Anatomic Shoulder Replacement
An anatomic shoulder replacement can be life changing - reducing constant pain, restoring mobility, and bringing back independence. With careful surgical planning, advanced technology, and structured rehabilitation, the vast majority of patients experience dramatic and lasting improvements in their quality of life.
What is an Anatomic Shoulder Replacement?
The shoulder functions as a ball-and-socket joint formed between the upper arm bone (humerus) and the shoulder blade (scapula). In a healthy shoulder, smooth cartilage lines these surfaces, allowing the joint to move easily and without pain. Damage from arthritis, injury, or wear over time can erode this cartilage, causing bone-on-bone contact that leads to pain, stiffness, and loss of motion.
An anatomic shoulder replacement restores the normal structure of the shoulder joint by replacing the worn surfaces with prosthetic components that replicate its natural anatomy. The existing ball (humeral head) and socket (glenoid) are precisely reshaped and fitted with artificial materials that move together smoothly. This procedure is most effective when the rotator cuff tendons—the key stabilisers of the shoulder—are healthy and intact.
Who Should Consider Anatomic Shoulder Replacement?
You may be a candidate for anatomic shoulder replacement if you have:
Ongoing shoulder pain interfering with sleep or daily activity
Stiffness or reduced range of motion
Weakness or reduced function that persists despite physiotherapy and medications
Pain not improved with injections or conservative management
This surgery is often recommended for those with:
Advanced osteoarthritis
Avascular necrosis (loss of bone blood supply)
Rheumatoid or inflammatory arthritis
Post-traumatic arthritis following injury
If the rotator cuff tendons are severely torn or non-functional, a reverse shoulder replacement may be more suitable. The rotator cuff is critical to the success of an anatomic replacement, as it keeps the joint stable and powers movement.
How is Anatomic Shoulder Replacement Performed?
Mr. Kirzner performs Anatomic shoulder replacement is performed through a 10 cm incision at the front of the shoulder using the deltopectoral approach. The operation takes approximately 1–2 hours under general anaesthetic, often with a nerve block to help manage postoperative pain.
1. Exposure of the Joint
Access is gained between the deltoid and pectoral muscles without cutting major muscle fibres.
The subscapularis tendon is temporarily released to allow safe access to the shoulder joint.
2. Preparing the Bones
The worn surfaces of the humeral head and glenoid are removed.
Specialised tools prepare the bone for accurate fitting of the prosthetic components.
Advanced preoperative 3D planning or patient-specific guides may be used to optimise alignment.
3. Inserting the Implants
A metal stem (usually titanium) is placed down the humerus with a polished or ceramic ball attached to recreate the humeral head.
A high-grade polyethylene socket is fitted to the glenoid surface and secured with cement or screws.
The subscapularis tendon is carefully repaired to restore stability.
This operation maintains the shoulder’s normal biomechanics and provides a more natural movement pattern compared with a reverse shoulder replacement.
Your Recovery & Follow-Up Schedule
2 Weeks: The wound is kept clean and dry. At your review, dressings are removed and healing is checked. Dissolvable sutures mean no stitches need removing.
6 Weeks: Patients are usually off all strong pain relief medication, and back to driving and light work. For the first 6 weeks avoid putting your arm behind your back – like tucking in a shirt or toileting. Avoid pushing up from a chair. When getting changed, put your operated arm in the sleeve first. No heavy lifting.
3 Months: A repeat clinical check and Xray is performed. For the first 12 weeks avoid pushing down on your operated arm (eg pushing up out of a chair)
12 Months: Most patients will achieve a pain-free shoulder with a functional range of motion. You should be able to freely reach key areas like the top of your head and toileting behind your back. Xrays are performed to confirm stable implant fixation.
Longterm: If all progresses as expected, follow-up Xrays and assessments are performed at 5year intervals to monitor implant health.
Frequently Asked Questions
What are the risks of Knee Replacement Surgery?
Anatomic shoulder replacement surgery is generally safe but, like any major procedure, it carries risks. These include:
Infection: Usually only a superficial wound infection to the top-most layer of the skin. In rarer cases a deep infection can develop and this is a serious complication that may require further surgery and exchange of the implants. Rare but serious, <1%.
