ENShoulder replacement in Germany is for people whose shoulder aches even at night, who cannot lie on that side or lift the arm to comb their hair or reach a shelf: the worn joint is replaced with an artificial one. It is rarer than hip or knee replacement, so the surgeon should operate on shoulders regularly.
This page covers when surgery is needed, implant types, the operation and recovery, specialist surgeons and how AlenMed organises treatment. Hip replacement and other joint problems are covered under orthopaedics and trauma surgery in Germany.
When a shoulder needs an artificial joint
A shoulder needs an artificial joint when the joint is destroyed beyond repair. Most often the cause is osteoarthritis: the cartilage on the ball of the upper arm bone wears away and bone rubs on bone. A long-standing tear of the rotator cuff, the muscles and tendons that keep the ball in its socket, can also ruin the joint. Other causes are complex upper arm fractures in older people, avascular necrosis (bone death from poor blood supply) and rheumatoid arthritis.
Surgery is discussed when tablets, injections and physiotherapy stop helping and pain and stiffness disrupt daily life. The surgeon needs X-rays, a CT scan of the socket and an MRI or ultrasound of the rotator cuff: the state of these tendons decides the type of implant.
Types of shoulder implants
Shoulder implants are anatomical, reverse or partial. An anatomical implant copies the natural joint: a metal ball on a stem sits in the upper arm bone and a plastic socket on the shoulder blade. It needs an intact rotator cuff that can still hold and turn the shoulder.
A reverse implant swaps the parts: the ball goes on the shoulder blade, the socket on the arm bone. The centre of rotation shifts, so the deltoid, the large muscle that rounds the shoulder, can lift the arm even without the rotator cuff. It is mostly used in older patients, for cuff tears and complex fractures. A recent systematic review of osteoarthritis with an intact cuff found fewer reoperations after reverse replacement and better outward rotation of the arm after anatomical replacement.
Sometimes only the ball is replaced, which is a partial replacement. Selected patients receive short-stem or stemless implants that take less bone. The surgeon chooses based on the scans, tendons, bone quality and age.
How shoulder replacement surgery is performed in Germany
Shoulder replacement surgery in Germany starts with planning on a CT scan: on a three-dimensional model of the shoulder blade the surgeon plans in advance where and at what angle the components will sit and which sizes fit.
The operation is done under general anaesthesia, often with a nerve block: local anaesthetic injected near the shoulder nerves keeps the first hours after surgery free of severe pain. The surgeon reaches the joint through an incision on the front of the shoulder. The hospital’s treatment plan states how long the operation and the hospital stay take.
Afterwards the arm rests in a sling. Physiotherapy starts early with passive exercises: the therapist moves the arm while the muscles stay relaxed. Antibiotics help prevent infection and painkillers ease the pain. The surgeon decides when it is safe to fly home.
Recovery after shoulder replacement
Recovery goes in stages: passive movement, then active movement, then strengthening. After a reverse implant the deltoid does the lifting, so its strength largely decides how high the arm goes, which makes training it especially important. No heavy lifting or sudden jerks in the first months: the implant’s anchorage in the bone is sensitive to overload.
Rehabilitation starts in Germany and continues at home with a written exercise programme for a local physiotherapist. The surgeon sets the timeline and restrictions; more on the page physiotherapy in Germany.
Frequently asked questions
Which shoulder implant is better, anatomical or reverse?
No implant suits everyone: the choice depends on the rotator cuff, the socket shape, bone quality, age and activity. An anatomical implant needs intact tendons; a reverse one works without them. The surgeon decides from CT and MRI or ultrasound, and a second shoulder specialist can review the scans.
Can a shoulder be replaced if the rotator cuff is torn?
Yes, that is what the reverse implant was designed for: the deltoid muscle lifts the arm instead of the torn tendons. It is used for long-standing tears that have destroyed the joint and after complex fractures in older people. As the deltoid carries the load, the surgeon first checks that it works well.
When can I fly home after shoulder replacement?
The surgeon decides after an examination: the wound should heal without complications, tablets should control the pain, and you should manage the sling and exercises confidently. On the journey the arm stays in the sling and must not lift luggage, so travel with a companion. Take home the discharge letter and exercise plan in a language your doctor reads.
Where shoulder replacement is done and how AlenMed arranges it
Shoulder replacement is done in orthopaedic departments across Germany; AlenMed looks for a surgeon for whom the shoulder is a core specialty. Prof. Andreas Lenich in Munich specialises in shoulder and elbow surgery: he sees patients at the orthopaedic centre on Stiglmaierplatz, home to the ZEST shoulder and elbow centre he founded, and operates at the IATROS clinic and Josephinum Clinic. From 2015 to 2020 he headed orthopaedics and trauma surgery at Helios Klinikum München West. Prof. Till Orla Klatte is chief of orthopaedics and trauma surgery at Albertinen Hospital in Hamburg. From 2021 he led shoulder surgery at the University Medical Center Hamburg-Eppendorf (UKE), and since 2023 he has led the revision of the German guideline on upper humerus fractures. Dr Matthias Hoppert directs orthopaedics and trauma surgery at ISAR Klinikum in Munich; he is a certified shoulder and elbow surgeon of the German Society for Shoulder and Elbow Surgery (DVSE) and performs joint replacement and revision surgery.
AlenMed translates your scans and reports, sends them to a shoulder surgeon and obtains the hospital’s cost estimate before you travel. German hospitals bill inpatient care under the DRG system: a fixed amount per case, set by diagnosis, operation and severity. General guidance is on the page treatment prices in Germany. We also arrange the visa invitation, an interpreter and accommodation. The AlenMed office is in Munich; partner hospitals are across Germany.
This material is for information only and is not an offer. The treatment plan is decided by a doctor at an in-person consultation.
News on this topic
Consensus Guideline for Bacteriophage Therapy in Bone and Implant Infections
An international consensus guideline published in Nature Medicine establishes standards for personalized bacteriophage therapy in complex orthopedic infections.
Ultrasound Regional Anesthesia Replaces General Anesthesia for Surgery
German specialists from DEGUM emphasize how ultrasound-guided regional nerve blocks improve surgical safety, lower medication doses, and protect high-risk patients.
Obesity and Rheumatism: Inflammatory Immune Changes Are Reversible
Leipzig researchers have revealed that obesity-induced immune system inflammation mirrors rheumatoid arthritis and can be reversed through substantial weight loss.
