Reverse Total Shoulder Replacement - OrthoInfo - AAOS (2023)

Every year, thousands of conventional total shoulder replacements are successfully done in the United States for patients with shoulder arthritis. This type of surgery, however, is not as beneficial for patients with large rotator cuff tears who have developed a complex type of shoulder arthritis called "cuff tear arthropathy." For these patients, conventional total shoulder replacement may result in pain and limited motion, and reverse total shoulder replacement is a better option.

A conventional shoulder replacement device mimics the normal anatomy of the shoulder: 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 a reverse total shoulder replacement, the socket and metal ball are switched. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus.

Reverse Total Shoulder Replacement - OrthoInfo - AAOS (1)

In a healthy shoulder, the "ball" of the humerus is held in the shoulder socket by several muscles and tendons, including the rotator cuff tendon.

A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion. A conventional replacement device also uses the rotator cuff muscles to function properly. In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm.

This surgery was originally designed in the 1980s in Europe. The Food and Drug Administration (FDA) approved its use in the United States in 2003.

Reverse Total Shoulder Replacement - OrthoInfo - AAOS (2)

(Left) Rotator cuff arthropathy. (Right) The reverse total shoulder replacement allows other muscles — such as the deltoid — to do the work of the damaged rotator cuff tendons.

(Video) Reverse Total Shoulder Replacement Surgical Video

Reverse total shoulder replacement may be recommended if you have:

  • A completely torn rotator cuff that cannot be repaired
  • Cuff tear arthropathy
  • A previous shoulder replacement that was unsuccessful
  • Severe shoulder pain and difficulty lifting your arm away from your side or over your head
  • A complex fracture of the shoulder joint
  • A chronic shoulder dislocation
  • A tumor of the shoulder joint
  • Tried other treatments, such as rest, medications, cortisone injections, and physical therapy, that have not relieved shoulder pain

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Your orthopaedic surgeon will help you plan and prepare for your shoulder surgery.

Medical Evaluation

Most patients must have a complete physical by their primary care doctor before surgery. This is needed to make sure you are healthy enough to have the surgery and complete the recovery. Many patients with chronic medical conditions, like heart disease, must also be evaluated by a specialist, such a cardiologist, before the surgery.

Medications

Be sure to talk to your orthopaedic surgeon about the medications you take. Some medications may need to be stopped before surgery. For example, the following over-the-counter medicines may cause excessive bleeding and should be stopped 2 weeks before surgery:

  • Non-steroidal anti-inflammatory medications, such as aspirin, ibuprofen, and naproxen sodium
  • Some arthritis medications

If you take blood thinners, either your primary care doctor or cardiologist will advise you about stopping these medications before surgery.

(Video) Management of Complications in Reverse Total Shoulder Arthroplasty

Home Planning

Making simple changes in your home before surgery can make your recovery period easier.

For the first several weeks after your surgery, it will be hard to reach high shelves and cupboards. Before your surgery, be sure to go through your home and place any items you may need afterwards on low shelves.

When you come home from the hospital, you will need help for a few weeks with some daily tasks like dressing, bathing, cooking, and laundry. If you will not have any support at home immediately after surgery, you may need a short stay in a rehabilitation facility until you become more independent.

Before Your Operation

Wear loose-fitting clothes and a button-front shirt when you go to the hospital for your surgery. After surgery, you will be wearing a sling and will have limited use of your arm.

You will most likely be admitted to the hospital on the day of your surgery. After admission, you will be taken to the preoperative preparation area and will meet a doctor from the anesthesia department.

You, your anesthesiologist, and your surgeon will discuss the type of anesthesia to be used. You may be provided a general anesthetic (you are asleep for the entire operation), a regional anesthetic (you may be awake but have no feeling around the surgical area), or a combination of both types.

Surgical Procedure

This procedure to replace your shoulder joint with an artificial device usually takes about 2 hours.

Your surgeon will make an incision either on the front or the top of your shoulder. He or she will remove the damaged bone and then position the new components to restore function to your shoulder.

Reverse Total Shoulder Replacement - OrthoInfo - AAOS (3)

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The components of a reverse total shoulder replacement include the metal ball that is screwed into the shoulder socket, and the plastic cup that is secured into the upper arm bone.

Reverse total shoulder replacement is a highly technical procedure. Your surgeon will evaluate your particular situation carefully and discuss the risks of surgery with you.

Risks for any surgery include bleeding, nerve damage, and infection. Complications specific to a total joint replacement include wear, loosening, or dislocation of the components. If any of these occur, the new shoulder joint may need to be revised, or re-operated on.

After surgery, your medical team will give you several doses of antibiotics to reduce your risk for infection, and pain medication to keep you comfortable. Most patients are able to eat solid food and get out of bed the day after surgery. You will most likely be able to go home on the second or third day after surgery.

(Video) Shoulder exercises

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few weeks of your surgery.

Rehabilitation

When you leave the hospital, your arm will be in a sling. Your surgeon may instruct you to do gentle range of motion exercises to increase your mobility and endurance. A formal physical therapy program may also be recommended to strengthen your shoulder and improve flexibility.

You should be able to eat, dress, and groom yourself within a few weeks after surgery.

Your surgeon may ask you to return for office visits and x-rays in order to monitor your shoulder.

  • Do follow the home exercise program prescribed by your doctor.
  • Do avoid extreme arm positions, such as behind your body or your arm straight out to the side for the first 6 weeks.
  • Don't overdo it.
  • Don't lift anything heavier than 5 lbs. for the first 6 weeks after surgery.
  • Don't push yourself up out of a chair or bed, as this requires forceful muscle contractions.
  • Don't participate in repetitive heavy lifting after shoulder replacement.

