Shoulder Resurfacing

Shoulder resurfacing is a bone-preserving surgical technique used to treat advanced arthritis or cartilage damage in the shoulder joint. Unlike total shoulder arthroplasty, which replaces large portions of bone with a stemmed implant, resurfacing focuses on restoring only the damaged joint surfaces. This approach preserves native bone, allows for easier revision if needed in the future, and often supports faster recovery. It is especially suited for younger or active patients who wish to maintain as much of their natural anatomy as possible.

How Common It Is and Who Gets It? (Epidemiology)

Shoulder resurfacing is less common than total shoulder replacement but is gaining popularity in younger patients under 50 years old who have shoulder arthritis or localized cartilage damage. It is most often chosen for patients who are active and wish to return to sports or manual work, and for those who may eventually require a total shoulder arthroplasty later in life. The procedure is also used in patients who have deformities, previous surgeries, or conditions that make traditional implants less suitable.

Why It Happens – Causes (Etiology and Pathophysiology)

The shoulder joint can develop arthritis or cartilage loss due to various conditions, including:

• Osteoarthritis (wear-and-tear degeneration)
• Post-traumatic arthritis (after fractures or injuries)
• Avascular necrosis (loss of blood flow to the humeral head)
• Rheumatoid or inflammatory arthritis
• Focal cartilage defects from repetitive overhead activities

When the cartilage surface deteriorates, the bones rub directly against each other, causing pain and stiffness. Shoulder resurfacing restores the smooth joint surface without removing large amounts of bone, preserving the underlying structure for future treatment options.

How the Body Part Normally Works? (Relevant Anatomy)

The shoulder joint is a ball-and-socket joint formed by the humeral head (the ball at the top of the upper arm bone) and the glenoid (the shallow socket on the shoulder blade). The rotator cuff muscles and tendons stabilize the joint and allow it to move freely. When cartilage damage or arthritis occurs, these surfaces become rough, causing pain, inflammation, and loss of motion. Shoulder resurfacing restores the joint’s natural smoothness while preserving bone and ligament function.

What You Might Feel – Symptoms (Clinical Presentation)

Patients with cartilage loss or shoulder arthritis often experience:

• Pain, especially with overhead movement or lifting
• Stiffness or loss of shoulder motion
• Grinding, catching, or clicking sensations
• Weakness and fatigue in the shoulder
• Difficulty performing daily activities such as dressing, reaching, or carrying objects

These symptoms typically worsen over time if left untreated.

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis begins with a thorough physical examination, including evaluation of shoulder strength, range of motion, and stability. Imaging studies such as:

• X-rays show the extent of arthritis, joint narrowing, and bone spurs.
• MRI reveals the condition of cartilage, rotator cuff, and surrounding soft tissues.
• CT scans provide 3D detail for precise surgical planning and implant sizing.

These tests help determine whether shoulder resurfacing or another procedure is most appropriate.

Procedure Types or Techniques (Classification)

Shoulder resurfacing can take several forms:

• Humeral Resurfacing: Covers the damaged humeral head with a smooth metal cap or biologic graft.
• Glenoid Resurfacing: Repairs the worn socket using a polyethylene implant or allograft.
• Total Biologic Resurfacing: Uses osteochondral allografts (donor tissue) to resurface both joint surfaces arthroscopically.

Each technique is selected based on the patient’s age, bone quality, and extent of cartilage loss.

Other Problems That Can Feel Similar (Differential Diagnosis)

Conditions that can mimic shoulder arthritis or cartilage damage include:

• Rotator cuff tears
• Labral tears or instability
• Shoulder impingement syndrome
• Biceps tendon disorders
• Avascular necrosis without collapse
• Glenoid dysplasia

A detailed physical exam and imaging help distinguish these from cases that would benefit from resurfacing.

