Reverse shoulder replacement surgery is recommended for patients who cannot undergo standard shoulder replacement surgery. It is a type of replacement (arthroplasty) surgery unique to the shoulder joint that is used to address specific situations where a standard shoulder replacement surgery would be unsuccessful. It is termed a “reverse” because the reverse prosthesis switches up the anatomy of the shoulder, replacing the socket portion of the joint with a ball and the ball portion of the joint with a socket. This unique configuration allows the deltoid muscle to become the power source of the shoulder.
X-ray of a reverse shoulder replacement
In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion.
When a patient has conventional shoulder replacement surgery, a plastic cup is fitted into the shoulder socket (glenoid) and a metal ball is attached to the top of the upper arm bone (humerus). In conventional shoulder replacement surgery, the rotator cuff tendons must be attached and the muscles must function properly for the replacement prosthesis to work successfully.
In reverse total shoulder arthroplasty surgery, the implant’s design allows the shoulder to work well even if the rotator cuff is torn or not working. It also works well in situations where a patient’s bone is severely worn from end-stage arthritis or a patient’s shoulder is severely fractured and cannot be repaired with a plate and screws.
The reverse shoulder replacement is frequently used in patients who have large, irreparable rotator cuff tears and have significant shoulder arthritis as well (this condition is called Rotator Cuff Tear Arthropathy). Reverse shoulder replacement is also recommended for certain patients who have had:
During your consultation, Dr. Jurek will discuss your medical history and your shoulder symptoms. She will conduct a thorough physical exam and review your imaging with you.
If Dr. Jurek determines that you are a candidate for reverse shoulder replacement, she will help you plan and prepare for your shoulder surgery. Please read Surgery Guidance before your surgery for information on what to expect before, during, and after your surgery and important tips and advice to make your recovery as easy and successful as possible.
Dr. Sara Jurek has extensive experience performing reverse shoulder arthroplasty procedures. She is a board-certified orthopedic surgeon with focused fellowship training in complex shoulder surgery. If you are interested in a consultation, please call (206) 386-2600 to schedule an appointment. For your convenience, you may also request an appointment online.
After surgery, your arm will be placed in a sling, and Dr. Jurek will have you start gentle shoulder range of motion exercises the day of or the day after surgery. You will be able to gently use your operative side for activities of daily living but you need to take things easy for a few weeks. Use cold therapy to help with postoperative pain and take pain medication as directed.
After surgery, you should follow these aftercare instructions to ensure proper healing and recovery:
Once you have discontinued the narcotic medication, you will likely have unused pills left over. It is best to dispose of these safely. Check out our page on Narcotic Disposal to learn safe ways to dispose of unused narcotic medication.
The success rate for reverse shoulder replacement surgery is high. Many patients report outstanding pain relief and patient satisfaction is typically very high. The degree of pain relief depends largely upon the reason the procedure was done. The degree of pain relief for revision cases (a reverse shoulder surgery performed to correct a previous failed surgery) is a little lower than for procedures done for the first time, and this is believed to be due to scar formation and long-term damage.
The reverse prosthesis also should restore range of motion to the shoulder, with the degree of return of full range of motion slightly less predictable than pain relief. Most patients obtain the ability to reach overhead and to use their shoulder functionally for daily activities. Most patients see improvement of motion in other directions, but depending on the severity of their shoulder arthritis or shoulder injury preoperatively, they may not regain completely full internal (reaching up behind your back) or external (rotating your arm away from your body) rotation after reverse total shoulder arthroplasty surgery.
The long-term survival rates (how long the implants stay in the shoulder before they start to loosen and need to have more surgery) of the reverse prosthesis are very favorable. Recent studies with 20-year follow-up after reverse total shoulder arthroplasty have documented sustained excellent outcomes.
Most complications of a reverse shoulder replacement are similar to those of a joint replacement performed in other parts of the body. There are a few possible complications that are unique to this prosthesis. Possible complications include: