Types of Shoulder Replacement Surgeries: A Comprehensive Guide

The shoulder joint is a ball-and-socket joint. The rounded end of the upper arm bone (head of the humerus) fits into the socket of the shoulder blade (the glenoid fossa of the scapula). The shoulder joint is most commonly damaged due to degenerative diseases such as arthritis, overuse or injury. Damage to the joint can cause pain and decrease mobility. 

Should conservative non-surgical treatments no longer be effective, shoulder replacement surgery may be effective in reducing pain and improving mobility. Shoulder replacement surgery, also known as shoulder arthroplasty, is an orthopaedic procedure that involves replacing the damaged or diseased parts of a shoulder joint with artificial components. The artificial components used in shoulder replacement surgery can be made of various materials, such as metal, plastic, or ceramic. 

Around 3.8 thousand shoulder replacements were conducted in the UK in 2020. There are different types of shoulder replacement surgery and the choice of the surgical approach depends on the extent of the damage to the joint, the patient's age and health status, and the surgeon's expertise. 

What Generally Happens During Shoulder Replacement Surgery?

Shoulder replacement surgery is typically done under general anaesthesia and may take several hours to complete. The surgeon will make an incision over the shoulder joint to access the bones. The invasiveness of the procedure (i.e. how large the incision is and how much it disrupts the bones and soft tissues) depends on the severity of the damage to the joint and the type of shoulder replacement surgery performed. 

• Once the surgeon has access to the joint, they will remove the damaged or diseased parts of the humerus (upper arm bone) and the glenoid (part of the shoulder blade). In some cases, only the head of the humerus is removed, while in others, both the humerus and the glenoid are replaced.
• The surgeon will then attach the artificial components to the remaining parts of the humerus and scapula. The humeral component typically consists of a metal stem with a ball-shaped head, while the glenoid component is usually made of plastic.
• Once the artificial components are firmly in place and the soft tissues returned to their places, the incision is closed with sutures or staples, and a sterile dressing is applied. The patient is then taken to the recovery room to be monitored as they wake up from anaesthesia. Pain management, physical therapy, and other forms of postoperative care will be necessary.
• After surgery, the patient will need to avoid certain movements and activities for several weeks while the joint heals. Physical therapy and rehabilitation are usually necessary to restore the range of motion and strength in the shoulder.
• Recovery time after shoulder replacement surgery depends on the extent of the surgery, the patient’s age and their overall health. The different types of shoulder replacement surgeries vary in how invasive they are, which also influences recovery time. 

Total Shoulder Replacement

Total shoulder replacement is the most common type of shoulder replacement surgery, making up about 91% of all shoulder replacements performed annually in the UK. Total shoulder replacement surgery involves replacing both the ball and socket of the shoulder joint with artificial components. This procedure is typically used for patients with severe arthritis or joint damage.

A total shoulder replacement is the most invasive type of shoulder replacement surgery, where the surgeon removes the damaged joint components and replaces them with a prosthetic shoulder joint. 

Reverse Shoulder Replacement

Reverse shoulder replacement accounts for about 8.2% of shoulder replacement surgeries in the UK. It involves “reversing” the natural anatomy of the shoulder joint so that the ball is attached to the scapula and the socket is attached to the humerus. This type of surgery is performed when the patient has a rotator cuff tear, shoulder arthritis, or a previous shoulder replacement has failed.

Partial Shoulder Replacement

Partial shoulder replacement, also known as hemiarthroplasty, accounts for about 0.8% of shoulder replacement surgeries in the UK. It involves replacing only the ball component of the shoulder joint with an artificial component. This procedure is typically used for patients with isolated damage to the humeral head.

Resurfacing Shoulder Replacement

Resurfacing shoulder replacement surgery is a minimally invasive procedure that makes up only around 0.1% of the shoulder replacement surgeries performed in the UK. It involves replacing only the damaged surface of the humeral head with a metal cap. This procedure is typically used for younger patients with early-stage arthritis or joint damage.

Summary Of The Different Types Of Shoulder Replacement Surgeries Available

Shoulder replacement surgery is typically recommended for patients with severe arthritis, rotator cuff tears, or other conditions that cause significant pain and loss of function in the shoulder joint. The goal of the surgery is to relieve pain, restore mobility and function, and improve quality of life.

The choice of shoulder replacement surgery depends on the specific condition of the patient and the extent of damage to the shoulder joint. Total shoulder replacement (where both the ball and socket are replaced) is the most common type of shoulder replacement surgery, followed by reverse shoulder replacement (where the position of the ball and socket are reversed).

Partial shoulder replacement (where only the ball is replaced) and resurfacing shoulder replacement (where a cap is placed over the humeral head) are less common. It's important to consult with a qualified orthopaedic surgeon to determine the best course of treatment for your specific condition.