In recent years, shoulder arthroplasty options for athletes and younger patients have expanded to include traditional anatomical, reverse, as well as stemless bone-preserving implants. New pyrocarbon implants, FDA approved in 2023, further extend hemiarthroplasty to younger, athletic patients, and Duke research is advancing shoulder treatment using machine learning (ML) to enhance patient-specific shoulder arthroplasty treatment.

Early referral is vital for managing shoulder conditions. “If a patient has shoulder pain or dysfunction, it can be a quick transition from the first X-ray to the point where they’d benefit substantially from a shoulder replacement,” says Duke Health sports medicine orthopaedic surgeon Jay M. Levin, MD, MBA.

“If we’re able to get these patients in earlier, it potentially allows us to keep options open that wouldn’t normally be available,” agrees sports medicine orthopaedic surgeon Jonathan F. Dickens, MD. When surgery is necessary, patients benefit from the cutting-edge research and experience of the Duke shoulder team, which performs thousands of shoulder surgeries every year.

The appropriate shoulder replacement approach can be key to a successful outcome. “With standard shoulder arthritis, anatomical replacement performs better for sports that require a large range of motion,” Levin explains. For large or irreparable rotator cuff tears, complex proximal humerus fractures, and revision surgery, reverse replacements better stabilize the shoulder and provide excellent long-term function.

For patients who have good rotator cuff musculature and sufficient bone stock, hemiarthroplasty is an option which replaces only the humeral side of the joint. Tested worldwide for a decade, new pyrocarbon implants are lighter than traditional titanium, with a surface more like natural bone. “Hemiarthroplasties with pyrocarbon implants have shown promising results because they can help preserve remaining cartilage on the socket side of the joint and allow for higher-impact activity without concern of implant wear or loosening,” Levin says.

Sports medicine orthopaedic surgeon Tally E. Lassiter Jr., MD, MHA, agrees: “Recent studies in the Australian database have shown hemiarthroplasties with pyrocarbon implants to last longer than conventional total shoulder arthroplasty. They’re often the treatment of choice in young people and people who may continue heavy lifting activities.”

Duke Orthopaedics research is using ML to improve shoulder procedures. “We’ve been at the forefront in utilizing Duke’s resources in machine learning, artificial intelligence, and other modalities to improve outcomes, including examining mechanics after shoulder replacement,” says Dickens.

At the American Shoulder and Elbow Surgeons annual meeting in October 2025, Levin co-presented findings using ML to analyze data from over 6,000 patients to predict and help prevent scapula fractures following reverse arthroplasties, which affect 4% of patients. “We’re scratching the surface of quantitative imaging and analysis,” Levin says. “In the future, we’ll better understand how to predict the perfect positioning of implants and then we can use robotics to execute those surgeries with precision.”