Shoulder Hemiarthroplasty in Delhi, India

Shoulder hemiarthroplasty is a surgical procedure to replace the ball of the upper arm bone (humeral head) with a metal implant, while keeping the socket (glenoid) intact. This procedure is commonly used to treat severe fractures, arthritis, or other conditions that damage the humeral head. By preserving the natural socket, this approach aims to support better movement and reduce shoulder pain.

Shoulder hemiarthroplasty is categorised based on the implant used and the specific condition being treated.

Standard Hemiarthroplasty

In this procedure, the damaged ball of the upper arm bone is removed and replaced with a metal implant. If the socket is in good condition, it is left unchanged. This type of surgery is typically used for serious fractures or cases where the humeral head is the main cause of pain and joint damage. The goal is to relieve discomfort and restore shoulder function.

Resurfacing Hemiarthroplasty

Instead of replacing the entire humeral head, a metal cap is placed over the surface of the damaged bone. This method is often recommended for younger patients with healthier bones and minimal joint damage. It preserves more of the natural bone while reducing pain and maintaining shoulder mobility.

Shoulder hemiarthroplasty may be considered when shoulder pain and restricted movement persist despite other treatments. Common reasons for undergoing this procedure include:

• Severe Shoulder Fractures: If the socket remains healthy, hemiarthroplasty may be considered as an option, especially in cases where joint wear leads to stiffness, pain, and reduced motion over time.
• Osteoarthritis: In this case, the shoulder joint wears down, leading to stiffness, pain, and reduced motion. The bone deteriorates, leading to joint damage and pain.
• Avascular Necrosis: When the blood supply to the humeral head is lost, causing the bone to deteriorate and the joint to become damaged.
• Chronic Shoulder Pain: When pain persists despite the use of medication, physiotherapy, or injections.
• Failed Previous Surgery: The previous surgery didn’t work or caused problems that require more treatment.

A thorough medical evaluation will determine whether shoulder hemiarthroplasty is the best option. The primary aim is to help reduce pain, improve function, and enhance quality of life.

Certain preparations are necessary before surgery to ensure a safe procedure and promote a smooth recovery.

Medical Evaluation 

The surgeon will review medical history, current medications, and overall health to assess if surgery is appropriate.

Diagnostic Tests 

Imaging tests such as X-rays, CT scans, or MRI scans help evaluate joint damage and guide surgical planning.

Pre-Surgery Instructions 

Certain medications, such as blood thinners, may need to be stopped temporarily to reduce the risk of complications. If general anaesthesia is used, fasting for several hours before the procedure is usually required.

Discussion of the Procedure 

The surgeon explains the surgery process, expected recovery, and potential risks. This is an opportunity to ask questions and address any concerns before moving forward.

Anaesthesia

Before surgery, anaesthesia is administered to ensure the patient remains comfortable and pain-free. Most patients receive general anaesthesia (which keeps them asleep) along with a nerve block to help manage pain after surgery.

Procedure 

Once the anaesthesia takes effect, the surgeon makes an incision over the shoulder to reach the joint. The damaged part of the shoulder is removed and replaced with a metal implant. The implant is secured using bone cement or a press-fit method. The socket remains unchanged, and surrounding soft tissues are repaired to promote joint stability. The surgeon aims to align the joint properly before closing the incision, supporting movement and healing.

Proper care and patience are important for recovery after shoulder surgery. Following the doctor’s advice, avoiding strain, and performing the recommended exercises can help promote healing and improve movement.

Hospital Stay and Immediate Care 

Most patients stay in the hospital for one to two days after surgery. A sling may be provided to support the shoulder and prevent unnecessary movement. Pain relief options will be available as needed.

Activity Restrictions and Healing

For the first few weeks, heavy lifting and overhead movements may need to be avoided. Gentle range-of-motion exercises may be recommended under medical supervision.

Rehabilitation and Follow-Up

Physiotherapy is often recommended to help strengthen the shoulder and improve movement. Follow-up appointments are important to monitor recovery and address any concerns.

Shoulder Hemiarthroplasty is a typically safe procedure; but like any other surgery, there are some risks and complications to consider. Here are some of the most common ones.

• Implant Loosening: Over time, the metal implant may wear down or become loose, which may require revision surgery.
• Infection: Although uncommon, infections can develop at the incision site or inside the joint. Most infections are treated with antibiotics, but severe cases may need further intervention.
• Nerve Injury: Nerves near the shoulder may be affected, causing temporary numbness or weakness. Nerve function can improve over time, but recovery differs for each individual.
• Stiffness and Reduced Motion: Some patients may experience limited movement after surgery, but physiotherapy is often recommended to help enhance flexibility.
• Fracture: In rare cases, bones around the shoulder may break during or after surgery, requiring further treatment.

