We have used ceramic artificial humeral head since 1984. We report on the cases in which ten years or more have passed since surgery in order to study the effect of ceramic artificial humeral head on rotator cuff. Subjects are 14 cases (6 males, 8 females) that we were able to follow the results for more than ten years among the patients who have PSS artificial humeral ceramic heads of the humerus. They are 14 shoulder joints (12 rights, 2 lefts), the average age at the time of operation was 55 years old (26 ∼ 79), and the average follow-up period is 14 years (10 ∼ 23). We studied physical findings, MRI, and the results of treatments. Regarding physical findings and MRI, 8 are almost normal, 4 have no pain but thinning, 2 show an obvious rupture in supraspinatus tendon, and both are old trauma. The results are mainly satisfactory as to pain score, however, ROM of elevation and external rotation vary form case to case, showing notable limitation of elevation in the case of rotator cuff rupture. There is no case showing clear loosening of stem or fracture around the implant. Oonishi et al. reported that after 23 years, ceramic femoral head shaped just concave while metal shaped both concave and convex. The convex part extremely damages polyethylene in touch. We can presume that ceramic head is more gentle to the rotator cuff as it does not shape convexly. This follow-up study also shows satisfactory results of the effect of ceramic artificial humeral head on rotator cuff.