Shoulder Surgery

Custom-Made Shoulder Replacement

Personalised implant manufacturing for complex shoulder reconstruction

A Custom shoulder replacement is a highly specialised technique used in selected cases where the anatomy of the shoulder is significantly altered. This approach involves detailed 3D computer planning to design and manufacture a completely personalised implant tailored to your individual bone structure.

The implant is 3D printed in titanium and shaped to fit your shoulder precisely. It is typically considered when there is severe bone loss or distortion, such that standard implants, even when combined with bone grafting, may not provide a stable or reliable reconstruction.

Custom shoulder replacement is considered a high-technology solution for complex shoulder problems, most commonly in revision surgery or cases with significant deformity. It requires detailed planning, collaboration with specialist engineers and careful surgical execution.

On this page, you will learn when custom shoulder replacement may be considered, how your implant is designed, and what to expect throughout the process.

When a custom shoulder may be considered

Custom shoulder replacement may be considered in selected patients where the normal anatomy of the shoulder has been significantly altered, and standard implants are unlikely to provide a stable or reliable reconstruction.

This approach is typically reserved for complex cases, including:

In these situations, conventional shoulder replacement implants, even when combined with bone grafting, may not fit securely or restore joint function effectively. Custom-made implants are designed to match your individual bone structure, helping to fill areas of bone loss and provide a stable foundation for shoulder reconstruction, most commonly in conjunction with reverse shoulder replacement.

If a bone defect or deformity can be corrected with a bone graft, it is Dr. Dallalana’s preference to do so in the first instance. Bone grafting in revision settings however is limited due to the size of the graft available from the hip or other parts of the body. Use of donated (allograft) bone is an option but not reliable when massive defects need to be filled, and as such is used only in a restricted number of scenarios.

This technique is not required for most patients undergoing shoulder replacement. It is considered where the complexity of the shoulder anatomy means that a more tailored approach may be beneficial.

How your shoulder is assessed and planned for custom replacement using personalised techniques

Clinical Examination

Your shoulder is first assessed through a detailed clinical examination. This includes evaluating:

Range of motion
Strength of the surrounding muscles
Joint stability and movement patterns

Advanced imaging and 3D planning

More detailed imaging is required to guide personalised planning and manufacture of the custom component
This may include:

X-rays to assess joint alignment and overall structure
CT scans to provide a detailed three-dimensional view of bone shape, defects, and deformity
MRI scans in some cases to assess soft tissues such as the rotator cuff

CT-based imaging is mandatory as it allows the creation of a 3D model of your shoulder in the planning software.

This allows Dr Dallalana to assess your shoulder anatomy in detail, including:

Areas of bone loss
The nature of any existing prosthetic components
Bone density and fixation options
Overall joint alignment

Custom implant design and engineering collaboration

Where a custom implant is required, 3D planning software is used to design a component tailored to your anatomy. Dr Dallalana works with specialised engineers to develop the implant design.

This process involves:

Analysing your individual anatomy in detail
Designing an implant to fill bone defects and restore joint structure
Planning how the implant will be positioned and fixed during surgery

This collaborative process helps ensure the implant design reflects the specific challenges of your shoulder. The final implant is then manufactured using 3D printed titanium with pre-drilled holes for fixation screws and featuring a fine lattice-work roughened finish onto which a patient’s bone adheres.

Surgical Process

The implantation surgery moves along the same lines as for a reverse shoulder replacement. After exposing the shoulder, preparation of the bone (and removal of existing implants if needed) the custom prosthesis is implanted onto the glenoid bone and secured. The same design software is used to create personalised 3D-printed single-use instruments to perfectly guide the insertion of the custom component.

A ball (glenosphere) is then connected to the new custom implant to complete one side of the reverse replacement. A prosthetic stem and socket are placed onto the humerus in a standard way to complete the replacement. Surgical time is most often longer than standard cases, particularly if it is in the context of a revision procedure. The same potential complications of surgery exist as for reverse replacement

What to expect before surgery

Imaging and planning phase

Following your initial assessment, detailed imaging is arranged including a CT scan required for the design software to create the fully customised implant. This can take between 2 and 4 weeks to finalise.

Implant design and manufacturing

Once the design is finalised, the implant is manufactured using 3D printing technology in titanium.

This process takes time to ensure accuracy and quality. There is typically a lead time of approximately 8 to 10 weeks to allow for production, sterilisation and shipping of the implant before surgery can be scheduled.

Pre-operative preparation

During this period, you may also be guided through standard pre-operative preparation, which may include:

Medical assessment and optimisation of your general health
Review of medications
Planning for your recovery and support at home

This ensures you are well prepared for surgery once the implant is ready.

Cost consideration

In some cases, custom-made implants may involve additional costs, depending on your health fund cover and individual circumstances.

These details are discussed with you in advance so you can make an informed decision. Australian private health funds are not obliged to pay fully for custom implants, and specific requests are made by Dr. Dallalana’s office to outline the specific individual circumstances requiring use of the custom solution.

Planning your surgery

Once the implant has been manufactured and all planning is complete, your surgery is scheduled. Pre-operative medical assessment is routinely arranged to ensure safety of the anaesthetic. No specific exercises or prehabilitation is needed.

Particular considerations and benefits of Custom Shoulder Replacement

Personalised planning techniques are used to support accuracy during shoulder replacement surgery, particularly where the anatomy is more complex. By understanding your shoulder structure in detail before surgery, this approach helps guide implant positioning and surgical decision-making.

1 Important considerations

Custom shoulder replacement is typically reserved for more complex cases and is not required for most patients undergoing shoulder replacement.

Once healed to bone it serves to function as any standard reverse replacement with a high expectation of pain relief and durability. Range of movement and strength are generally more limited than standard cases due to muscle weakness, scarring and other factors related to complex situations or repeat surgery.

The shoulder in most cases may be used for simple tasks right away after the surgery, as with a standard reverse replacement.

Points to consider include:

It involves a high level of surgical planning and expertise
It is most commonly used in revision surgery or severe deformity
There is a longer lead time due to implant design and manufacturing
It may involve additional costs, depending on individual circumstances

2 A tailored approach to complex problems

Custom-made implants are designed to address challenges where standard techniques may not be suitable. This approach allows reconstruction to be tailored to your individual anatomy.

In many patients it may represent the only viable way to control pain and achieve a functioning shoulder.

Dr. Dallalana has a specific interest in complex and revision shoulder replacement and has a high level of experience with custom replacement surgery.

Recovery and Rehabilitation

Following surgery, your recovery and rehabilitation pathway is similar to reverse shoulder replacement, with small changes advised individually based on the nature of the custom reconstruction performed.

Length of hospitalisation is similar to that of reverse or revision replacement, 2 days on average.

If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.