What’s New in Shoulder Replacements: Pyrocarbon Hemiarthroplasty for Younger Patients

Orthopedic Procedures, Shoulder

Advanced Pyrocarbon Hemiarthroplasty shoulder replacement for younger patients

Written by Thomas F. Burke, MD

When you’re young, active, and facing shoulder pain from arthritis, you want a treatment that helps you keep moving—and lasts for years.

Historically, shoulder replacements in young people have been avoided. Young people are active and often wear out their new shoulder replacements too quickly. But there is hope. One newer option for certain patients is pyrocarbon hemiarthroplasty. But what does that mean, and how does it compare to other shoulder surgeries?

What Is Pyrocarbon Hemiarthroplasty?

Pyrocarbon hemiarthroplasty is a type of shoulder surgery where just the “ball” part of your shoulder joint (the humeral head) is replaced with a special implant made of pyrocarbon—a smooth, durable material. Pyrocarbon is not metal.

Instead, it a super polished ceramic-like material. In this procedure, the “socket” part of your shoulder stays natural and is preserved. This approach can be great for people who are younger or have active lifestyles because it preserves more of your natural bone and joint. If this were your knee, think partial knee replacement.

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Pyrocarbon Shoulder Replacement at Boston Orthopaedic & Spine

Why Pyrocarbon?

Pyrocarbon Feels More Like Bone

Pyrocarbon is closer to natural bone in how stiff or “hard” it is. That means it moves more naturally and is less likely to damage the socket. For the engineers out there, pyrocarbon has a modulus of elasticity that is similar to bone.

Less Pain, Less Erosion

Studies show pyrocarbon implants cause less wear and tear on the shoulder socket, leading to less pain and a lower chance you’ll need another surgery down the road. With less bone erosion on the socket side, that means that more bone is preserved in case you need a revision replacement in the future.

Helps Preserve the Joint

Pyrocarbon allows the body to create a “neo-membrane” over the implant, which acts a little like cartilage and helps keep the joint healthy for longer.

Delays Bigger Surgeries

By using pyrocarbon, you might be able to put off (or even avoid) a total shoulder replacement, which is a bigger surgery that replaces both the ball and the socket.

Saves Bone For Future Surgery

By preserving the joint, more bone is preserved and the implant within the humerus can often be converted to a reverse total shoulder replacement if needed.

How Does Pyrocarbon Hemiarthroplasty Compare to Other Surgeries?

In the past, a metal hemiarthroplasty (replacing just the ball with standard cobalt-chrome metal implants) often led to problems because the metal implant would wear down the socket, causing pain. The metal, cobalt chrome, was too stiff and incredibly hard, and would erode the bone of the socket.

Pyrocarbon is “softer.”  It’s similar in hardness to bone. It wears much less on the socket, which is a big improvement. It’s also self-lubricating (so it slides smoothly) and resists infections better than some other materials. The highly polished material makes it difficult for bacteria to adhere to the surface—unlike standard cobalt chrome.

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What Do the Studies Say?

Survivorship (How Long the Implant Lasts)

Pyrocarbon hemiarthroplasty has a high success rate, with studies showing up to 94% of implants still working well after 5 years and 89% after 10 years. In comparison, the best total shoulder replacements (TSAs) have a similar 10-year survival rate (about 91-92%) for young patients.[1-3]

Revision Rates (Needing Another Surgery)

Pyrocarbon hemiarthroplasty has lower revision rates than older metal implants. For example, after 6 years, about 9% of pyrocarbon implants needed revision, compared to 17% for metal ones.[3-4]

Complications

With pyrocarbon, socket (glenoid) erosion is less common than with metal implants. Moderate erosion happens in about 24% of cases, and severe erosion in about 8%, but very few patients need another surgery just for that reason. With standard total shoulder replacements, the most common problem is the plastic socket becoming loose over time, which is the main reason for revisions.[3,10]

Who Is Pyrocarbon Hemiarthroplasty Best For?

This procedure is most helpful for young, active patients (usually under 65) with shoulder arthritis, especially if the shape of their socket is still good or can be corrected during surgery. Patients that want to play sports or have jobs that put a lot of demands on their shoulder do best.

Making the Choice: What Should You Consider?

Shoulder replacement surgery is a big decision. It’s important to talk with your surgeon about your options, including pyrocarbon hemiarthroplasty and total shoulder arthroplasty. Things to consider include:

  • Your age and activity level
  • Have you tried some conservative management?
  • Your goals—pain relief, range of motion, returning to sports or work
  • How long you want your implant to last before possibly needing another surgery
  • Is your rotator cuff intact? This is an absolute requirement for a pyrocarbon shoulder replacement.

