the best procedure in your particular circumstances. This will depend on the condition of the muscles around your shoulder, the stability of your shoulder and the strength of your bones.

The three main types of shoulder replacement procedure are described here.

Reverse shoulder replacement

This is the most commonly used shoulder replacement procedure. It gets its name from the fact that the positions of the ball and socket in your joint are switched around. A metal ball is attached to your shoulder blade, where your socket was before. And a new socket is attached to the top of your upper arm, where the ball was before. The new ball and socket each have a stem which, together with special cement, helps anchor them to your bone.

Total shoulder replacement

A total shoulder replacement is the second most common type of shoulder replacement procedure. If you have this type of operation, your surgeon will replace the ball at the top of your upper arm with a new metal ball. They’ll also replace the socket in your shoulder blade with a new socket. These replacements mimic the original structure of your shoulder.

Partial shoulder replacement (hemiarthroplasty)

In a partial shoulder replacement, only the ball at the top of your upper arm is replaced. The new metal ball will then move within your existing socket.

Preparing for a shoulder replacement

Most hospitals invite you for a pre-admission visit a week or so before your surgery. In the clinic, they’ll check that you’re fit for your operation and the anaesthetic. This visit gives you a chance to ask any questions you have about your admission. You’ll be told how to prepare for your procedure. For example, if you smoke, you’ll be asked to stop. Smoking increases your risk of getting a chest or wound infection, which can slow your recovery.

Before you go into hospital, it’s a good idea to think about how you’re going to get to and from hospital and manage at home afterwards. Make sure someone can take you to the hospital and bring you home after your operation. Plan to be away from home for between two and five days. And you may also want someone to stay with you at home to help out for a while.

In hospital

If you’re having a general anaesthetic, you’ll have been asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon or anaesthetist’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. Once you understand the procedure and if you agree to have it, your doctor will ask you to sign a consent form.

What are the alternatives to shoulder replacement?

Your surgeon will usually only recommend that you have shoulder replacement surgery if other treatments haven’t worked for you. These may include:

To find out more about the range of treatments for arthritis, see our information on osteoarthritis and rheumatoid arthritis.

If they recommend shoulder replacement, your surgeon will discuss with you why they think this is a good option in your particular circumstances.

What happens during a shoulder replacement?

Shoulder replacement is carried out by an orthopaedic surgeon (a doctor who specialises in bone surgery).

You’ll have a shoulder replacement with either general anaesthesia or local (regional) anaesthesia. General anaesthesia means you’ll be asleep during the operation. Local anaesthesia completely blocks pain from your shoulder and you’ll stay awake during the operation. You may have both types of anaesthesia, to help ease pain after your surgery. Your anaesthetist will talk to you about which type of anaesthesia is best for you. If you’re feeling very anxious, you might have a sedative as well as local anaesthetic.

Once the anaesthesia is working, your surgeon will reach your shoulder joint by making a cut, either down the front or the side of your shoulder.

After your procedure, your surgeon will close the cut with stitches or clips and cover the wound with a dressing.

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What to expect after a shoulder replacement

You may need to stay in hospital for two to five days after your operation, depending on how good your general health is.

If you have a local anaesthetic, it may take several hours before the feeling comes back into your treated shoulder. You’ll be given pain relief to help with any discomfort as this happens. Tell your nurse if you’re still in pain.

You may have fine tubes running out from your wound. These drain fluid into a bag and are usually removed after a day or two.

You’ll probably be able to eat normally and get out of bed the day after your surgery.

A physiotherapist will visit you after your operation. They’ll guide you through exercises and ways to move your shoulder to help you recover. Your surgeon will probably want you to start moving your shoulder from the first day after your operation. This helps to prevent stiffness and will help your shoulder to heal. It’s very important that you follow the advice you’re given about how to move your shoulder.

You may have an X-ray taken of your new joint while you’re in hospital.

Your nurse should give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

Having a general anaesthetic can temporarily affect your co-ordination and reasoning skills. So you mustn’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.

Recovering from a shoulder replacement

It usually takes at least three to six months to make a full recovery from a shoulder replacement.

For up to four weeks after the operation, you may need to keep your arm in a sling, especially at night. Your surgeon or physiotherapist will give you specific advice about when to wear your sling.

Within a few weeks after surgery, you should be able to do simple everyday tasks like washing and dressing yourself. Don't place your arm in any extreme positions (such as straight out to your side or behind your back) for six weeks after your operation.

Your surgeon may recommend that you don't lift anything heavier than a cup of tea for the first six weeks after your operation. Don’t do any heavy lifting or contact sports for at least six months.

