Shoulder Hemiarthroplasty: Everything You Need to Know

A.K.A. Partial Shoulder Replacment

Sutured shoulder surgery incision

Birgit R / EyeEm / Getty Images

In This Article

A shoulder hemiarthroplasty, or partial shoulder replacement, is surgery to remove the rounded top portion of the humerus (the upper arm bone) and replace it with a prosthesis. This is the "ball" of the shoulder's ball-and-socket joint, and it can become severely damaged due to chronic disease or an acute injury. Restoring the shoulder joint's integrity through shoulder hemiarthroplasty can alleviate pain and help improve mobility.

What Is Shoulder Hemiarthroplasty?

The metal prothesis that is used to replace the head of the humerus during a shoulder hemiarthroplasty is secured in place with a metal stem that is positioned inside the long hollow portion of this bone. Regional anesthesia , general anesthesia, or a combination of both are used during the procedure.

The rounded head of the humerus naturally fits into the glenoid fossa, the curved opening of the scapula bone (shoulder blade). Within this glenohumeral joint, the ends of the bones are protected by cartilage. Ligaments, tendons, and the rotator cuff muscles give the joint a substantial range of motion.

A shoulder hemiarthroplasty surgery may involve repair of other structures in the glenohumeral joint, but only the humeral head is replaced.

Contraindications

Your doctor might recommend against a shoulder hemiarthroplasty if your shoulder joint is altered in ways that are not compatible with this specific procedure.

In such cases, one of the following may be recommended instead:

You also can't have this surgery if your rotator cuff or other parts of your glenohumeral joint are structurally damaged in a manner that could interfere with the optimal placement of the bones. For instance, a glenoid fracture can be a contraindication for a shoulder hemiarthroplasty, and your doctor may suggest another type of treatment instead.

The best surgical option for you depends on the condition of the structures in your shoulder.

Even when shoulder hemiarthroplasty is indicated, it may be contraindicated if you have certain acute health issues or chronic disorders due to the risk for harm.

You can develop a serious post-operative infection if you already have an infection of structures in and around your joint. Ideally, your doctor will want to treat your infection before proceeding with surgery.

Cancer affecting your shoulder joint can prevent healing after surgery and might be a cause to reconsider the procedure. And severe osteoporosis can make your humerus bone so fragile that the metal stem that is placed could cause fractures.

Potential Risks

This surgery is considered safe, but there are general risks associated with anesthesia and surgery. Additionally, shoulder hemiarthroplasty is associated with specific risks that you should know about before your procedure.

Risks include:

  • Post-operative infection
  • Sensory issues due to nerve damage
  • Decreased mobility due to an injury of any structures in the joint
  • Bone fracture
  • Stiffness of the joint
  • Impaired healing after surgery

These problems could potentially result in worsening shoulder pain or weakness, and they may cause new and persistent arm pain and/or sensory changes.

Purpose of Shoulder Hemiarthroplasty

The goal of a partial shoulder replacement is to reduce pain and improve mobility. You might benefit from a shoulder hemiarthroplasty if the head of your humerus bone is badly degenerated, fractured, or otherwise damaged and your glenoid fossa is in reasonably good condition.

Sometimes the best option is to replace, rather than repair, the bone, and this surgery allows for that.

Shoulder symptoms that may improve after a shoulder hemiarthroplasty include:

  • Pain
  • Decreased range of motion
  • Swelling
  • Stiffness
  • Instability

Conditions that warrant a shoulder hemiarthroplasty generally cause severe symptoms. You might also need pain medication and anti-inflammatory medication to be able to function throughout the day.

If you have these symptoms, your doctor will do a physical examination to check your arm and shoulder strength, range of motion, sensation, tenderness, swelling, and evidence of trauma. You will have imaging tests, like a shoulder X-ray or magnetic resonance imaging (MRI) test to visualize the head of your humerus and the surrounding structures.

A shoulder hemiarthroplasty might be indicated for:

  • Avascular necrosis: Degeneration of the joint due to diminished blood flow
  • Shoulder arthritis with bone pain
  • Chondrolysis: Disintegration of the cartilage
  • A fracture or multiple fractures of the head of the humerus due to an injury or a pathological fracture (one without corresponding trauma)
  • A tumor that has caused damage to the head of the humerus, sparing other joint structures
  • Rotator cuff tear arthropathy: In situations when this procedure is considered more advantageous than reverse shoulder replacement

Your doctor might discuss other non-surgical and surgical treatments with you as you are considering a shoulder hemiarthroplasty. Pain medication, anti-inflammatory medications, pain injections, and exercises are among the options that you might try before moving on to surgery.

