Reverse Shoulder Replacement

What is a Reverse Shoulder Replacement?

A reverse shoulder replacement is a type of shoulder replacement in which the normal ball-and-socket anatomy is intentionally reversed, usually done in patients who do not have a functioning rotator cuff tendon.  A metal ball is attached to the shoulder socket, and a socket-shaped component is placed on the upper arm bone called the humerus. 

In a traditional shoulder replacement, the rotator cuff muscles are important for moving and stabilizing the new joint. When the rotator cuff is severely damaged or no longer functional, a conventional replacement may not work well. 

The reverse design changes the shoulder’s mechanics so that the deltoid muscle can do more of the work of raising the arm, even when the rotator cuff isn’t functioning normally. 

When Should Reverse Shoulder Replacement Be Considered?

Potential candidates for reverse shoulder replacement in general surgery often suffer from:

• Massive, irreparable rotator cuff tears, particularly when accompanied by shoulder arthritis 

• Rotator cuff tear arthropathy, where longstanding rotator cuff damage has contributed to joint deterioration 

• Severe shoulder arthritis in certain patients 

• Some complex fractures of the upper humerus 

• Certain situations involving chronic shoulder instability or significant bone loss 

If non-surgical treatments, like physical therapy, anti-inflammatory medicines and cortisone injections have not relieved this pain or immediate and long-lasting relief is sought, Fox Valley Orthopedics may recommend surgery.

While a conventional shoulder replacement works for most patients, there are some cases that benefit from a reverse shoulder replacement. Some particular factors that may indicate a reverse shoulder replacement include:

• Large or complete rotator cuff tears
• Previously unsuccessful shoulder replacement
• Severe shoulder pain that prevents raising the arm away from the side

How Well Does Reverse Shoulder Replacement Work?

Reverse shoulder replacement is generally a reliable procedure with a high success rate, especially when the goal is to reduce pain and restore everyday function. When mid to long range studies were conducted, approximately 88% of patients rated their result good or very good, and no revisions had been required in the previous decade since their surgery.  

Pain relief is usually the big win. The American Academy of Orthopaedic Surgeons describes pain relief as excellent and patient satisfaction as typically very high. Many patients can ultimately raise the arm above shoulder height and perform activities such as reaching their head or into a cupboard, which were either impossible or extremely painful before surgery. 

What Can I Expect After Reverse Shoulder Replacement?

Before your reverse shoulder replacement, your Fox Valley Orthopedics care team will provide instructions to help you prepare for surgery. Depending on your health history, you may need a pre-surgical physical, medical testing, or clearance from another physician. On the day of surgery, you will meet with your orthopedic surgeon and anesthesia team to review the procedure and answer any last-minute questions.  

Reverse shoulder replacement is typically performed under general anesthesia, often combined with a regional nerve block to help manage pain after surgery. Depending on your individual needs, this surgery can be done at a surgery center where you may go home the same day or at times this can be done at a hospital with a stay in the hospital overnight. 

During the first few days after surgery, you may need help with everyday activities such as dressing, bathing, preparing meals, household tasks, and transportation. Your arm will typically be supported in a sling while the shoulder begins to heal. Your surgeon will provide specific instructions about how long to wear the sling, when you can begin using your arm, and when it is safe to return to activities such as driving and work. 

Most patients are able to begin gentle movement relatively early, but the repaired tissues need time to heal. A sling is commonly used initially, followed by progressively increasing motion and strengthening. 

Recovery occurs in stages rather than overnight. Many people notice substantial improvement during the first 3–6 months, with strength and function sometimes continuing to improve for a year or longer. 

Physical therapy and prescribed home exercises are important parts of recovery after reverse shoulder replacement. Your rehabilitation program will gradually focus on restoring shoulder movement, strength, and function while protecting the new joint as it heals. Because every patient is different, your Fox Valley Orthopedics surgeon and therapy team will develop a personalized recovery plan based on your procedure, overall health, and individual goals. 

Following your surgeon’s post-operative instructions and physical therapy program will help support the best possible recovery. 

What Are the Risks Associated with Reverse Shoulder Replacement?

Reverse shoulder replacement is a safe and effective treatment for many patients with severe shoulder arthritis, rotator cuff damage, or other complex shoulder conditions. As with any joint surgery, there are potential risks and complications. These may include infection, bleeding, blood clots, nerve or blood vessel injury, fracture, joint instability or dislocation, and loosening or wear of the shoulder replacement components over time.  

While serious complications are uncommon, your surgeon will discuss your individual risks and take steps to help ensure a safe recovery and the best possible outcome. Our team at Fox Valley Orthopedics prides itself on maintaining the highest standards and very low complication rates.