Stiffness and ongoing pain: 1-20 in every 100 people will have some mild ongoing pain or stiffness in the shoulder after the operation
Damage to the nerves and blood vessels around the shoulder: Rare but serious, <1%
Clots – Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE): These are very rare in upper limb surgery, and much lower when compared to lower limb cases like hip and knee replacements. Rare and affects <1%
Shoulder Dislocation: This is very uncommon and could suggest another complication like infection. Occurs between 1-5 cases per 100
Loosening of the Implants: This is not likely to happen for many years after the surgery. The implants used by Mr Kirzner have an excellent track record in the AOA National Joint Registry
Rotator cuff problems over time:
Because the anatomic design relies on healthy rotator cuff tendons, there is a small but important long-term risk that these tendons may weaken or tear years after surgery. This can occur due to age-related degeneration or trauma. When this happens, patients may experience pain, reduced strength, or loss of overhead movement.
If the rotator cuff tendons deteriorate to a point where the shoulder loses function, the anatomic replacement can be converted to a reverse shoulder replacement. This conversion procedure replaces the joint configuration so that the deltoid muscle, rather than the damaged tendons, provides power and stability. Although such revisions are relatively uncommon, discussing this possibility helps patients understand how treatment can adapt if future cuff problems arise.
Compared with reverse shoulder replacement, anatomic replacement is associated with:
Better natural movement when the rotator cuff is healthy
Lower risk of instability (dislocation)
However, a higher long-term risk of cuff degeneration and possible conversion if tendon failure occurs
We will go through your personal risk profile and ensure that every step is taken to minimise complications and maximise success. The fitter and stronger you are prior to your surgery, the safer and quicker your recovery will be and the more you will get out of your shoulder.
What does the recovery look like?
You will wake up with your arm in a sling after your surgery. If you have had a nerve block, you shouldn’t feel any pain till the next day. The nurses will provide you pain relief and the next morning a physio will see you to go through some exercises you can do to help strengthen the muscles around the shoulder and stop the shoulder from becoming too stiff.
These exercises will change over the next few months but you should try to do them regularly to maximise your rehabilitation. Early rehabilitation focuses on regaining walking ability and strength.
Most patients spend 1-2 days in hospital after surgery, before going home. A number of allied health staff (physios, occupational therapists) will make sure you have adequate support at home before discharge. An appointment will be made for you for a wound check
Will it Set Off the Metal Detector at an Airport?
Yes, it's possible that the metal components in a shoulder replacement will set off airport metal detectors. Be proactive and advise the security guards that you have had a shoulder replacement. Having a letter or medical certificate will not prevent these security measures.
When Can I Drive After a Anatomic Shoulder Replacement?
To drive you will need to be off all strong pain relief and out of your sling and have the ability to perform an emergency stop safely. For most patients this takes 6 weeks.
When Can I Fly After a Anatomic Shoulder Replacement?
Short flights are often safe within a few weeks after surgery, but longer flights may increase the risk of blood clots. This is less of an issue compared with lower limb joint replacement surgery.
What about sports and hobbies after a Anatomic Shoulder Replacement?
Gentle swimming (breastroke not freestyle): after 12 weeks
Gardening (light tasks only): 8-12 weeks
Bowls: after 3-6 months
Golf, tennis, badminton, squash: after 4-6 months
Do I Need Antibiotics After a Reverse Shoulder Replacement for Dental Work?
For the first 3 months following a shoulder replacement you should be given antibiotics by your dentist if you require urgent dental work. This is to prevent bacteria from your mouth entering your bloodstream and travelling to the shoulder joint.
After 3 months routine antibiotics are not required for dental work unless your immune system is compromised. If you are in doubt, please get your dentist to contact us prior to your dental procedure.
Is the surgery painful?
We use a multimodal pain control approach, including local anaesthetic, nerve blocks, and tailored medication. Pain is usually well managed, and many patients describe it as far less painful than they expected. Most patients are discharged on medications no stronger than paracetamol and ibuprofen.