However, if you have had fractures of your humeral head due to recent trauma, you might need to have urgent surgery so your bones can heal properly.

How to Prepare

Prior to your surgery, you need to talk with your orthopedic surgeon about the recovery process. You will have to reduce your regular physical activity (like self-care and driving) for approximately one or two months after your surgery. After that, you need to make sure that you can devote time to physical therapy for several months.

Given this, it can be helpful to make arrangements that will allow you to get the rest you need to recover before you go in for your procedure.

If you're going to have surgery on both shoulders, speak with your doctor about the pros and cons of having both procedures done at the same time. Having two separate procedures prolongs your overall recovery time, but having them simultaneously means use of both shoulders must be restricted at once.

Your surgeon will select the size of your prosthesis based on pre-surgical 3-dimensional imaging of your joint, usually a computerized tomography (CT) scan. You might want to talk to your surgeon about your incision scar, so you will know its location and size in advance.

You will have pre-operative testing for your anesthesia planning, including a complete blood count (CBC), a blood chemistry panel, a chest X-ray, and an electrocardiogram (EKG).

You might have your own blood collected and stored prior to your surgery in case you experience substantial blood loss during your procedure and require a transfusion.

Location

You will have your surgery in an operating room in a hospital or a surgical center. You might go home on the same day as your surgery, or you may spend one night in the hospital for observation.

What to Wear

You can wear anything comfortable to your surgery appointment. You will need to wear a hospital gown during your procedure.

Be sure to wear (or bring) clothes that you can easily slip over or around your shoulder cast when you go home after surgery.

Food and Drink

Your doctors will ask you to abstain from food and drink after midnight the night before your surgery.

Medications

Your surgeon might instruct you to stop taking certain medications, like blood thinners and anti-inflammatory treatments, for several days or weeks before your surgery.

You might also be given a prescription of antibiotics to take before your procedure.

What to Bring

Bring your personal identification, health insurance information, and a form of payment for any portion of your surgery that you will be paying for.

You won't be able to drive for a few weeks after your surgery, so someone will have to take you home.

Pre-Op Lifestyle Changes

While no major lifestyle adjustments are customary prior to a shoulder hemiarthroplasty, you should be careful to avoid injuring your shoulder.

What to Expect on the Day of Surgery

When you go in for your surgery, you will need to register and sign a procedure consent form. You might have some preliminary tests, including a chest X-ray, CBC, blood chemistry tests, and a urine test. These tests are done to ensure that you don't have an acute medical problem (like an infection) that warrants a delay in your surgery until it's resolved.

You will go to a pre-operative area, where you can change into a hospital gown. You will have your blood pressure, pulse, respiratory rate, and oxygen level checked. You will also have an intravenous (IV, in a vein) line placed in your hand or arm on the side opposite your surgical shoulder.

Your surgeon will examine your shoulder to see if there have been any changes since your last appointment. You might have a shoulder X-ray or CT scan on the day of your surgery as well.

Before the Surgery

You will be taken to the operating room to have your surgery. Your surgical team will cover you with a drape, exposing your shoulder. Your skin will be cleansed with an antiseptic solution.

You will have anesthetic medication injected into your IV to make you drowsy, but this medication won't put you to sleep or control your pain.

Given this, you will also likely have a regional nerve block with an anesthetic medication injected near your brachial plexus or your suprascapular nerve. This prevents the nerve from receiving sensory input. The aesthetic may be injected all at once with a needle that's immediately removed, or your anesthesiologist may leave a catheter in place during surgery and gradually inject the medication.

If you are also having general anesthesia, you will have anesthetic medication injected into your IV to put you to sleep and prevent you from moving or feeling pain during your surgery. With general anesthesia, you will also have a tube placed in your throat to have mechanical breathing assistance.

Your oxygen level, pulse, and blood pressure will be monitored with the anesthesia equipment throughout your surgery.

During the Surgery

Your surgeon will make sure that your arm is positioned for optimal access to your humerus. They will begin by making an incision that is about five to seven inches in length at the front of your shoulder .

Your nerves and blood vessels will be gently moved out of the way, and some muscles and connective tissue will be cut for access to your bone.