Ask your surgeon for advice about returning to work and other activities. You may be able to drive again by about four weeks after the operation, but this will depend on how well you are recovering. You must be able to control your vehicle and perform an emergency stop. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

It’s usual for you to be given some painkillers to take home with you when you leave hospital. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist. Some people need painkillers for longer than others. If you’re in a lot of pain, contact the hospital or your surgeon for advice.

It’s important to continue to do the exercises your physiotherapist recommends. These will help your shoulder to heal and may help you to recover more quickly.

Side-effects of a shoulder replacement

Side-effects are the unwanted but mostly temporary effects you may get after having the operation.

After shoulder replacement surgery you may have:

  • discomfort or pain in your shoulder
  • some difficulty moving your shoulder due to pain and weakness
  • numbness around your scar
  • swelling of your fingers
  • numbness or tingling in your arm and fingers, especially if you’ve had a local (regional) anaesthetic

However, these side-effects should gradually settle over four to six weeks.

Complications of a shoulder replacement

Complications are when problems occur during or after the operation. These complications don’t happen very often, but it’s good to be aware of them.

The possible complications of any operation include an unexpected reaction to the anaesthetic and excessive bleeding. You may also develop a blood clot, usually in a vein in the leg (deep vein thrombosis).

Some of the complications of shoulder replacement are listed below.

  • Instability of your shoulder joint, which may even move out of its socket (dislocate).
  • Infection of the wound or joint. Your surgeon may give you antibiotics around the time of surgery to help prevent this.
  • Loosening of the replacement parts, especially the new ‘socket’ part in the shoulder.
  • Fracture (breakage) of your upper arm bone either during or after the operation.
  • Accidental damage to nerves, muscles and blood vessels around your shoulder. Over time, some nerve injuries may improve and even recover completely.

In some cases, these complications might mean you have to have a further operation on your shoulder. If you want to know more about possible complications, ask your surgeon.

Frequently asked questions

  • It’s natural to feel some pain after a surgical operation, but don’t worry – immediately after your operation, and while you’re in hospital, you’ll be given pain-relieving medicines. You may be given an injection, tablets to swallow, or have the medicine via a patient-controlled system. This allows you to control the amount of pain relief you receive.

    In some cases, even if you have a general anaesthetic, your doctor will also inject a local (regional) anaesthetic into your shoulder. This continues to numb your shoulder even after you wake up.

    Before you go home, you can discuss pain relief with your nurse or surgeon. They’ll usually give you some suitable painkillers to take with you. Always read the patient information leaflet that come with your medicine and, if you have any questions, ask your pharmacist for advice.

    If your pain is severe or doesn’t improve, contact the hospital or your surgeon for more advice.

  • Your surgeon and physiotherapist will decide the best type of exercises for you. You’ll be given an exercise plan to help your recovery after a shoulder replacement. Most exercises will help to get your shoulder joint moving and strengthen the muscles around your shoulder.

    It’s really important that you follow their advice about what you should and shouldn’t do with your shoulder. That will give you the best chance for a good recovery.

    Speak to your physiotherapist if you have any questions or concerns about the exercises you’re doing.

  • Your shoulder replacement should last for at least 10 years and will probably last a lot longer. For more than seven out of 10 people, their shoulder replacement lasts for 20 years. However, in time, the artificial parts of the joint may start to loosen from general wear and tear.

    A repeat shoulder replacement operation is also known as a revision. If you need to have your artificial joint replaced, the procedure can be more complicated than your first operation. This is because your surgeon will need to remove your artificial joint before they can put in a new one. Also, removing more of the bone of your upper arm in a second operation can make it more likely to fracture. It usually takes you a little longer to recover from a repeat shoulder replacement than from the first operation.

    Your surgeon will give you more information about a second joint replacement if you need one.

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Related information

    • Public and patient guide to the NJR’s 14th annual report 2017: shoulder replacement edition. Healthcare Quality Improvement Partnership, 2018.
    • Shoulder joint replacements. PatientPlus., last edited July 2016
    • Common Postoperative Complications. PatientPlus., last edited July 2016
    • Shoulder hemiarthroplasty. Medscape., updated July 2018
    • Glenohumeral arthritis – overview of the arthritic shoulder. Medscape., updated November 2015
    • Reverse total shoulder replacement. OrthoInfo|AAOS, American Academy of Orthopaedic Surgeons., last reviewed March 2017
    • Shoulder and elbow replacement. Versus Arthritis., accessed November 2018
    • Nerve blocks for surgery on the shoulder, arm or hand. The Royal College of Anaesthetists, 2015.
    • Personal communication, Mr Roger M Tillman, Consultant Orthopaedic Surgeon, January 2019
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, February 2019
    Expert reviewer, Mr Roger M Tillman, Consultant Orthopaedic Surgeon
    Next review due February 2022