Rotator cuff tear arthropathy is the end-stage condition where a massive, irreparable rotator cuff tear has led to superior migration of the humeral head and secondary arthritis. Treatment ranges from non-operative management to reverse shoulder replacement.
The primary surgical treatment is reverse total shoulder replacement — a prosthesis designed to function without the rotator cuff. The ball and socket are reversed: a metal ball (glenosphere) is fixed to the glenoid and a plastic socket is placed on the humerus. This allows the deltoid muscle to power the shoulder instead of the deficient rotator cuff. The operation takes one and a half to two hours.
Surgery is recommended for cuff tear arthropathy causing significant pain, weakness, and functional limitation. Reverse shoulder replacement has revolutionised the treatment of this condition, providing reliable pain relief and restoration of overhead function.
Physiotherapy (anterior deltoid rehabilitation programme), corticosteroid injection, activity modification, and pain medication. These can be effective for patients with acceptable function.
X-rays showing superior humeral head migration and glenohumeral arthritis. CT scan to assess glenoid bone stock for implant fixation. Standard pre-assessment.
Reliable pain relief and restoration of overhead reach. Most patients can elevate the arm above shoulder height. Reverse shoulder replacement for cuff tear arthropathy has excellent satisfaction rates exceeding 90%.
External and internal rotation are often limited after reverse replacement.
Erosion of the scapular neck by the humeral component. Seen on X-ray in approximately 50% but rarely clinically significant.
The increased deltoid tension may fracture the acromion. Approximately 3–5%.
Risk approximately 2–5%, higher than anatomic total shoulder replacement.
Prosthetic joint infection approximately 2–3%.
Fracture around the implant.
Long-term concern.
Axillary or brachial plexus stretch from arm lengthening.
General anaesthesia with nerve block. Beach-chair position.
Sling for four to six weeks. Gentle exercises from one week. Active elevation from four to six weeks. Strengthening from eight to twelve weeks. Full recovery six to twelve months. Lifetime activity restrictions — no heavy lifting above shoulder level.
X-rays at six weeks, three months, one year, and then every two years for life.
A standard shoulder replacement requires a functioning rotator cuff to work. In cuff tear arthropathy, the rotator cuff is gone. The reverse design allows the deltoid to power the shoulder instead.
Modern reverse replacements show approximately 90% survival at ten years. Long-term data continues to mature.