The damaged head of your humerus bone will be cut away, as will any remaining degenerated cartilage on the head of the humerus. The long portion of your humerus will be fitted with the stem of your prosthesis. Sometimes, the inside opening of the humerus needs to be widened to properly fit the stem.

Once the prosthesis is put into its place, you might have a special type of cement inserted to help hold the prosthesis in place. The remaining structures of your joint are then positioned to properly fit the new humeral head replacement.

The muscles and any connective tissue structures that were cut may be repaired. Nerves and blood vessels will be gently returned to their optimal location, and the skin will be closed with suture.

Your incision will be bandaged and wrapped with gauze. You will likely have a cast placed to immobilize your shoulder.

Your anesthetic medication will be stopped or reversed and your breathing tube will be removed. Your anesthesiologist will make sure that you are stable and breathing on your own before you can head to the recovery area.

After the Surgery

Your medical team will continue to monitor your blood pressure and oxygen level for several hours when you are in the post-operative area. You will receive pain medication as necessary.

You might stay overnight or go home on the day of your surgery. If you aren't having any complications, expect your stay to last as long as you and your doctor originally discussed when planning your procedure.

Before you are discharged to go home, your doctor will examine your shoulder.

Your medical team will give you instructions about your prescribed pain medication, wound care, follow-up appointments, physical therapy and rehabilitation, and signs of complications that you should watch out for.

Recovery

Generally, complete recovery after a shoulder hemiarthroplasty takes approximately six months. You will need to follow up with your doctor several times throughout this period.

Your doctor will remove your sutures and examine your healing wound. You might need imaging tests of your shoulder joint so your medical team can follow the progress of your shoulder as it heals.

Over the first several weeks after your surgery, your shoulder will be immobilized with a cast. After that, you might have a splint placed. Eventually, several months after your surgery, you will be able to participate in physical therapy and gradually increase in your activity.

Healing

If your surgical dressing isn't water-resistant, you will need to follow the instructions you were given to avoid getting your incision wet when you shower. You might need to change your dressing as instructed as well.

You should take your pain medications as prescribed, but call your doctor if you are experiencing severe or increasing pain.

Importantly, watch for signs of post-operative complications, including:

  • Worsening pain in and around your shoulder
  • Swelling of your arm
  • Redness near your surgical area
  • Warmth near your surgical area
  • Tingling or decreased sensation of your hand or arm
  • Fever

Be sure to call your doctor if you experience any of these issues.

Activity

Your shoulder is immobilized to limit your overall shoulder movement. Activities you may need to modify include work, driving, and self-care. Your doctor will have given you very specific instructions regarding limitations and how to advance your activities.

In general, you should be prepared for shoulder immobility for up to a month, and modified activities for about a month after that.

You will need to begin your rehabilitation a few weeks after your surgery. This will include strengthening drills and movements to improve your range of motion. You might be given exercises to do on your own at home in between your supervised sessions.

Long-Term Care

Overall, you may need long-term care for a medical condition that caused you to develop joint problems. Pain, swelling, and stiffness are signs that your disease may need better management. For instance, if you have arthritis, you will need to continue taking medication like anti-inflammatories.

Know, too, that your condition can lead to joint problems in a different joint or around your prosthesis at some time in the future. If you have had avascular necrosis of your shoulder associated with sickle cell disease, you could be at risk of developing joint disease in the future.

Possible Future Surgeries

A partial shoulder replacement is intended to be a one-time procedure without additional surgical steps. However, complications like infections or fractures may necessitate surgical intervention.

Delayed problems, like degeneration of the joint that's unrelated to the shoulder hemiarthroplasty procedure, may need to be corrected with a reverse total shoulder arthroplasty or other surgical procedure.

Lifestyle Adjustments

After a full recovery, you should be able to participate in activities that involve the full range of motion of your shoulder.

If you start to experience pain, stiffness, or instability of your shoulder at any point after your surgery, see your doctor. While the surgery is generally successful, a prosthesis that's placed during a shoulder hemiarthroplasty may loosen or get out of place at some point, potentially requiring revision.

A Word From Verywell

If you are considering having a shoulder hemiarthroplasty for the treatment of a shoulder problem, you should know that this procedure is generally effective. This surgery can be beneficial if you are able to participate in the rehabilitation phase that's required after the operation. Patients should be prepared for several weeks or months of shoulder immobility, followed by months of therapy and exercises.

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