Background As the artificial joint technology and material become matured gradually, the humeral head replacement starts to play an important role in the clinical treatment of severe lesion of shoulder joint, which can effectively relieve pain and recover the passive range of motion of the shoulder joint after operation, but its active motion still depends on the shoulder muscle strength, so the early postoperative rehabilitation training has become the key treatment measures after the humeral head replacement. This paper discusses the effect of early rehabilitation training on the shoulder joint recovery after artificial humeral head replacement.Methods From February 2010 to June 2013, 11 cases of severe shoulder joint lesion received the artificial humeral head replacement operation. Among them, 3 were males, 8 were females; aged 46 to 73 years old, averagely 52.1 years old. The cause of injury: 9 cases of proximal humeral fractures, 1 case of ischemic necrosis of the humeral head and 1 case of giant cell tumor of proximal humerus. With the contralateral shoulder as control, preoperative routine anteroposterior, oblique and axillary plain X-ray of shoulder joint were required, and also the shoulder MRI examination, in order to assess the damage of skeletal and soft tissue.Use the beach chair position under general anesthesia. Then routinely do the skin preparation and draping. We take the deltoid and pectoralis major muscle interval approach, then release the deltoid along the shaft of humerus, and retract the conjoint tendon medially, incise the subscapularis tendon and the anterior capsule, adjust the hypsokinesis angle according to the joint stability, cut off it and measure the diameter of humeral head to determine the size of prosthesis, carefully clean the broken ends of the proximal humerus fracture patients. Install the suitable size of test model after largening the medullary cavity, check the ROM and soft tissue tension after the reduction of the shoulder. Remove the template if it is ideal, pulse flushing the medullary cavity, use the bone cement to stabilize the prosthesis, reset the shoulder joint, use the Ethibond suture to fix the subscapularis and tubercules, carefully repair of the rotator cuff, at last make sure the shoulder joint function is good without impingement. Rinse the wound again and place a plasma drainage, finally close the incision layer by layer. Keep the drainage according to the amount of blood in 24-48 h, protect the limb with a wrist neck sling for 3-6 weeks.The rehabilitation training started the first day after the operation, operated by specialized rehabilitation physicians in different stages. Passive activities are in the main position during the early stage, then gradually transit to the active and strength training. The first stage: do the hand, wrist, elbow flexion and extension training, passive shoulder flexion and lateral external rotation exercise 1 to 2 weeks postoperatively. According to the individual tolerance, gradually increase the amount of activity. The second stage: the shoulder swelling is gone and the pain is relieved, also the surgical suture is removed after 3-6 weeks, patients were instructed to gradually strengthen the shoulder internal rotation, muscle isometric and active anti resistance training in the clinic. The third stage: the tendon has healed and the activity of shoulder joint has improved after 7-12 weeks, mainly do the active muscle strength exercise to increase the range of motion. The fourth stage: 12 weeks later, on the basis of former training, further strengthen the strength resistance training, and selectively focus on some muscle and joint assess the patient′s houlder function before operation and 6 and 12 weeks post operatively. The modified UCLA score is taken in evaluation of pain relief, joint function, range of motion and muscle recovery. In 35 total points: 34-35 is excellent, 29-33 is good; 29 or less is poor.Results 1 patient died of tumor metastasis 6 months after operation, the other 10 cases were followed up for averagely 15.4 months (12-40 months). The incision of all the patients were healed without infection, 2 cases complained the shoulder pain, which was relieved by symptomatic treatment. All the 11 patients got X-ray examinations the first day after operation, before leaving the hospital, after 6 and 12 months. It showed a good position of prosthesis and there was no sign of loosening, joint instability, shoulder impingement, joint stiffness and other complications. The patients were satisfied with their shoulder joint function. After 6 weeks, the active ROM of shoulder improved significantly, compared with it before the surgery, the difference was statistically significant (t=7.32,P<0.05); the shoulder AROM further recovered after 12 weeks, then they can look after themselves, the difference was statistically significant in each direction′s activity, compared with 6 weeks after operation (t=5.56,P<0.05). The difference of shoulder direction was statistically significant, compared with the healthy side (t=2.05,P<0.05). We use a modified UCLA score to evaluate the shoulder function : excellent in 8 cases, good in 2 cases, poor in 0 cases, the average score was 33.6. For the data processing, we use SPASS 17.0 software to deal with the statistics, all the data are expressed by (s)before and after treatment, using one sample t test, P<0.05 means the difference was statistically significant.Conclusions The early rehabilitation training activities is good to maintain the ROM of the reconstructed joint, promote the recovery of muscle strength and improve the function of joint. It plays a key role in the long-term effect of humeral head replacement.