Reverse Total Shoulder Replacement

Reverse total shoulder replacement, also known as reverse shoulder arthroplasty, is a procedure that replaces the damaged shoulder joint but reverses the normal ball-and-socket structure. The ball component is attached to the shoulder blade, and the socket is attached to the upper arm bone. This design allows other muscles like the deltoid to move the arm instead of a damaged rotator cuff.

The goal of reverse total shoulder replacement is to relieve pain, restore motion, and improve shoulder stability when a standard shoulder replacement or rotator cuff repair isn’t possible.

Why Would I Have Reverse Total Shoulder Replacement?

Reverse total shoulder replacement is typically recommended for patients who have severe shoulder arthritis combined with irreparable rotator cuff damage or severe glenoid (socket) bony erosion, or for those who have had a failed prior shoulder surgery.

You may be a candidate for reverse total shoulder replacement if you have:

• Rotator cuff tear arthropathy: Arthritis caused by chronic rotator cuff tears
• Severe shoulder arthritis with weakness or instability
• Failed rotator cuff repair or prior shoulder replacement
• Complex shoulder fracture, especially in older patients
• Avascular necrosis: Bone deterioration due to poor blood supply
• Chronic shoulder dislocation or deformity

How Can This Surgery Help Me?

By reversing the normal joint mechanics, reverse total shoulder replacement allows the deltoid muscle to lift and stabilize the arm even when the rotator cuff is no longer functional. The surgery can:

• Eliminate or reduce pain
• Restore shoulder mobility and strength
• Improve function for daily activities such as dressing or reaching overhead
• Enhance overall quality of life and independence

Many patients report being able to sleep comfortably again and return to routine activities without limitation.

What Type of Anesthesia Is Used?

The procedure can typically be performed using regional anesthesia (a nerve block), which numbs the shoulder and arm while you remain in a relaxed, “twilight” sleep, similar to a colonoscopy.

What Are the Risks?

As with any surgical procedure, there are some risks, including:

• Bleeding or infection
• Nerve or blood vessel injury
• Anesthesia complications
• Shoulder stiffness or instability
• Dislocation of the artificial joint
• Fracture around the implant
• Implant loosening or wear over time
• Need for revision surgery

Your surgeon will discuss your specific risk profile and measures to minimize complications.

What Will My Recovery Involve?

Recovery is a gradual process that focuses on protecting the joint and restoring mobility and strength.

• Hospital Stay: Most patients go home the same day or stay 1–2 nights.
• Immobilization: Your arm will be in a sling for 2 weeks to protect the new joint.
• You can remove the sling on post-op day 1 to move elbow, wrist, and fingers.
• Physical Therapy: Formal PT begins 2 weeks post-operatively.
• Strengthening Phase: The deltoid and supporting muscles are gradually strengthened to restore function.

How Long Does Recovery Take?

Recovery after reverse total shoulder replacement typically takes 4-6 months, with continued improvement for up to a year. Most patients resume light activities around 3 months post-surgery and can return to more demanding tasks as strength improves.

What Improvements Can I Expect?

Most patients experience:

• Significant pain relief
• Increased range of motion and shoulder strength
• Better arm function for daily activities
• Improved sleep and comfort

Studies show that over 90% of patients experience long-lasting pain relief and improved shoulder function after undergoing reverse total shoulder replacement.

What Are My Alternative Treatment Options?

Nonsurgical Treatments

• Physical therapy to improve shoulder motion and strength
• Pain medications or anti-inflammatory drugs
• Corticosteroid injections to reduce pain and swelling (you cannot have shoulder replacement if you have had ANY injections within 3 months of the desired surgery date)
• Activity modification

Surgical Treatments (Depending on Diagnosis)

• Anatomic shoulder replacement: For patients with intact rotator cuff tendons

Your surgeon will determine whether a reverse or traditional shoulder replacement is the best fit based on your anatomy and level of rotator cuff function.

What Is the Outlook for Reverse Shoulder Arthroplasty?

RSA has an excellent long-term success rate, especially for patients with rotator cuff deficiency or complex shoulder problems. Most patients regain pain-free use of the arm and enjoy durable results for 15–20 years or more. Sticking to therapy and safe activity modifications can help maintain long-term function.