No single treatment is best for everyone. For some, a pyrocarbon hemiarthroplasty is a great option to preserve more bone and keep future treatment options open, especially for younger, active people.

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Shoulder Replacement in Boston, Waltham, and Cambridge

At Boston Orthopaedic & Spine, we believe in a collaborative approach to patient care. We partner with you, your care team, primary care physician, and physical therapy team to ensure you are taken care of in the weeks leading up to and following your surgery. With this support, patients can take on their recovery with confidence and peace of mind.

Pyrocarbon hemiarthroplasty is a promising, bone-preserving shoulder surgery for younger, active patients. It offers good pain relief, durability, and a high rate of return to work and sports, with fewer socket problems than older implants.  Always make the decision together with your orthopedic surgeon.

Boston Orthopaedic & Spine proudly serves the Boston, Cambridge, and Waltham communities. Patients in the greater Boston area considering a shoulder replacement can schedule a consultation at Boston Orthopaedic & Spine offices in Waltham and Cambridge.

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Appendix: Key Studies and References

  1. McBride AP, Ross M, Hoy G, et al. Mid-Term Outcomes of Pyrolytic Carbon Humeral Resurfacing Hemiarthroplasty Compared With Metal Humeral Resurfacing and Metal Stemmed Hemiarthroplasty for Osteoarthritis in Young Patients: Analysis From the Australian Orthopaedic Association National Joint Replacement Registry. Journal of Shoulder and Elbow Surgery, 2022.
  2. Boileau P, Cointat C, Raynier JL, Schippers P, Ranieri R. Pyrocarbon Hemiarthroplasty for the Treatment of Shoulder Osteoarthritis in Young, Active Patients: Survival and Risk Factors for Revision. Journal of Shoulder and Elbow Surgery, 2025.
  3. Garret J, Cuinet T, Ducharne L, Godenèche A. Pyrocarbon Humeral Heads for Hemishoulder Arthroplasty Grant Satisfactory Clinical Scores With Minimal Glenoid Erosion at 5-9 Years of Follow-Up. Journal of Shoulder and Elbow Surgery, 2024.
  4. Gao R, Viswanath A, Frampton CM, Poon PC. Short-Term Outcomes Following 159 Stemmed Pyrolytic Carbon Shoulder Hemiarthroplasties and How They Compare With Conventional Hemiarthroplasties and Total Shoulder Arthroplasties in Patients Younger Than 60 Years With Osteoarthritis: Results From the New Zealand National Joint Registry. Journal of Shoulder and Elbow Surgery, 2023.
  5. McBride A, Hurley R, Gill D, et al. Outcomes of Pyrolytic Carbon Humeral Resurfacing Hemiarthroplasty Compared to Best in Class Total Shoulder Arthroplasty in Young Patients With Osteoarthritis: Analysis From the Australian Orthopaedic Association National Joint Replacement Registry. Journal of Shoulder and Elbow Surgery, 2025.
  6. Jomaa M, Ingoe H, Hollman F, et al. Stemless Anatomic and Reverse Shoulder Arthroplasty in Patients Under 55 Years of Age With Primary Glenohumeral Osteoarthritis: An Analysis of the Australian Orthopedic Association National Joint Replacement Registry at 5 Years. Journal of Shoulder and Elbow Surgery, 2025.
  7. Colasanti CA, Lin CC, Simovitch RW, Virk MS, Zuckerman JD. International Consensus Statement on the Management of Glenohumeral Arthritis in Patients ≤50 Years Old. Journal of Shoulder and Elbow Surgery, 2023.
  8. Park CN, Zhang GX, Chang J, et al. Pyrocarbon Hemiarthroplasty of the Shoulder: A Systematic Review and Meta-Analysis of Clinical Results. Journal of Shoulder and Elbow Surgery, 2023.
  9. Sayegh ET, Mascarenhas R, Chalmers PN, et al. Surgical Treatment Options for Glenohumeral Arthritis in Young Patients: A Systematic Review and Meta-Analysis. Arthroscopy, 2015.
  10. Bartelt R, Sperling JW, Schleck CD, Cofield RH. Shoulder Arthroplasty in Patients Aged Fifty-Five Years or Younger With Osteoarthritis. Journal of Shoulder and Elbow Surgery, 2010.
  11. Roberson TA, Bentley JC, Griscom JT, et al. Outcomes of Total Shoulder Arthroplasty in Patients Younger Than 65 Years: A Systematic Review. Journal of Shoulder and Elbow Surgery, 2017.
  12. Khoriati AA, McBride AP, Ross M, et al. Survivorship of Shoulder Arthroplasty in Young Patients With Osteoarthritis: An Analysis of the Australian Orthopaedic Association National Joint Replacement Registry. Journal of Shoulder and Elbow Surgery, 2023.