Who is a candidate for shoulder hemiarthroplasty?

Anyone with severe humeral head damage due to fractures, arthritis, or avascular necrosis, but with a healthy shoulder socket, is a candidate for shoulder hemiarthroplasty. It is also an option for those who haven’t responded to non-surgical treatments.

How does shoulder hemiarthroplasty differ from total shoulder replacement?

Shoulder hemiarthroplasty replaces only the ball of the shoulder joint, while total shoulder replacement replaces both the ball and the socket. It is typically performed when the socket remains undamaged.

Is shoulder hemiarthroplasty a major surgery?

Yes, it is considered a major surgical procedure as it involves replacing part of the shoulder joint. However, advancements in surgical techniques have improved recovery times and outcomes.

How long does shoulder hemiarthroplasty surgery take?

The procedure typically lasts 1.5 to 2.5 hours, depending on the complexity of the case. Factors such as bone quality and the presence of previous surgeries may affect the duration.

What type of anaesthesia is used for shoulder hemiarthroplasty?

General anaesthesia is commonly used, often combined with a nerve block for post-operative pain relief. This ensures the patient remains comfortable during and after surgery.

How soon can a patient move their arm after shoulder hemiarthroplasty?

Gentle movements may be encouraged within a few days, but full shoulder mobility takes weeks to months. A structured rehabilitation program is essential for recovery.

What is the typical hospital stay after shoulder hemiarthroplasty?

Most patients stay in the hospital for one to two days post-surgery. The length of stay depends on pain management, wound healing, and early rehabilitation progress.

When can a patient resume daily activities after the surgery?

Light activities may be resumed within a few weeks, but strenuous tasks and heavy lifting should be avoided for several months. Full recovery can take up to six months.

What is the expected pain level after surgery?

Pain is typically moderate to severe in the first few days but improves with medications and rehabilitation. Most patients experience significant relief from pre-surgery pain within a few weeks.

How long does it take to achieve full recovery?

Full recovery usually takes between three to six months, depending on the patient’s overall health and adherence to rehabilitation exercises. Strength and flexibility continue to improve over time.

Will the metal implant set off airport security scanners?

Most modern implants are made of materials that do not trigger airport scanners. However, carrying a medical implant card can help in case additional screening is required.

Can shoulder hemiarthroplasty be redone if needed?

Yes, revision surgery may be required if complications such as implant loosening, infection, or persistent pain occur. The need for revision depends on factors like implant wear and patient activity levels.

Does the procedure affect sleep positions?

Sleeping on the operated side should be avoided initially to reduce discomfort. Many patients find sleeping in a reclined position helpful during the early recovery phase.

Will there be permanent movement restrictions after surgery?

While most patients regain good range of motion, some may experience mild limitations in certain overhead or extreme rotational movements. Strength and flexibility improve with consistent physiotherapy.

Are there any dietary restrictions after surgery?

There are no specific dietary restrictions, but a balanced diet rich in protein, vitamins, and calcium supports healing. Staying hydrated and maintaining proper nutrition can aid recovery.

Can shoulder hemiarthroplasty be performed on both shoulders?

Yes, but it is usually done one shoulder at a time to ensure proper rehabilitation and recovery. In rare cases, both shoulders may be treated if necessary, with sufficient recovery time between surgeries.

Is shoulder hemiarthroplasty suitable for athletes?

It can be beneficial for athletes with severe shoulder injuries, but return to high-impact sports may be limited. Low-impact activities like swimming or cycling are generally safe after full recovery.

What happens if shoulder hemiarthroplasty fails?

If the implant loosens, pain persists, or complications arise, revision surgery may be needed. Surgeons may replace the implant or convert the procedure to a total shoulder replacement.

How does age affect the success of shoulder hemiarthroplasty?

Older patients may have a slower healing process, but the surgery is still effective in reducing pain and improving function. Younger patients may benefit more from resurfacing techniques that preserve bone.

Can shoulder hemiarthroplasty cure arthritis?

While it does not cure arthritis, it helps relieve pain and restore function by replacing the damaged bone. It is an effective solution when arthritis severely affects the humeral head.

Reviewed by Dr. Vikas Gupta, Senior Director - Max Institute of Musculoskeletal Sciences and Orthopaedics. Hand and Wrist, Elbow, Shoulder Specialist, on 16 Apr 2025.

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