A little shoulder anatomy: the humeral head is the upper end of the humerus, comprising a cartilaginous part that articulates with the scapula, and another part — the tuberosities — to which the rotator cuff tendons attach, tendons essential for shoulder function. The glenoid is the name given to the articular surface of the scapula; it articulates with the cartilaginous part of the humeral head, forming the glenohumeral joint.

A total shoulder replacement replaces the articular surfaces of the glenohumeral joint. The prosthesis thus replaces both articular surfaces: the glenoid and the cartilaginous surface of the humeral head.

Which type of shoulder replacement?

There are two very different types of total shoulder replacement: the anatomical total shoulder replacement, and the reverse total shoulder replacement. The anatomical shoulder replacement reproduces the anatomy of the shoulder: on the humeral side, there is a hemisphere equivalent to the humeral head being replaced; on the scapular side, a small cup equivalent to the glenoid surface. The reverse shoulder replacement, as the name suggests, inverts the articular surfaces: the hemisphere is fixed to the scapula and the cup to the humerus.

The choice between an anatomical shoulder replacement and a reverse shoulder replacement depends primarily on the condition of the tendons attached to the humeral head, i.e. the rotator cuff. If the rotator cuff tendons are damaged, an anatomical shoulder replacement cannot function correctly. There are also other situations where a reverse shoulder replacement is preferable to an anatomical one, particularly when taking into account glenoid wear or poor centring of the humeral head against the glenoid.

Why do I need an anatomical or reverse shoulder replacement?

A little anatomy

The humeral head is the upper end of the humerus, comprising a cartilaginous part that articulates with the scapula, and another part — the tuberosities — to which the rotator cuff tendons attach. The glenoid is the articular surface of the scapula; it articulates with the cartilaginous part of the humeral head, forming the glenohumeral joint.

A total shoulder replacement replaces both articular surfaces of the glenohumeral joint: the glenoid and the cartilaginous surface of the humeral head.

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Which type of shoulder replacement?

There are two very different types of total shoulder replacement: the anatomical total shoulder replacement and the reverse total shoulder replacement.

The anatomical total shoulder replacement reproduces shoulder anatomy: on the humeral side, a hemisphere equivalent to the humeral head being replaced; on the scapular side, a small cup equivalent to the glenoid surface. A French innovation almost 30 years old, the reverse total shoulder replacement, as the name suggests, inverts the articular surfaces: the hemisphere is fixed to the scapula and the cup to the humerus. The choice between anatomical and reverse shoulder replacement depends primarily on the condition of the rotator cuff tendons. If the rotator cuff tendons are damaged, an anatomical shoulder replacement cannot function correctly. There are however other situations where a reverse total shoulder replacement is preferable

to an anatomical total shoulder replacement, particularly taking into account glenoid wear or poor centring of the humeral head against the glenoid.

The reverse total shoulder replacement

The reverse total shoulder replacement is most often (though not always) required to treat osteoarthritis. Osteoarthritis is defined as the mirror-wear of all or part of the articular cartilage covering the humeral head and the glenoid. The slow, progressive and inexorable wear of cartilage can be compared to the wear of a car tyre. It is excessive loading or abnormal orientation of the articular surfaces that explains this wear.

This is the point at which a total shoulder replacement is required. To continue the car analogy: replacing the worn tyre with a new one is the solution, as everyone knows you cannot drive for long on the rim!

Note: other factors can promote the development of osteoarthritis, such as genetic factors which remain unexplained to date, traumatic factors (post-fracture or post-instability sequelae), but also certain inflammatory diseases (rheumatoid arthritis, ankylosing spondylitis), or others such as a blood disease, aseptic necrosis, a metabolic disorder such as gout, or chondrocalcinosis.

The reverse replacement is also sometimes proposed when there is no osteoarthritis, but simply a significant or long-standing rotator cuff tear.

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Physiotherapy 2 to 3 times a week if possible.

Self-rehabilitation: exercises 1, 2 & 3 to be done 5 times a day (1 minute per exercise).

Use of the operated arm permitted for simple daily activities such as dressing, eating, washing.

Carrying loads and strength activities are strictly FORBIDDEN.

At the end of the 6 weeks, you will have your first post-operative review with a follow-up X-ray.

Physiotherapy 1 to 2 times a week if possible.

Self-rehabilitation: start exercise 4, then gradually exercises 5 and 6.

Use of the operated arm permitted for simple daily activities. Nothing physical, no lifting.

Resuming driving.

At the end of the third month, you will have your second post-operative review with a follow-up X-ray.

Authorisation to do housework, swimming, cycling...

More physical activities, DIY, gardening...

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The anatomical total shoulder replacement

Why do I need an anatomical total shoulder replacement?

The anatomical total shoulder replacement is most often required to treat osteoarthritis. Osteoarthritis is defined as the mirror-wear of all or part of the articular cartilage covering the humeral head and the glenoid. The slow, progressive and inexorable wear of cartilage can be compared to the wear of a car tyre. It is excessive loading or abnormal orientation of the articular surfaces that explains this wear. This is the point at which a total shoulder replacement is required. To continue the car analogy: replacing the worn tyre with a new one is the solution, as everyone knows you cannot drive for long on the rim!

Note: other factors can promote the development of osteoarthritis such as genetic factors which remain unexplained to date, traumatic factors (post-fracture or post-instability sequelae), but also certain inflammatory diseases (rheumatoid arthritis, ankylosing spondylitis), or others such as a blood disease, aseptic necrosis, a metabolic disorder such as gout, or chondrocalcinosis.

Physiotherapy 3 times a week if possible.

Self-rehabilitation: exercises 1 & 2 to be done 5 times a day (1 minute per exercise).

Wear a sling day and night (except at rest during the day and during dressing, washing,

meals, physiotherapy sessions and self-rehabilitation exercises).

Use of the operated arm permitted for simple daily activities

such as dressing, eating, washing (without the hand being above the head).

Carrying loads and strength activities are strictly FORBIDDEN.

Physiotherapy 3 times a week if possible.

Self-rehabilitation: exercises 1, 2 & 3 to be done 5 times a day (1 minute per exercise).

Gradually remove the sling: first during the day at home, then during outdoor

activities, and finally at night.

Use of the operated arm permitted for simple daily activities

such as dressing, eating, washing (without the hand being above the head).

Carrying loads and strength activities are strictly FORBIDDEN.

Physiotherapy 3 times a week if possible. Self-rehabilitation: start exercise 4, then gradually exercises 5 and 6 according to your progress.

No more sling.

Use of the operated arm permitted for simple daily activities BUT nothing heavy, nothing repetitive, no housework, no washing-up.

Resuming driving.

No prolonged or excessive walking.

At the end of the 3rd month, you will have your second post-operative review.

Physiotherapy 2 times then once a week.

All self-rehabilitation exercises adding exercise 7.

Authorisation to gradually resume housework, road or indoor cycling,

swimming, jogging or brisk walking.

At the end of the 6th month, you will have your third post-operative review.

Physical activity, lifting, DIY, gardening...

Need more information?

Contact Dr. Collin
Consultation locations
  • Clinique Drouot Molitor – Sports & Arthritis
    37 rue Molitor, 75016 Paris
    +33 1 88 40 20 30
  • American Hospital of Paris
    55 Bd du Château, 92200 Neuilly-sur-Seine
    +33 1 88 40 20 30
Surgical venues
  • American Hospital of Paris
    55 Bd du Château, 92200 Neuilly-sur-Seine
  • Clinique Victor Hugo
    5 Bis Rue du Dôme, 75116 Paris
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