Reverse Shoulder Arthroplasty

Who is a candidate?
Reverse shoulder arthroplasty is designed for people who have severe shoulder arthritis combined with a rotator cuff tear that cannot be repaired. It may also be recommended for patients with complex shoulder fractures, failed prior shoulder replacements, or certain conditions that weaken the rotator cuff. In these situations, the shoulder’s normal mechanics no longer work, and a reverse replacement can restore function by using different muscles to power the arm.

What does the surgery involve?
In this procedure, the normal ball-and-socket structure of the shoulder is “reversed.” The surgeon places a ball where the socket used to be (on the shoulder blade) and a socket where the ball used to be (on the arm bone). This design allows the deltoid muscle—the large muscle on the outside of the shoulder—to lift the arm, even when the rotator cuff is no longer functioning.

How is it different from anatomic shoulder replacement?
Anatomic shoulder replacement recreates the joint in its natural orientation and relies on a healthy rotator cuff to work properly. Reverse replacement, on the other hand, is specifically built to work without the rotator cuff. By changing the mechanics of the joint, the reverse design gives the deltoid muscle more leverage, making it possible to raise the arm even when the rotator cuff is torn or absent.

What are some of the long-term downsides?
While reverse shoulder arthroplasty can provide excellent pain relief and improve function, it has its own risks. Over time, stress on the shoulder blade can sometimes lead to small fractures (especially at the acromion, the bony roof of the shoulder). The artificial joint may also wear or loosen after many years, and there can be limits in range of motion compared with an anatomic replacement. Younger, highly active patients may outlive their implant and require revision surgery in the future.

What is recovery like?
Recovery is similar to that of an anatomic replacement but may take slightly longer. The arm is supported in a sling for several weeks after surgery. Physical therapy starts soon after to restore movement, followed by gradual strengthening. Most patients are able to perform daily activities by 6–12 weeks, with continued improvement over 4–6 months. While it may not restore the shoulder to “normal,” the goal is dependable pain relief and the ability to use the arm for everyday activities that were previously too painful or impossible.