Shoulder Replacement Surgery - Shoulder Prosthesis Surgery

A shoulder replacement swaps a worn ball and socket for metal and plastic. The reverse design now accounts for most of them.

Shoulder replacement, also called shoulder prosthesis surgery, treats arthritis, a torn rotator cuff that has let the joint collapse, and some fractures in older bone. Surgeons choose between an anatomic replacement, which copies the normal shape of the joint, a reverse replacement, which swaps the ball and socket so the deltoid muscle can lift the arm, and a half replacement that covers only the ball. This page explains which design suits which shoulder, what national registries and trials show, how the recovery runs, and what to send for a free review of your X-rays and scans.

Three ways to replace a shoulder

The design follows the state of the rotator cuff, the four tendons that hold the ball in its socket.

Anatomic total replacement

A metal ball on a short stem, or on a stemless anchor, replaces the head of the upper arm bone, and a plastic cup lines the socket. It needs a working rotator cuff. In return it keeps the most natural rotation, which counts when you reach behind your back or into a high cupboard.

Reverse total replacement

Here the ball goes on the shoulder blade and the cup on the arm bone. That swap moves the pivot point of the joint, so the deltoid muscle lifts the arm once the cuff can no longer do it. The design began as an answer to torn tendons in older patients. It now makes up most shoulder replacements in national registers, including 72.1 percent of the 25,188 recorded in the Netherlands, and the table below sets the three designs side by side.

This table scrolls sideways on a narrow screen. Swipe or drag to see every column.

Half replacement

Hemiarthroplasty replaces the ball alone and leaves the worn socket in place. In the Australian national registry, wear of that socket was the leading reason these shoulders needed a second operation in patients under 55.

Who is a candidate

Replacement comes up when pain wakes you at night and limits daily tasks after months of physiotherapy, pain medicine and injections, and the X-rays show a worn joint. The conditions behind it fall into five groups.

• Osteoarthritis of the shoulder joint
• Rheumatoid and other inflammatory arthritis
• A large rotator cuff tear that has let the ball ride up and wear the joint
• A complex fracture of the upper arm in an older patient
• A failed earlier repair or replacement

Anatomic or reverse

For arthritis with an intact cuff, both designs relieve pain. The differences lie in rotation, further operations and age.

What the comparisons show

Across 14 comparative studies, patients with a reverse replacement had fewer complications, with an odds ratio of 0.54, and fewer further operations, with an odds ratio of 0.31, at an average follow-up of 3.4 years. They lost some outward rotation of the arm. In patients over 70 with no full-thickness cuff tear, pooled data from 2,731 shoulders showed half the odds of revision after reverse replacement, while anatomic replacement scored higher on the Constant shoulder score, 80 against 68. So neither design wins outright, and the choice turns on the tendons, the bone in the socket and how you use the arm.

On a phone, slide this table sideways to read all of its columns.

Younger patients

Patients under 55 put more years and more load on the implant. Among 2,111 replacements for arthritis in this age group in the Australian registry, the share revised by six years was 12.8 percent after resurfacing, 14.1 percent after half replacement, 12.4 percent after stemmed anatomic replacement, 7.0 percent after stemless anatomic replacement and 6.5 percent after reverse replacement.

Replacement after a broken shoulder

In older patients with a badly broken upper arm, reverse replacement gave better function than a sling and physiotherapy.

The gap was large. In a randomized trial of 80 patients aged 60 to 90 with three- or four-part fractures, the shoulder scored 76.9 one year after reverse replacement against 56.2 without surgery, and the arm lifted to 118.6 degrees against 90 degrees, a difference patients notice every time they reach for a shelf or comb their hair. Five patients in the non-surgical group crossed over to delayed surgery. Pooled data from six studies and 439 patients with a mean age of 79 point the same way. Forward lifting was better and overall complications did not differ, though slightly more patients needed a later operation after replacement.

Risks and what raises them

Instability was the leading reason for a second operation after reverse replacement in younger patients in the Australian registry.

Infection, a fracture around the implant, nerve irritation and loosening make up the rest. Two factors stand out before surgery.

Earlier shoulder surgery

History counts. In the Dutch national register of 25,188 shoulder replacements, a previous operation on the same shoulder raised the risk of revision by 48 percent, with the highest risk after fracture fixation and after rotator cuff repair, and these patients also gained less in function and in pain relief by the end of the first year.

A low blood count

So does anemia. Among 5,231 replacements at one center, moderate to severe anemia came with surgical complications in 19.3 percent of shoulders against 11.6 percent without it. Transfusion followed in 40.3 percent. We check the count from blood tests sent before the flight and correct it first.

Recovery and the sling

Six studies with 1,763 patients, reviewed together, found that starting movement early after reverse replacement gave slightly better lifting and pain scores. Dislocations did not rise. Fractures around the implant were fewer.

