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.
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.
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.
Medications
Be sure to let your surgeon know about any medications you're taking. Some medications need to be stopped before surgery to reduce the risk of complications. You may need to stop pain relievers like aspirin, ibuprofen, naproxen and certain arthritis medications at least two weeks before surgery because they can cause extra bleeding.
If you take blood thinners, your doctor will tell you when to stop them. Some rheumatoid arthritis medications might also need to be paused for a short time.
Home preparation
It helps to make a few simple changes at home before surgery to make your recovery easier. For example, it might be hard to reach high shelves after surgery, so you'll need to move items to low shelves before the procedure.
After surgery, you'll likely need help with daily tasks like dressing, bathing, cooking and laundry for a few weeks. If you don't have someone to assist you at home, a short stay in a rehabilitation facility may be recommended to help you regain your independence.
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.
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Before surgery
Follow your surgeon’s instructions closely for eating, drinking and taking medications on the day of your surgery. Plan to wear loose-fitting clothes and a button-down shirt to the hospital.
Make sure you know exactly where and when to arrive on the day of surgery. When you arrive, you will meet your surgeon and anesthesiologist. You will have general anesthesia, where you are asleep for the procedure, and a nerve block that numbs the nerves in your shoulder. You will have a chance to ask any questions.
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During surgery
Your surgeon will make a cut either at the front or on the side of your shoulder joint. They will remove the damaged parts of your bone and put artificial replacements in place.
A metal ball will be screwed into your shoulder socket. Your surgeon will then insert a tray into your upper arm bone, which is usually secured with a stem and special cement that allows your bone to grow onto it. Then, a plastic cup or liner will be secured above the tray to form the socket part of the joint.
Your surgeon will then close the incision with stitches or staples and bandage it.
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After surgery
After surgery, you will be moved to a recovery room until the anesthesia wears off. The majority of the time, you will go home the same day. In rare cases, you may need to stay in the hospital overnight.
You may feel some pain or numbness after surgery. Your team will provide pain medicine for when you are at home. You will start performing the exercises shown to you prior to surgery to keep your muscles from getting stiff before your first follow-up visit. Your healthcare team will also show you how to care for the wound. Your arm will be in a sling for six weeks while your shoulder heals. You will be able to take the sling on and off as needed, but it is important that you wear the sling when you are sleeping or in crowded areas.
You will need some help for the first few days with everyday tasks, such as washing and dressing. Your care team will teach you exercises to do at home. Follow these instructions, and avoid any extreme arm movements, heavy lifting or strenuous exercise for the first six weeks. You might not be able to drive for up to six weeks, but your provider can give you specific recommendations about when it’s okay to drive.
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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What are the limitations after reverse shoulder replacement?
After a reverse shoulder replacement, you will be limited in what you can do and how much you can lift. Your surgeon will likely recommend:
- Avoiding lifting anything heavier than 1-2 pounds (such as a coffee cup, cell phone or bottle of water) for about 12 weeks
- Do not put your hand or arm behind your back for the first 12 weeks following surgery
- Avoiding tasks that require repeated heavy lifting for the long term
- Using your affected shoulder to push yourself out of bed or a chair
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What happens to rotator cuff muscles after reverse shoulder replacement?
After a reverse shoulder replacement, your deltoid muscles, which cover the top of your shoulder, do most of the work moving the joint. Your rotator cuff muscles are still present and functioning, but now have the assistance of the deltoid muscle. The previously torn rotator cuff tendons are not repaired, and the intact rotator cuff tendons are left alone.
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How long does pain last after reverse shoulder replacement?
You will probably feel some pain and discomfort following your surgery. This is different for everyone and a normal part of the healing process. Your doctor will give you pain medication to take when you leave the hospital. If you are still experiencing pain after a few weeks, talk to your doctor.
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How long is physical therapy after reverse shoulder replacement?
Your physical therapy plan will depend on your individual needs. Typically, physical therapy begins one week after surgery, and may continue for four to six months, depending on your individual needs.
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How long does a reverse shoulder replacement last?
Doctors are still researching long-term outcomes for reverse shoulder replacement. Current research suggests that reverse shoulder replacement may last over 20 years. Recent research demonstrates >95% survivorship at 15-20 years following the procedure, which means no additional surgery is required.
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Is reverse shoulder replacement a major surgery?
Yes, reverse shoulder replacement is a major surgery. During the procedure, the damaged shoulder joint is replaced with artificial parts. It usually takes under an hour, requires general anesthesia and does not require an overnight hospital stay. Recovery can take time, and your doctor will discuss any potential risks with you.
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How long does reverse shoulder replacement surgery take?
Reverse shoulder replacement surgery usually takes less than one hour. However, time before and after the surgery can make the process longer. Every case is unique, and your surgeon will take the time needed to make sure everything is done safely and correctly.