Signs You May Need a Shoulder Replacement Rather Than a Repair
Shoulder pain can significantly affect daily life — from getting dressed and sleeping comfortably to working, exercising, or lifting objects overhead. Many people assume shoulder surgery always means a “repair,” such as fixing a torn tendon or smoothing damaged tissue. However, in some cases, a shoulder replacement offers better outcomes than attempting another repair.
Understanding when a shoulder is no longer suitable for repair alone is crucial. Factors such as arthritis patterns, rotator cuff quality, and imaging findings play a key role in determining the most appropriate treatment.
This article explains the key signs that may indicate a shoulder replacement is more suitable than a repair, helping patients make informed decisions in partnership with their treating specialist.
Understanding the Difference: Repair vs Replacement
Before exploring the signs, it helps to understand the difference between these two approaches.
Shoulder repair
- Focuses on fixing damaged structures such as the rotator cuff, labrum, or bursa
- Preserves the natural joint
- Works best when tissue quality is good and arthritis is minimal
Shoulder replacement
- Involves replacing part or all of the shoulder joint with prosthetic components
- Aims to relieve pain and restore function when the joint is significantly damaged
- More predictable outcomes in advanced joint disease
Repairs are less invasive, but they are not always durable if the underlying joint is severely worn or unstable.
Arthritis Patterns That Suggest Replacement Is More Appropriate
Arthritis is one of the most common reasons shoulder repairs fail or provide limited relief.
Advanced glenohumeral arthritis
- Widespread cartilage loss on both the humeral head and socket
- Bone-on-bone contact visible on imaging
- Pain at rest and night pain that disrupts sleep
In these cases, repairing soft tissue does not address the main source of pain — the damaged joint surfaces.
Asymmetric or eccentric wear
- Uneven wear of the joint, often with the humeral head shifting off-centre
- Leads to instability and poor mechanics
- Reduces the success of tendon repairs
Arthritis with stiffness
- Marked loss of shoulder movement
- Painful restriction despite physiotherapy
- Suggests structural joint changes rather than soft tissue irritation
When arthritis dominates the clinical picture, joint replacement often provides better long-term relief.
Rotator Cuff Quality: A Major Decision Factor
The rotator cuff plays a critical role in shoulder stability and movement. Its condition strongly influences whether repair is realistic.
Massive or irreparable rotator cuff tears
- Tendons cannot be mobilised back to bone
- Long-standing tears with muscle shortening
- High risk of repair failure
Poor tendon tissue quality
- Thin, frayed, or degenerative tendons
- Limited healing potential
- Re-tear rates significantly higher
Fatty muscle degeneration
- Muscle replaced by fatty tissue over time
- Indicates chronic dysfunction
- Repair may restore anatomy but not strength or control
In these situations, certain types of shoulder replacement can compensate for lost tendon function more effectively than repair.
Persistent Pain Despite Prior Repairs
Previous surgery does not always mean another repair is the answer.
Failed rotator cuff repair
- Ongoing pain and weakness after adequate rehabilitation
- Imaging confirms re-tear or progression of damage
- Reduced chance of success with repeat repair
Multiple prior surgeries
- Scar tissue and altered anatomy
- Reduced blood supply to tissues
- Less predictable healing
When pain persists despite well-executed repairs, replacement may provide more reliable symptom relief.
Imaging Findings That Favour Replacement
Imaging plays a key role in surgical decision-making. Certain findings strongly suggest replacement over repair.
X-ray indicators
- Loss of joint space
- Bone spurs (osteophytes)
- Humeral head deformity
MRI indicators
- Full-thickness rotator cuff tears with retraction
- Fatty infiltration of cuff muscles
- Cartilage loss across the joint
CT scan indicators
- Bone loss in the socket
- Joint alignment abnormalities
- Helps guide implant choice in replacement surgery
When imaging shows both joint damage and poor soft tissue quality, replacement is often the more durable solution.
Functional Limitations That Signal Replacement
Symptoms alone are important, but how the shoulder functions is equally telling.
Loss of overhead function
- Difficulty lifting the arm above shoulder height
- Weakness that does not improve with rehab
Pain at rest and at night
- Indicates joint involvement rather than isolated tendon strain
- Often unresponsive to injections or physiotherapy
Impact on daily activities
- Trouble dressing, grooming, or sleeping
- Reduced independence and quality of life
When pain and dysfunction dominate daily life, replacement may offer more meaningful improvement.
Age and Activity Considerations
Age alone does not determine the right procedure, but it influences expectations.
Older, lower-demand patients
- Arthritis progression more likely
- Lower tolerance for prolonged rehab
- Replacement often restores comfort faster
Younger but structurally compromised shoulders
- Severe arthritis or irreparable cuff damage
- Repairs unlikely to last
- Carefully selected replacement may still be appropriate
The goal is durability and function, not simply preserving native anatomy at all costs.
Management Options Before Surgery
Surgery is not always the first step. Conservative care is often appropriate initially.
Non-surgical options
- Physiotherapy tailored to joint health
- Activity modification
- Targeted injections
When conservative care is no longer enough
- Pain persists despite appropriate management
- Progressive loss of movement
- Imaging confirms advanced structural damage
At this stage, replacement may be discussed as a definitive option.
Key Differences at a Glance (List Format)
Repair may be suitable when:
- Minimal arthritis
- Good-quality rotator cuff tissue
- Localised damage
- Preserved shoulder mechanics
Replacement may be suitable when:
- Advanced joint arthritis
- Irreparable or poor-quality rotator cuff
- Failed previous repairs
- Pain and stiffness dominate function
Frequently Asked Questions (FAQ)
Is shoulder replacement only for elderly patients?
No. While more common in older adults, younger patients with severe joint damage or irreparable rotator cuff tears may also benefit.
Will a shoulder replacement limit my movement?
Most patients experience improved movement and reduced pain, especially compared to pre-surgery function. Outcomes depend on the type of replacement and rehabilitation.
Can arthritis be fixed with a repair alone?
Repairs address soft tissue problems but do not reverse cartilage loss. In advanced arthritis, replacement is often more effective.
How long does a shoulder replacement last?
Modern implants are designed to last many years. Longevity depends on activity level, implant type, and overall joint health.
Is recovery longer after replacement than repair?
Rehabilitation differs rather than being strictly longer. Replacement often provides more predictable pain relief, while repairs may require prolonged tendon healing.
