- Affects
- Approximately 10% of adults over 65
- Cardinal feature
- Loss of motion + deep ache
- First-line
- Activity modification, physio, analgesia
- Injection
- Glenohumeral corticosteroid or hyaluronic acid
- Definitive
- Anatomic or reverse total shoulder replacement
What shoulder osteoarthritis is.
Osteoarthritis is the progressive wearing of the joint surfaces — cartilage thins and is eventually lost, bone becomes exposed, and the shape of the joint changes (osteophytes, glenoid wear, joint-space narrowing). In the shoulder, the changes most often affect the glenohumeral joint (the ball and socket). The neighbouring acromioclavicular joint can be affected independently.
Shoulder osteoarthritis is less common than knee or hip arthritis but follows a similar logic: progressive pain, progressive stiffness, and eventually a decision about whether and when to replace the joint.
Who develops it.
Primary shoulder osteoarthritis affects approximately 10% of adults over 65. Secondary osteoarthritis (developing as a consequence of an earlier injury or condition) is seen in younger patients with a history of recurrent dislocation, prior fracture, or extensive prior surgery. There is a meaningful family component.
How the diagnosis is made.
The history is one of slowly progressive deep shoulder pain, stiffness on dressing and reaching behind the back, and (often) night pain that interferes with sleep. The most important diagnostic test is a plain radiograph — in particular an axillary view, which shows the joint space directly. MRI is obtained before consultation to assess the rotator cuff (which is critical to surgical planning) and to give Dr Coory a complete picture of the joint on the day. If you do not have an MRI when referred, Dr Coory's team will arrange one before your appointment.
Non-operative treatment.
The majority of patients with shoulder osteoarthritis are managed without surgery. The mainstays are:
- Activity modification — adjusting the way certain tasks are done; lighter weights; reducing overhead loading.
- Physiotherapy — preserving motion, strengthening the cuff and scapular stabilisers.
- Analgesia — paracetamol and short-course anti-inflammatories where safe.
- Intra-articular corticosteroid injection — image-guided, typically performed by a musculoskeletal radiologist; useful for symptom flares.
- Hyaluronic acid injection — used selectively, with variable evidence.
When surgery is considered.
Surgery — specifically shoulder replacement — is considered when pain dominates daily life, sleep is consistently disturbed, and non-operative treatment is no longer enough. The two principal operations are:
- Anatomic total shoulder replacement — for the patient with an intact rotator cuff. The natural geometry of the joint is preserved.
- Reverse total shoulder replacement — for the patient with a torn or deficient cuff. The ball-and-socket geometry is reversed so the deltoid can elevate the arm without the cuff.
Dr Coory uses CT-based pre-operative planning and robotic-assisted glenoid preparation for most shoulder replacements, particularly where the glenoid anatomy is worn or deformed.
Outcomes.
Both anatomic and reverse total shoulder replacement produce substantial pain relief in well-selected patients. Australian National Joint Replacement Registry data show implant survivorship of greater than 95% at 10 years. Function continues to improve out to a year after surgery.1
Frequently asked questions.
Will I definitely need a shoulder replacement?
No. Most patients with shoulder osteoarthritis are managed without surgery. Shoulder replacement is considered when pain dominates daily life and sleep, and non-operative measures are no longer enough.
Anatomic or reverse — what's the difference?
Anatomic preserves the natural geometry of the joint and is used when the rotator cuff is intact. Reverse swaps the ball and socket, relying on the deltoid muscle to elevate the arm — it is used when the cuff is torn or deficient.
How long does a shoulder replacement last?
Australian registry data show implant survivorship above 95% at 10 years. Modern designs, accurately implanted, are expected to last considerably longer.
Will I get full motion back?
Most patients regain functional motion — comfortable reach overhead and behind the back. The pain relief is more reliable than the restoration of motion.
Can my GP do anything before I see Dr Coory?
Yes — a plain radiograph series, simple analgesia, and a course of physiotherapy are all reasonable first steps. If you have already tried these, bring a copy of your imaging to the consultation.
References.
- Australian Orthopaedic Association National Joint Replacement Registry. Shoulder Arthroplasty Annual Report. Adelaide: AOA; 2024.
- Walch G, et al. Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis: long-term outcomes. J Shoulder Elbow Surg. 2012;21(11):1526–1533.
- Bacle G, et al. Long-term outcomes of reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2017;99(6):454–461.