A reverse total shoulder replacement is a specialised form of shoulder arthroplasty where the ball and socket components are placed in the opposite positions to a conventional replacement. This allows the deltoid muscle to power arm movement when the rotator cuff is irreparably damaged.
An incision is made over the front or side of the shoulder. A metal ball (glenosphere) is fixed to the shoulder blade socket, and a plastic cup-shaped component is placed on the top of the arm bone. This reversed configuration allows the deltoid muscle rather than the rotator cuff to lift and rotate the arm. The operation takes approximately one and a half to two hours.
This procedure is recommended for patients with shoulder arthritis combined with a large, irreparable rotator cuff tear (cuff tear arthropathy), or for certain complex fractures in older patients where the rotator cuff is unlikely to function. It may also be used for failed previous shoulder surgery.
Pain medication, gentle physiotherapy, activity modification, and injections may manage symptoms. However, when the combination of arthritis and rotator cuff deficiency causes severe pain and loss of function, surgery is often the most effective option.
Pre-operative assessment includes blood tests, cardiac screening, and medication review. You should plan for wearing a sling and being one-handed for several weeks. Arrange for help at home during the initial recovery period.
The reverse replacement is particularly effective at relieving pain and restoring the ability to lift the arm overhead — something that is often impossible with a deficient rotator cuff. Most patients experience excellent pain relief and improved function for activities of daily living.
Internal and external rotation may be more limited than with a conventional replacement.
Wear of the bone on the shoulder blade beneath the implant. Usually does not cause symptoms.
Expected around the shoulder and upper arm in the early weeks.
Slightly higher risk than conventional replacement. Occurs in approximately 2–5% of patients. Precautions help reduce this risk.
Deep infection in 1–2% of cases. May require revision surgery and prolonged antibiotics.
Stretching of nerves during surgery. Usually temporary.
Fracture around the implant, particularly of the acromion.
May occur over time, potentially requiring revision.
Performed under general anaesthesia, usually with a nerve block for post-operative pain relief. Your anaesthetist will explain the specific risks and benefits.
A sling is worn for four to six weeks. Gentle exercises begin early with guidance from a physiotherapist. Active movement starts gradually from six weeks. Driving resumes at around six to eight weeks. Most patients notice significant functional improvement by three to six months. Full recovery may take up to a year.
Wound review at two weeks, then follow-up at six weeks, three months, and one year. Long-term surveillance may include periodic X-rays to monitor the implant.
A conventional replacement relies on the rotator cuff to power the shoulder. If the rotator cuff is irreparably damaged, a reverse replacement uses the deltoid muscle instead.
Most patients can lift their arm well above shoulder height after a reverse replacement, which is one of its main advantages.
Current evidence suggests longevity similar to conventional replacements — typically 15–20 years, though long-term data is still accumulating.