Treatment Options

Shoulder resurfacing can be performed using two main approaches:

1. Biologic Resurfacing (All-Arthroscopic Technique):
This technique, developed by Gobezie and colleagues, uses donor cartilage (osteochondral allografts) to restore both the humeral head and glenoid surfaces arthroscopically. The key steps include:

• Arthroscopic access through small incisions (rotator interval portals)
• Reaming of damaged bone surfaces
• Press-fit insertion of donor cartilage grafts on both the humeral head and glenoid
  This minimally invasive approach avoids cutting through major tendons and allows early rehabilitation.

2. Prosthetic Resurfacing:
A thin metal cap (usually cobalt-chromium or titanium) is placed over the reshaped humeral head. This avoids entering the bone shaft and preserves most of the humerus. Some designs include a small glenoid component, while others treat only the humeral surface (hemiresurfacing).

Recovery and What to Expect After Surgery

Recovery after shoulder resurfacing is usually faster than with total shoulder arthroplasty. Patients typically wear a sling for comfort for 1–2 weeks. Early motion exercises begin soon after surgery to prevent stiffness.

• Weeks 0–4: Gentle passive movements; avoid external rotation beyond comfort.
• Weeks 4–8: Active-assisted exercises to rebuild strength.
• Weeks 8–12: Full range of motion and strengthening exercises; gradual return to daily activities.

Most patients experience substantial pain relief and improved mobility within three months.

Possible Risks or Side Effects (Complications)

While generally safe, shoulder resurfacing carries certain risks, including:

• Infection (especially with donor grafts)
• Graft resorption or loosening
• Periprosthetic fracture (rare)
• Glenoid wear or erosion over time (in humeral-only resurfacing)
• Disease transmission from donor tissue (extremely rare, less than 1 in a million)

Proper patient selection and surgical technique minimize these risks.

Long-Term Outlook (Prognosis)

Studies report excellent outcomes for shoulder resurfacing. In one series, pain scores improved from 8.7 to 1.5, and ASES functional scores rose from 57 to 89. Grafts remained stable with no resorption. For prosthetic resurfacing, results show comparable pain relief and motion restoration to stemmed arthroplasty, with easier revision options in the future. Most patients return to sports and physical activities such as golf, tennis, and weight training within a few months.

Out-of-Pocket Costs

Medicar

CPT Code 23472 – Shoulder Resurfacing Arthroplasty (Partial or Total Shoulder Replacement with Resurfacing Technique): $340.19

Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and lower patient financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining coinsurance or small deductibles, which usually range between $100 and $300, depending on your plan and provider network.

Workers’ Compensation

If your shoulder resurfacing arthroplasty is required due to a work-related injury or degenerative joint condition, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and postoperative care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your shoulder resurfacing procedure is needed due to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and follow-up care. The only possible out-of-pocket cost may be a small deductible or co-payment, depending on your insurance policy.

Example

Emily Carter underwent shoulder resurfacing arthroplasty (CPT 23472) to treat severe shoulder arthritis while preserving bone structure. Her estimated Medicare out-of-pocket cost was $340.19. Since Emily had supplemental insurance through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the surgery.

Frequently Asked Questions (FAQ)

Q. What is shoulder resurfacing?
A. Shoulder resurfacing is a surgical procedure that replaces the damaged surface of the humeral head with a smooth metal cap without removing a large portion of the bone.

Q. When is shoulder resurfacing recommended?
A. It is recommended for patients with arthritis or damage limited to the surface of the humeral head while preserving the patient’s bone stock.

Q. How is shoulder resurfacing different from total shoulder replacement?
A. Shoulder resurfacing involves capping the humeral head with a metal implant, whereas total shoulder replacement replaces both the humeral head and the glenoid component.

Q. What are the advantages of shoulder resurfacing?
A. Advantages include bone preservation, shorter surgery time, quicker recovery, and ease of future conversion to total shoulder replacement if needed.

Q. Who is an ideal candidate for shoulder resurfacing?
A. Ideal candidates are typically younger, more active individuals with arthritis isolated to the humeral head and good bone quality.

Q. What conditions may lead to the need for shoulder resurfacing?
A. Common conditions include osteoarthritis, avascular necrosis, and post-traumatic arthritis limited to the humeral head.

Q. How long does the shoulder resurfacing procedure take?
A. The procedure typically takes about one to two hours to complete.