1. Day one, hand, wrist and elbow exercises and gentle pendulum swings
2. Weeks one to six, the sling outside exercise sessions and assisted movement with the physiotherapist
3. Weeks six to twelve, active lifting and light daily tasks
4. From three months, strengthening and a return to sport once the surgeon agrees

Return to sport was reported in 91 percent of patients after anatomic replacement and 80 percent after reverse replacement. Return to work was 76 percent against 46 percent. Most reasons for not going back had nothing to do with the shoulder. Age, retirement and other illness weighed more.

Planning the trip

One published shoulder replacement package in Istanbul lists three to five nights in hospital and a week in a hotel afterward. Plan ten to twelve days in Istanbul in total.

From the first message, one coordinator handles the whole trip and stays on the same WhatsApp number after you fly home. Coordinators work in English, Arabic, French, Russian, Serbian, Romanian and Spanish, and an interpreter joins for any other language. A relative sleeps on a companion bed in the patient room. The international patients office reserves the hotel, meets you at the airport and drives you to every appointment, which matters during the hotel week, because a fresh shoulder replacement rules out lifting a suitcase or gripping a rail on a tram. Halal, vegetarian and diabetic meals come from the hospital kitchen. A prayer room is on site. Patients who prefer a female surgeon are assigned one wherever the rota allows, and the visa invitation letter goes out ten days before you travel. Long flights raise the risk of clots, so walk the aisle every hour. The sling stays on through airport security and the whole flight home, and the coordinator books wheelchair help at both airports for anyone who wants it. Back home, your local physiotherapist follows the written plan, and the surgeon reviews new X-rays sent through the coordinator at six weeks and three months.

Drag sideways on a narrow screen to see the whole table.

What shapes the quote

Cost depends on the design, the implant, whether a worn socket needs 3D planning or a bone graft, and the nights in hospital. The published package for this market includes the surgeon's fee, anesthesia, the implant, the hospital stay, follow-up visits until you fly home and complication insurance with limited benefits. Hotel, transfers and flights are extra.

A figure worth comparing names the design and the implant brand, and it comes after a surgeon has seen your X-rays and CT scan.

Shoulder replacement surgery FAQ

For a free review, send these to us.

• X-rays of the shoulder from the front and the side
• A CT scan or MRI if you have one
• Notes from any earlier shoulder surgery
• A recent blood count and a list of medications

References

1. Daher M, Boufadel P, Fares MY, et al. Reverse versus anatomic total shoulder arthroplasty for glenohumeral osteoarthritis with intact cuff: a meta-analysis of clinical outcomes. J Shoulder Elbow Surg. 2025;34(1):190-202.
2. Dragonas CG, Mamarelis G, Dott C, et al. Anatomic total shoulder arthroplasty versus reverse total shoulder arthroplasty in patients aged over 70 without a full-thickness rotator cuff tear: a systematic review and meta-analysis. J Shoulder Elb Arthroplast. 2023;7:24715492231206685.
3. Jomaa M, Ingoe H, Hollman F, et al. Stemless anatomic and reverse shoulder arthroplasty in patients under 55 years of age with primary glenohumeral osteoarthritis: an analysis of the Australian Orthopedic Association National Joint Replacement Registry at 5 years. J Shoulder Elbow Surg. 2025;34(4):1032-1042.
4. Jetten EEJ, Janssen ERC, Hollman F, et al. The influence of prior shoulder surgery on implant survival and patient-reported outcomes of shoulder arthroplasty as analyzed by the Dutch Arthroplasty Register. J Shoulder Elbow Surg. 2026;35(8):1870-1881.
5. Hanisch KWJ. Reverse shoulder arthroplasty for acute Neer type III and IV proximal humeral head fractures with different humeral stem inclination versus nonsurgical treatment: a prospective, single-blinded, randomized controlled trial. JSES Int. 2026;10(2):101617.
6. Lu VYZ, Shah H, Alshaber Z, Limonard A, Domos P. Non-operative versus reverse shoulder arthroplasty for the treatment of 3- or 4-part proximal humeral fractures: a systematic review and meta-analysis. J Clin Orthop Trauma. 2025;65:102982.
7. Alder KD, Yu KE, Rode MM, et al. Increasing severity of preoperative anemia is associated with higher postoperative medical and surgical complications after primary shoulder arthroplasty. J Shoulder Elbow Surg. 2024;33(6):1243-1253.
8. Thamrongskulsiri N, Itthipanichpong T, Kongmalai T, Kongmalai P. Early mobilisation versus delayed protocols after reverse total shoulder arthroplasty for nonfracture indications: a systematic review and meta-analysis. J Exp Orthop. 2025;12(4):e70449.
9. van der Poel WJ, Macken AA, Eygendaal D, Buijze GA, van den Bekerom MPJ. Why do patients not return to sports or work after anatomical or reverse total shoulder arthroplasty? A systematic review and meta-analysis. JSES Int. 2025;9(5):1713-1722.