Reverse Shoulder Replacement

Overview

Reverse shoulder replacement "reverses" the position of the ball and the socket. A metal ball replaces the glenoid (socket), and a plastic cup replaces the end of the humerus (upper arm bone). This design allows the deltoid muscle to compensate for a deficient rotator cuff, making it the gold standard treatment for patients with rotator cuff tear arthropathy.

Unlike anatomic total shoulder replacement which requires an intact rotator cuff, reverse shoulder replacement can restore function and relieve pain even when the rotator cuff is severely damaged or absent. The altered biomechanics rely on the deltoid muscle to power shoulder movement.

Who Is a Candidate?

Reverse shoulder replacement is recommended for patients with:

• Rotator cuff tear arthropathy (massive rotator cuff tear with arthritis)
• Severe degenerative joint disease with rotator cuff deficiency
• Pseudoparalysis (inability to actively lift the arm)
• Failed rotator cuff repair with arthritis
• Complex fractures in older patients

Expected Outcomes

Reverse shoulder replacement performed for osteoarthritis generally yields more favorable outcomes than other conditions treated with the same procedure. Patients with osteoarthritis tend to have more predictable outcomes due to preserved deltoid and soft tissue integrity, whereas those with complex indications often face higher complication rates and less consistent functional gains.

The Surgical Procedure

The surgical procedure for reverse shoulder replacement is very similar to anatomic total shoulder replacement, only the implants are different. The ball is made of stainless steel, titanium, and cobalt-chrome. The plastic cup is made of ultra-high molecular weight polyethylene.

Key Advantages

Compared to anatomic shoulder replacement, reverse shoulder replacement:

• Does not require a subscapularis repair
• Allows for earlier motion and less restrictive post-operative protocols
• Can restore function even with severe rotator cuff damage
• Relies on the deltoid muscle for shoulder movement

Anesthesia and Pain Management

You will receive a nerve block on the day of surgery to manage postoperative pain for 18-24 hours. We use a comprehensive multimodal pain management approach to minimize discomfort and narcotic use, including Tylenol, anti-inflammatory medications, and low-dose steroids.

Recovery Timeline

Recovery from reverse shoulder replacement takes up to a full year, with approximately 90% of progress made by 6 months.

Early Recovery (Weeks 1-6)

Focus on protecting your shoulder while controlling pain and beginning basic motion.

• Arm in sling for comfort
• Can move hand, wrist, and elbow immediately
• Less restrictive than anatomic replacement (no subscapularis repair to protect)
• Physician-directed exercises begin at 4 weeks
• Physical therapy may start earlier than with anatomic replacement

Intermediate Recovery (Weeks 6-12)

Work on improving range of motion through physician-directed, patient-led exercises. You don't ever have to do formal physical therapy! Progress is gradual - slow and steady wins the race.

Late Recovery (3-6 Months)

Return to certain sporting activities in a graduated fashion:

• 4 months: Start golf chipping, light tennis ground strokes
• 5-5.5 months: Full golf swings without hitting ball
• 6 months: Full unrestricted golf and tennis
• Continue daily stretching exercises to maximize function

Full Recovery (6 Months - 1 Year)

Many patients continue to improve significantly up to one year. Long-term, Dr. Kirsch doesn't put formal restrictions on activity or weightlifting. The best rule of thumb: if you can't lift or do something 20 times, it is likely too much.

What to Expect

Hospital Stay

Patients are typically discharged either the same day or the day after surgery. Most patients prefer to go home the same day. It is Dr. Kirsch's strong preference to have patients discharged to their home without the need for a rehab facility.

Pain Management

Most patients find reverse shoulder replacement to be less painful than anatomic replacement since there is no subscapularis repair to protect. The multimodal pain management approach keeps most patients very comfortable.

Function Expectations

While reverse shoulder replacement provides excellent pain relief and functional improvement, rotation may be somewhat limited compared to normal. However, most patients are extremely satisfied with their ability to perform daily activities pain-free.