Information about shoulder replacement and some frequently asked questions
The shoulder is a ball-and-socket joint made up of three bones, which are connected by muscles, ligaments and tendons. These bones are:
- the clavicle, which is the collarbone
- the scapula, which is the shoulder blade
- the humerus, which is the upper arm bone
What is a shoulder replacement?
A shoulder replacement, often referred to as a shoulder implant (and sometimes simply as a ‘device’), is, in basic terms, an artificial implant that replaces a shoulder joint that is damaged.
Joint replacements are nearly always carried out because of pain that cannot be controlled by other methods such as painkillers, physiotherapy or other surgery. The most common cause of pain is osteoarthritis.
Shoulder replacements are used to replace the ball (humeral head) and shoulder socket (glenoid fossa). These can be fitted in a variety of ways. You can see our details below for a breakdown of all the procedures. Ask your specialist about what shoulder replacement they recommend and what the advantages and disadvantages of it are.
Introduction to shoulder implants
- Humeral head
- Glenoid component (socket)
- Standard shoulder replacement
- Reverse total shoulder replacement
- Resurfacing Humeral Hemi- arthroplasty
- Resurfacing total shoulder arthroplasty or replacement
This is fixed into the top of the humerus (upper arm bone) after the removal or shaping of the patient’s existing humeral head. It is usually a highly polished metal ball on top of a metal stem which is fitted into the bone cavity of the upper arm bone and can either be uncemented or cemented. The stem can be short or long.
For resurfacing procedures, the humeral component is a cap-like prosthesis with a very short stem. Again, this may be uncemented or cemented.
This is the shallow cup or socket of the shoulder joint against which the humeral head moves. The cup is made of plastic and is usually fitted with the use of bone cement. Some types of socket are now made of plastic with a metal backing, which can be fitted to the bone without the use of cement.
For all procedures, different sizes of implants are available to aid the surgeon in finding the most suitable ‘fit’ for the patient.
For a standard total shoulder replacement, a humeral head (metal ball) and plastic socket are fitted.
In a reverse total shoulder replacement, the socket and metal ball are switched. In this procedure the socket is fixed to the top of the upper arm with a stem to secure it in place. The stem can be uncemented of cemented. The metal ball is fixed to the existing shoulder socket usually with screws.
A patient’s joint may only require the humeral head to be replaced. This is where the highly-polished metal ball would move against the patient’s existing shoulder socket (glenoid fossa).
This procedure involves reshaping of the patient’s own humeral head and placing a cap-like component on the bone with a short stem.
This involves the use of a cap-like component on the patient’s humeral head with a plastic socket component.
Thinking about your treatment options
Joint replacement is a highly successful operation that can bring relief from pain and improve mobility. However, going through the process can be baffling and many patients do not always understand their options or the detail of their treatment plan. It is important you feel supported by your surgeon when discussing your available options.
Working together with your practitioner is known as shared decision-making.
Shared decision-making recognises all the different factors in your life that will lead to better quality decisions, from your surgeon’s advice, through to the support from your family and friends.
Sources such as this National Joint Registry information should make you feel confident in asking questions about your surgery, your implant and your recovery. There are some commonly-asked questions below. You may wish to write these out and make some notes.
Whatever the reason for your joint replacement, there are many others going through the same process, and it may help to know you are not alone. There is additional support out there for you on shared decision-making as well as advice on looking after yourself before and after surgery.
As you make plans for your joint replacement surgery it may be helpful for you to make a note of any questions or queries you may have either for your surgeon or clinical team at the hospital. Some commonly asked questions are:
- Do I need joint replacement surgery? Are there other options available to me?
- If I do, how should I prepare for surgery?
- What type of implant are you recommending? What are the pros and cons?..
- What surgical technique would be used? What are the pros and cons?
- What should I know about my aftercare?
- What do I need to think about when I return home after my operation?
Further information about shoulder replacement
There are many organisations that provide additional general information about shoulder joint replacement, including specific guidance before and after surgery as well as online discussion forums. Please see links here for some of these, such as: patient groups including Versus Arthritis; and the British Elbow and Shoulder Society (BESS) who all have further useful advice.
The National Institute for Health and Care Excellence (NICE) recently published Quality Standard Guidelines for Joint Replacement (hip, knee and shoulder). This quality standard covers care for adults before, during and after primary elective hip, knee or shoulder joint replacement and is another useful source of reference. You can find this document here