Joint Replacement
Shoulder Replacement – How the Surgery Works
The shoulder is a ball-and-socket joint made up of the humeral head and the glenoid, guided by the tendons of the rotator cuff. In osteoarthritis (omarthrosis) or after major tendon tears, every movement becomes painful and weak.
Which prosthesis is suitable depends mainly on the condition of the rotator cuff. If the tendons are intact, an anatomical prosthesis is usually sufficient. If they are irreparably damaged, a reverse prosthesis restores stability and mobility.
Which prosthesis is right?
Anatomical prosthesis
It replicates the natural joint: the humeral head is replaced with a metal ball, and the socket as well if needed. This requires an intact rotator cuff.
Reverse shoulder prosthesis
The ball and socket are swapped: the ball now sits on the shoulder blade, the new socket on the humerus. This lets the powerful deltoid muscle take over guidance – the solution for an irreparable tendon defect.
Partial & resurfacing prosthesis
For limited damage, a bone-preserving resurfacing of the humeral head is sufficient.
How the surgery works
Planning
X-rays and often a CT scan assess the bone and tendons. The right type of prosthesis is normally decided before the surgery, only in rare exceptional cases during the procedure itself.
Anaesthesia
The surgery is performed under general anaesthesia, usually supplemented with a pain catheter. You are positioned in a semi-upright ("beach chair") position.
Access
The joint is gently exposed through an incision at the front of the shoulder.
Preparing the joint
The worn humeral head is removed and the socket prepared for the implant.
Anchoring the components
The stem, ball and socket are inserted – reversed in position for a reverse prosthesis. The stem is usually fixed uncemented, or with bone cement if bone stability is reduced.
Adjusting soft-tissue tension
Finally, tension and mobility are checked and finely adjusted before the final components are fitted.
After the surgery
A shoulder brace protects the joint for the first few weeks. The shoulder is gently mobilised according to a fixed schedule; targeted strengthening usually begins around week nine. Physiotherapy is especially important for the outcome here.
More about physiotherapy →Your specialists for the Shoulder
This overview does not replace a consultation with a doctor. Which procedure is right for you is something you decide together with your doctor during your appointment.