Pyrocarbon Hemiarthroplasty

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Pyrocarbon Hemiarthroplasty to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of this innovative, bone-preserving procedure is to treat glenohumeral (shoulder) arthritis in young, high-demand patients who wish to avoid the wear risks associated with a traditional total shoulder replacement. Unlike metal implants which can rapidly erode the native socket (glenoid), pyrocarbon is a material with an elastic modulus similar to cortical bone. It is durable and wear-resistant, yet "friendly" to the native cartilage, allowing us to replace only the damaged humeral head while leaving your natural socket intact. This seems particularly promising in younger patients with shoulder arthritis as surgeons must always be thinking about the potential for a shoulder to need another surgery years later. By not violating the glenoid with the plastic component necessary in an anatomic total shoulder arthroplasty, the potential future revision surgery years after a pyrocarbon hemiarthroplasty will not have to deal with large defects left behind from the placement of that plastic, making the surgery technically much easier and more likely to succeed.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

For more information on living with a joint replacement, see the American Academy of Orthopaedic Surgeon's educational page here.

The Procedure

  • The Approach: Performed through a standard deltopectoral incision to expose the ball-and-socket joint while protecting the surrounding muscles.

  • Humeral Resection: The arthritic humeral head is carefully removed. Unlike a total shoulder, the socket is not replaced with plastic but it may be gentle "reamed" to create a smooth, concentric surface that matches the new implant.

  • Pyrocarbon Implant: A pyrocarbon humeral head is press-fit into the humerus. This material is biologically inert and has superior lubrication and hardness properties compared to metal, allowing it to articulate directly against your native glenoid bone without causing significant erosion or pain.

  • Subscapularis Repair: The subscapularis tendon, which is detached to access the joint, is meticulously repaired at the end of the case. Protecting this repair is the primary focus of the early recovery phase.

Post-Op Protocol

  • Start Formal PT: Professional physical therapy begins at Post-Op Week 0 (immediately).

  • Phase 1 (0–4 weeks): Sling: Use as needed during the day for comfort and wear at night. You may remove it for hygiene and to perform elbow, wrist, and hand motion.

    • Motion: Formal therapy focuses on progressive passive (PROM) and active-assisted range of motion (AAROM). Scapular strengthening begins.

    • Restriction: External rotation is strictly limited to 30 degrees to protect the subscapularis repair. No active motion (AROM), pushing, pulling, or weightbearing.

  • Phase 2 (4–6 weeks): Wean from Sling: You will gradually stop using the sling.

    • Motion: Progress to full PROM, AAROM, and begin active range of motion (AROM). Strengthening exercises continue per protocol.

    • Lifting: You may lift light objects weighing 1–2 pounds (e.g., a cup of coffee).

  • Phase 3 (6–8 weeks): Progression: Continue advancing range of motion. Strengthening intensity increases.

    • Lifting: You may lift up to 10 pounds.

  • Phase 4 (8–12 weeks): Full Motion: The goal is to achieve full active range of motion. Strengthening continues.

  • Phase 5 (12+ weeks): Return to Activity: Continued strengthening. A return to labor-intensive work or sports is typically discussed at the 16-week mark.

When to Seek Care

You should schedule a consultation if: