What is a reverse shoulder replacement?

A reverse total shoulder replacement is a surgery for severe shoulder problems, and can be used when other treatments haven’t worked. The surgery removes the damaged parts of the shoulder joint and replaces them with a special artificial joint.

The goal of this surgery is to improve shoulder function and quality of life. It is often recommended for conditions like large rotator cuff tears or rotator cuff arthritis, which affect the shoulder muscles. In these conditions, the rotator cuff muscles can’t function properly. Instead of using these muscles, the reverse shoulder replacement relies on the deltoid muscle (on top of your shoulder) to move and position your arm. This helps restore movement and reduce pain, making it easier to lift and move your arm—even when the rotator cuff is no longer working.

healthy shoulder vs arthritic shoulder

What is the difference between reverse shoulder replacement and standard shoulder replacement?

With standard, or anatomic, shoulder replacement surgery, a metal ball repla ces the round ball of your arm bone, and a plastic socket replaces your shoulder socket. But in a reverse shoulder replacement, the positions of the ball and socket are reversed. The surgeon places a plastic cup attached to a stem on the top of your arm bone. In the socket part of your shoulder, the surgeon places a stem with screws going into your shoulder blade.

Reversing the parts allows different muscles to move your shoulder joint. Your deltoid muscles, which form the rounded curve of your shoulder, will move your shoulders once you have recovered, instead of your rotator cuff muscles.

standard vs reverse shoulder replacement

Who is a good candidate for reverse shoulder replacement?

A reverse shoulder replacement is usually recommended for people with shoulder arthritis, a severely torn or damaged rotator cuff, or those who have had a previously unsuccessfully shoulder replacement. This surgery can help reduce pain and improve movement in the shoulder.

Your doctor may suggest a reverse shoulder replacement if you have:

  • A rotator cuff that is completely torn and can’t be repaired
  • Rotator cuff tear arthritis (arthropathy)
  • A previous rotator cuff repair that was unsuccessful
  • Severe shoulder arthritis
  • A previous shoulder replacement that didn’t work
  • A complex shoulder fracture
  • Chronic shoulder dislocations
  • A tumor in the shoulder joint

Your doctor may also recommend this surgery if nonsurgical treatments, like rest, medications, cortisone injections or physical therapy, haven’t helped relieve your pain.

How to prepare for a reverse shoulder replacement surgery

Your orthopedic surgeon will help you get ready for your shoulder surgery with a few important steps.

Medical evaluation

Before your surgery, you'll need a physical exam by your primary care doctor to make sure you're healthy enough for the procedure and recovery. If you have ongoing health issues, like heart disease, you may also need to see a specialist, such as a cardiologist.

The reverse shoulder replacement surgery

Your surgery will take place in the hospital and will take about two hours. It may last longer if you have had a previous shoulder replacement. Your surgeon will review the steps involved in the surgery with you before you arrive, so you know what to expect.

What are the risks of reverse shoulder replacement?

All surgeries carry some risks. Reverse shoulder replacement is complex, and some people experience complications. Your surgeon will discuss the benefits and risks of surgery with you beforehand.

The risks of reverse shoulder replacement are similar to other joint replacement surgeries and include loosening of the implant over time and wear and tear on your joint components.

Other potential complications of shoulder replacement surgery include:

  • Infection
  • Dislocation of the artificial joint
  • Stress fracture
  • Damage to the surrounding nerves
  • Blood clots
  • Complications from anesthesia

Reverse shoulder replacement recovery

Recovery from reverse shoulder replacement can vary depending on factors like your age, overall health, the extent of shoulder damage, number of previous shoulder surgeries and how committed you are to your rehab. Shoulder replacement surgery requires rehabilitation to help restore strength and movement.

Recovery timeline:

  • 1–6 weeks: In the first few weeks, the focus will be on managing pain, healing and gently moving your shoulder. Physical therapy will begin to help improve your range of motion.
  • 6 weeks–3 months: You'll continue physical therapy to build strength, stability and mobility. You can gradually start using your arm for daily activities with some limitations.
  • 3–6 months: Many people see a big improvement in shoulder function by this point. Physical therapy will focus on strengthening muscles and improving coordination for more complex movements.
  • 6–12 months: By six months to a year, most people can do everyday tasks with improved shoulder function, though recovery may continue beyond a year as you gain more strength and movement.
  • 24 months: At two years, most people will achieve optimal improvement from their shoulder surgery.

Recovery times can differ from person to person, and sticking to your rehab plan is key to getting the best results. It's important to avoid heavy lifting, high-impact activities, and any movements that put too much strain on your shoulder during your recovery. Be sure to follow your healthcare team's advice to reduce the risk of complications and support your recovery.

Frequently asked questions

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