Offered a partial (hemiarthroplasty) after I broke the top of my arm. Is a partial worse than a full replacement?

Bit of a different route into this than most of you. I did not spend years with arthritis, I came off a step ladder pruning an apple tree back in September and shattered the top of my arm bone, the ball end of it, in three or four pieces apparently. So this all happened in about a fortnight rather than over years.

The fracture surgeon has said the break is too smashed to just pin back together and he is leaning towards a partial replacement, a hemiarthroplasty, where they put in a new metal ball but leave my own socket alone. My daughter went straight on the internet and came back worried, saying a partial is only "half a job" and why am I not getting the full total or the reverse that everyone else on here seems to have.

So my honest questions. Why a partial for a fracture when arthritis people get the full thing? Is it genuinely a lesser operation or is it just the right tool for a broken ball? And if it does not go well down the line, am I stuck, or can they upgrade it to a proper one later? I'm 71 and reasonably fit if that changes anything.

Can't speak to fractures myself, mine was pure worn out arthritis and I could barely sleep for two years before they replaced it, so a very different starting point to yours. But I'd gently push back on the "half a job" line from your daughter. My understanding from all the reading I did is that they only replace what's actually broken. Your socket is fine, so why carve out a healthy socket? That's not them cutting a corner, that's them not damaging a good part.

What sleptsittingup said. The bit I'd want answered in your shoes is the "can they change it later" question, because that's the one that would keep me up. Wait for the moderator, they usually give the straight version on this stuff.

Taking your three questions head on, because they are good ones and the "half a job" worry deserves a proper answer.

A hemiarthroplasty replaces only the ball, the humeral head, and leaves your own socket in place. It is used mainly for two situations: some fractures of the top of the humerus where the ball is broken but the socket is intact and preserved, and younger patients or shoulders where the socket is genuinely healthy and worth keeping. That is exactly your position after a fall, so it is not a lesser version handed out to save effort, it is the operation matched to a broken ball and a sound socket. Replacing a healthy socket would mean cutting away good bone for no gain. Our page on a shoulder hemiarthroplasty sets out where it fits and, just as honestly, its limits.

Two things worth knowing so nothing surprises you. First, for many older patients with this type of shattered fracture, a lot of surgeons now favour a reverse replacement over a hemiarthroplasty, because the reverse does not depend on the fractured pieces and tendons healing back in the right place, and the movement afterwards is often more reliable. So do ask your surgeon why hemiarthroplasty rather than reverse for your particular break, it is a fair and useful question. Second, on your "am I stuck" worry: a hemiarthroplasty can in principle be revised to another type of replacement later if it wears the socket or the result fades, though revision is a bigger undertaking than a first operation and not something to bank on lightly. The idea that a partial is simply the weaker cousin of the others is one we tackle directly in the myths and facts piece. Which type your smashed shoulder actually needs is a judgement for the surgeon holding your scans and looking at exactly how those pieces have broken, so put the reverse question to him and let his answer, not ours, decide it.

The reverse point above is the one I'd chase up. My neighbour broke her shoulder much like yours and was offered a hemi first, asked the "why not a reverse" question, and after a proper look at her scans they actually switched her to a reverse because of how her tendons had torn. Might not apply to you at all, every break is different, but it cost her nothing to ask and it changed her operation.

Thanks all, and yes I asked the reverse question straight out at my next appointment, felt a bit cheeky doing it but he was pleased I had. For my break, the way the socket and the tendons sit, he still reckons the hemiarthroplasty is the better fit and talked me through why, which I'd never have known to ask without this thread. Booked for later this month. One arm out of action and a garden going to seed, but at least I understand what they're doing now.