Shoulder replacement (arthroplasty): an OR 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Shoulder replacement in one minute
What it is: surgery to replace a worn or damaged shoulder joint with metal and plastic parts.
Who it is for: people with severe shoulder arthritis, a large cuff tear with arthritis, or some fractures.
Main risks: infection, stiffness, dislocation, nerve injury, loosening over time.
Usually: under general anaesthetic with a nerve block, 1.5–3 hours, home in 1–3 days.
On this page: What is a shoulder replacement? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ
What is a shoulder replacement?
The shoulder is a ball-and-socket joint: the ball at the top of the arm bone (humerus) sits in a shallow socket (glenoid).
There are two main types:
- Anatomic replacement: a metal ball on a stem and a plastic socket, copying the normal shape; needs a working rotator cuff
- Reverse replacement: the ball and socket are swapped (ball on the shoulder blade, cup on the arm bone), so the deltoid muscle can lift the arm when the cuff is badly damaged
Implants are cemented or press-fit, per device and operator.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- severe shoulder arthritis
- a large rotator cuff tear with arthritis (often reverse replacement)
- some complex fractures of the top of the arm bone
The decision is made by your surgical team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
Most operations are planned; some are urgent. Before it, you usually have:
- an examination and X-rays, and sometimes a CT or MRI scan
- blood tests and, for bigger operations, an ECG
- a review of your medicines, especially blood thinners, as per centre protocol
- fasting instructions
- a chance to ask questions and give consent
Step by step
1. Getting ready
Team brief and WHO checklist first, including the implant check and confirming the site and side marking. The anaesthetic team and ODP give the anaesthetic (general, usually with a nerve block, as per centre protocol); antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning and pressure areas, the diathermy plate, warming, and radiation protection if X-ray is used. The scrub practitioner checks implant and instrument trays are complete and sterile, and does the first count. Theatre traffic is kept to a minimum, especially in laminar-flow theatres. The patient sits in the beach-chair position with the head secured.
2. Access
A cut is made at the front of the shoulder, between the deltoid and chest muscles (deltopectoral approach), per surgeon.
3. Replacing the shoulder
- A. Joint exposed. The joint is opened and the arm bone delivered forward.
- B. Ball cut. The worn ball is cut off the arm bone.
- C. Socket prepared. The socket is shaped and the socket part fitted, size per device and operator.
- D. Stem and ball fitted. The arm bone is prepared, trials tested, and the final parts fitted and the joint reduced.
4. Finishing
Tendons are repaired, the wound closed in layers, and the arm placed in a sling. Final counts are confirmed, implant details recorded, and the patient goes to recovery with a full handover, including limb checks (circulation and nerves), as per centre protocol.
Recovery and aftercare
- First hours: in recovery, then a ward; pain relief, anti-sickness medicine and limb checks.
- Getting up: physiotherapists help you walk, often on the day of surgery or the next day (enhanced recovery).
- Going home: often 1–3 days after surgery.
- Exercises: do your physiotherapy exercises every day; they matter as much as the operation.
- Clot prevention: injections, tablets or stockings, as per centre protocol.
- Sling: usually for a few weeks.
- Driving: usually not for about 6 weeks; ask your team.
- Follow-up: wound check and clinic review, as per centre protocol.
Call 999 if you have chest pain or sudden breathlessness. Contact your team if you have increasing pain, a cold, numb or very swollen limb, calf pain, fever, or a wound that becomes red, hot or leaky.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- infection, including deep joint infection
- stiffness
- dislocation
- nerve injury (uncommon)
- fracture around the implant
- loosening or wear needing further surgery
Theatre kit list (printable)
Example kit list
Every theatre has its own protocol, and sizes and doses vary.
- shoulder arthroplasty instrument trays
- implants and trials, sizes per device and operator
- power saw, drill and reamers
- bone cement if cemented, per device and operator
- beach-chair positioner and arm holder
- closure sutures, dressings and sling
Procedural steps
- Team brief, WHO sign in; side marked; implant check; anaesthesia and block
- Beach-chair; head secure; prep and drape; count
- Incision; joint exposed
- Humeral head cut; glenoid prepared and fitted
- Trials; final implant check; stem and head; reduction
- Repair; closure; sling; counts; implant log; sign out and handover
First time in theatre?
đź’ˇ First-time tip
- Implant check. Read back the implant type, side and size before opening, and record it in the implant log.
- Site and side. Check the marking at sign in and again before the cut.
- Counts matter. Swabs, needles, instruments and small implant parts are counted; speak up if one is missing.
- Positioning. In beach-chair, check the head is secure and pressure areas padded; watch blood pressure.
- Cement timing. Know the cement timings if cement is used.
FAQ
What is a reverse shoulder?
A design that swaps the ball and socket, used when the rotator cuff is badly damaged.
How much movement will I get?
Pain relief is usually good; movement varies. Your team will advise.
How long does it last?
Many last many years; your surgeon will discuss what to expect.
Related guides
Sources
All checked on 14 October 2026. Each page's own date is shown where it gives one.
- StatPearls (NCBI Bookshelf), search: shoulder arthroplasty. ncbi.nlm.nih.gov/books
- NICE. Joint replacement (primary): hip, knee and shoulder (NG157). nice.org.uk/guidance/ng157
- National Joint Registry. njrcentre.org.uk
- World Health Organization. Surgical Safety Checklist. who.int
Disclaimer
Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
