Reverse Total Shoulder Arthroplasty
A reverse shoulder replacement is a surgery that replaces a damaged shoulder joint with artificial parts, but unlike a standard shoulder replacement, the normal “ball-and-socket” anatomy is reversed. The ball is attached to the shoulder blade, and the socket is attached to the upper arm bone. This unique design allows the large deltoid muscle to lift the arm instead of relying on the rotator cuff tendons, which may be severely torn or no longer working. Reverse shoulder replacement is most commonly used for patients with severe arthritis with severe bony wear or severe shoulder arthritis combined with an irreparable rotator cuff tear, certain complex shoulder fractures, or a failed previous shoulder replacement. The goal of the surgery is to relieve pain, restore shoulder function, and help patients return to everyday activities with improved comfort and movement.
At Midwest Orthopedic and Musculoskeletal Alliance, our surgeons can significantly reduce pain and improve mobility.
Who Is a Candidate for a Reverse Shoulder Replacement?
A reverse shoulder replacement may be recommended if you have one or more of the following conditions:
- A large rotator cuff tear that cannot be repaired. The muscles and tendons that normally lift and rotate the arm are too damaged to function.
- Rotator cuff tear arthritis. Arthritis has developed because of a long-standing rotator cuff tear, causing pain and loss of shoulder function.
- Severe shoulder arthritis with poor shoulder movement. The shoulder joint is worn out and you have significant pain and stiffness.
- A failed previous shoulder replacement. A prior shoulder replacement has become loose, worn out, unstable, or painful.
- A complex shoulder fracture. A severe fracture of the upper arm bone, especially in older adults, that cannot be repaired reliably.
- A fracture that healed incorrectly (malunion) or never healed (nonunion).
- Chronic shoulder instability with severe bone loss. Repeated dislocations have damaged the joint beyond repair.
- Certain shoulder tumors requiring removal of part of the shoulder joint.
- Pseudoparalysis. You cannot lift your arm overhead even though the nerves are working because the rotator cuff no longer functions.
- Persistent shoulder pain and disability that significantly limits daily activities despite medications, injections, physical therapy, or previous surgery.
Who Should Not Have a Reverse Shoulder Replacement?
A reverse shoulder replacement may not be appropriate if you have:
- An active infection anywhere in the shoulder or bloodstream.
- A non-functioning deltoid muscle. Reverse shoulder replacement depends on the deltoid muscle to move the arm.
- Permanent nerve damage affecting the deltoid muscle (such as severe axillary nerve injury).
- Poor overall health that makes surgery or anesthesia too risky.
- Poor bone quality that cannot adequately support the implant.
- Uncontrolled medical conditions such as severe diabetes, heart disease, or lung disease until these are better managed.
- Inability to follow postoperative restrictions or rehabilitation.
- Severe untreated mental health or cognitive disorders that would make recovery unsafe.
- Unrealistic expectations about what surgery can achieve.
How Is a Reverse Shoulder Replacement Performed?
- Anesthesia – You are given general anesthesia so you are asleep during surgery. Most patients also receive a nerve block to provide pain relief for many hours after the procedure.
- Making the Incision – The surgeon makes an incision along the front or top of the shoulder to safely reach the shoulder joint while protecting the surrounding nerves and blood vessels.
- Preparing the Shoulder – The damaged ball of the upper arm bone and the worn socket are carefully exposed. Any remaining damaged cartilage, bone spurs, or inflamed tissue are removed.
- Preparing the Shoulder Blade – The worn socket is reshaped to create a solid surface. A metal baseplate is securely attached to the shoulder blade using screws. In cases of severe deformity of the cup, sometimes a component custom-made for you is utilized to correct this bone loss.
- Attaching the New Ball – A polished metal ball (called a glenosphere) is attached to the baseplate on the shoulder blade. This is why it is called a “reverse” shoulder replacement—the ball is moved to the shoulder blade.
- Preparing the Arm Bone – The upper arm bone (humerus) is prepared to accept the new stem. Depending on your bone quality, the stem may be cemented or press-fit into place.
- Inserting the New Socket – A durable plastic socket is attached to the top of the humeral implant. This socket fits over the metal ball attached to the shoulder blade.
- Testing the New Joint – The surgeon moves the shoulder through its full range of motion to ensure the joint is stable, smooth, and properly tensioned before closing the incision.
- Closing the Incision – The tissues are repaired, the skin is closed with sutures or staples, and a sterile dressing is applied.
- Recovery – Your arm is placed in a sling. Most patients go home the same day or after one night in the hospital. Physical therapy begins soon after surgery to restore motion and strength.
What Makes a Reverse Shoulder Replacement Different?
In a normal shoulder, the ball is on the arm bone and the socket is on the shoulder blade.
In a reverse shoulder replacement, these positions are switched:
- The metal ball is attached to the shoulder blade.
- The plastic socket is attached to the arm bone.
This design allows the deltoid muscle to lift the arm instead of relying on a damaged rotator cuff, making it an excellent option for patients whose rotator cuff can no longer function.
Expected Benefits
Most patients experience:
- Significant pain relief
- Improved ability to lift the arm
- Better ability to perform everyday activities such as dressing, eating, and reaching overhead
- Improved sleep due to reduced shoulder pain
- High patient satisfaction and quality of life
Possible Risks
Although reverse shoulder replacement is highly successful, potential complications include:
- Infection
- Blood clots
- Shoulder dislocation
- Implant loosening over time
- Fracture around the implant
- Nerve or blood vessel injury
- Shoulder stiffness
- Persistent pain
- Need for additional surgery in the future
Long-Term Expectations
Most patients recover well and return to normal daily activities within a few months, although strength and motion continue to improve for up to a year after surgery.
Most patients notice significant pain relief soon after surgery, while strength and motion continue to improve over several months with physical therapy and home exercises. Although the artificial joint is very durable, it is important to follow your surgeon’s recommendations regarding rehabilitation and activity to protect your new shoulder and maximize its lifespan. Many patients are able to return to activities such as golfing, swimming, gardening, and other recreational pursuits once they have fully recovered.
Schedule a Reverse Shoulder Arthroplasty Consultation
If you have a torn rotator cuff or cuff tear arthropathy and want to explore your options, contact Midwest Orthopedic and Musculoskeletal Alliance today at 414-384-6700. Our orthopedic team in Southeastern Wisconsin is here to help.