Q. What is the recovery time after shoulder resurfacing?
A. Most patients recover in a few weeks to a few months, with physical therapy being an important part of the recovery.

Q. What are potential complications of shoulder resurfacing?
A. Complications may include infection, implant loosening, fracture, nerve injury, and continued pain.

Q. Can shoulder resurfacing be revised to a total shoulder replacement later?
A. Yes, shoulder resurfacing can be revised to a total shoulder replacement if needed in the future.

Q. What is used to cap the humeral head during shoulder resurfacing?
A. A smooth metal cap is used to cover the damaged surface of the humeral head.

Q. Will I need physical therapy after shoulder resurfacing?
A. Yes, physical therapy is a key part of the recovery process to regain strength and range of motion.

Q. Is hospitalization required for shoulder resurfacing?
A. Yes, the procedure is typically performed in a hospital or surgical center, and patients may stay overnight.

Q. How long before I can return to normal activities after shoulder resurfacing?
A. Return to normal activities varies, but many patients resume daily tasks within a few weeks and more strenuous activities in a few months.

Summary and Takeaway

Shoulder resurfacing offers an excellent bone-preserving option for younger or active patients with arthritis or cartilage damage. It relieves pain, restores motion, and maintains future surgical options by preserving bone stock. Advances in prosthetic design and biologic grafting techniques continue to make this procedure a durable and effective choice for long-term shoulder function.

Clinical Insight & Recent Findings

A recent study evaluated long-term outcomes of cementless, metal-free ceramic-coated shoulder resurfacing in 586 patients treated for arthritis, avascular necrosis, or rotator cuff arthropathy, with an average follow-up of 11 years.

The results showed 94% of patients achieved excellent or good outcomes, and 92% reached an acceptable symptom state, while only 6% required revision. The ceramic surface, made of titanium nitride, provided exceptional durability with minimal wear (0.6 mm glenoid cartilage loss over 10 years) and no cases of metal sensitivity or implant loosening.

Compared to stemmed total replacements, resurfacing preserved bone, maintained joint biomechanics, and allowed easier future revisions—benefits that make it ideal for younger, active patients seeking motion preservation and quicker recovery. (“Study of cementless ceramic shoulder resurfacing – see PubMed.”)

Who Performs This Surgery? (Specialists and Team Involved)

Shoulder resurfacing is performed by orthopedic surgeons specializing in shoulder and joint reconstruction. The surgical team includes anesthesiologists, surgical nurses, and physical therapists who guide preoperative preparation and postoperative recovery.

When to See a Specialist?

If you experience persistent shoulder pain, stiffness, or loss of function despite conservative treatment, or imaging shows advanced cartilage wear, you should consult a shoulder specialist to discuss resurfacing options.

When to Go to the Emergency Room?

Seek emergency care if you develop severe pain, redness, drainage, or fever after surgery, which may indicate infection, or if you experience a sudden inability to move the shoulder.

What Recovery Really Looks Like?

Recovery from shoulder resurfacing involves gradual, steady progress. Pain improves within weeks, motion increases with therapy, and most patients regain normal function within 2–3 months.

What Happens If You Delay Surgery?

Delaying surgery can allow arthritis or cartilage loss to worsen, leading to greater stiffness and pain. Early intervention may help preserve joint mobility and make future treatments easier.

How to Prevent Recurrence or Failure?

Following rehabilitation instructions, avoiding overuse, and maintaining shoulder strength are essential to protect the resurfaced joint. Regular follow-up visits allow monitoring for early signs of implant wear or graft issues.

Nutrition and Bone or Joint Health

A diet rich in calcium, vitamin D, and lean protein supports bone and cartilage health. Avoid smoking and maintain a healthy weight to improve healing and reduce joint stress.

Activity and Lifestyle Modifications

After recovery, patients can return to low-impact activities like swimming, cycling, yoga, and golf. Avoid repetitive heavy lifting or contact sports that could stress the joint. Maintaining an active but balanced lifestyle will help ensure long-term success of the resurfacing procedure.