After rehabilitation, you will most likely be able to lift your arm to just above shoulder height and bend your elbow to reach the top of your head or into a cupboard. Reverse total shoulder replacement provides outstanding pain relief and patient satisfaction is typically very high.

Early and mid-term studies of the results of this surgery have been very promising. Currently, very few long-term studies exist. This is an area for future research.

To help doctors in the management of glenohumeral joint arthritis — the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information:Glenohumeral Joint Osteoarthritis - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org)

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FAQs

What are the limitations after reverse shoulder replacement? ›

Following a reverse shoulder replacement surgery, just like a traditional total shoulder arthroplasty, there are life long restrictions. We advise no lifting of greater than 25lbs. over head repetitively. Our goal is for the patient to regain 150+ degrees of range of motion (ROM).

What is the difference between shoulder replacement and reverse shoulder replacement? ›

The major difference between a standard shoulder replacement and a reverse procedure is that in a reverse shoulder replacement the ball and socket parts of the shoulder joint switch sides. This means their natural position is reversed.

How is a reverse total shoulder replacement done? ›

In a reverse total shoulder replacement, a surgeon removes the rounded head of the upper arm bone. Using screws and special tools, he or she attaches a plastic socket to the remaining bone. The surgeon also removes part of the socket of the shoulder blade. This is then replaced with a metal ball.

Is reverse shoulder replacement considered major surgery? ›

An orthopedic surgeon will replace the natural bone in the ball and socket of your shoulder joint with a material that could be metal or plastic. It's a major surgery that'll keep you in the hospital for several days. You'll also need several weeks of physical therapy afterward.

How long does it take to fully recover from reverse shoulder replacement? ›

Recovery from Reverse Total Shoulder Replacement

You will have outpatient physical therapy to strengthen your shoulder and improve flexibility. You should be able to eat, dress and do most daily activities within the first week after surgery. Full recovery usually takes up to four months.

What happens to your rotator cuff after reverse shoulder replacement? ›

In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. It essentially re-creates the function of the torn rotator cuff.

Why is a reverse shoulder replacement better? ›

A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion.

How long should you sleep in a recliner after shoulder surgery? ›

Sleeping on an incline for 4-6 weeks after surgery is best. For the first week or two, a recliner may be the most comfortable option. Purchasing a 45 degree wedge from a medical supply store can also provide a stable base to prop yourself up in the bed. Wear your sling.

What is the most common complication following reverse total shoulder arthroplasty? ›

The most common complications of RSA include instability, infection, notching, loosening, nerve injury, acromial and scapular spine fractures, intra-operative fractures and component disengagement.

How painful is reverse shoulder replacement? ›

Even though reverse shoulder arthroplasty is a very successful procedure, painful complications occur. During the initial postoperative years, the most common reasons for pain are instability, postoperative fracture of the acromion or spine, and periprosthetic infection.

Can you get full range of motion after reverse shoulder replacement? ›

Immediately following reverse shoulder replacement surgery, you won't have a vast range of motion; you'll likely be unable to move your arm over your head. Instead of mistakenly putting stress on your affected joint, you should have more critical objects moved to lower shelves to make them easier to access.

What metal is used in reverse shoulder replacement? ›

A solution, which allows both pain relief and improved function, is the Reverse Shoulder Replacement. This type of replacement corrects the arthritis by replacing the worn out joint surfaces with an artificial joint made of metal (cobalt chrome) and plastic (polyethylene).

What is the average age for a shoulder replacement? ›

How old are your shoulder replacement patients? The typical age group for a shoulder replacement patient is 60-80 years old. I have performed shoulder replacements on patients as old as 88 and as young as the mid-40s.

Which is more painful rotator cuff or shoulder replacement? ›

Rotator cuff repair is more painful than other arthroscopic shoulder procedures. Arch Orthop Trauma Surg. 2019 May;139(5):669-674.

How big is the incision for reverse shoulder replacement? ›

The surgery is performed thru a 6-10cm incision in the front of your shoulder (front crease of your deltoid).

How long do you have to wear a sling after reverse shoulder replacement? ›

Patients undergoing Total Shoulder Replacement or Reverse Total Shoulder Replacement surgery will be required to wear their sling for 4 to 6 weeks postoperatively. Those patients undergoing Arthroscopic Bankart Repair or Arthroscopic Latarjet Surgery will be required to wear a sling for 6 weeks after surgery.

How long does pain last after total shoulder replacement? ›

Persistent pain is common 1–2 years after shoulder replacement - PMC. The .

How much weight can you lift after shoulder replacement? ›

Typically, the boundaries have been set by the surgeon, with many patients cautioned or even prohibited from overhead sports, weight training, or heavy work responsibilities. A typical set of guidelines may include no repetitive overhead sports, except for recreational swimming, and no lifting over 20 pounds.

Are muscles cut during shoulder replacement surgery? ›

Traditional shoulder replacement requires that the bone attachment of the front rotator cuff muscle, the “subscapularis”, be cut to expose the joint and repaired at the end of surgery.

How do you strengthen the deltoid muscle after reverse shoulder replacement? ›

To strengthen your deltoid:
  1. Stand with your arm at your side.
  2. Lift your arm up in front of you, keeping your palm facing down.
  3. Raise your arm until it is parallel with the floor, and then hold for a few seconds.
  4. Slowly lower your arm down.
  5. Repeat 10 to 15 repetitions.
8 Aug 2022

Can you have an MRI after reverse shoulder replacement? ›

It should be noted that there is no absolute contraindication to MRI for these patients with shoulder prostheses (even with older prostheses).

What is the success rate of a reverse shoulder replacement? ›

A recent study showed an 85 percent success rate for reverse shoulder arthroplasty, with success being defined as the percentage of patients who returned to one or more sporting activities within five months after surgery.

Can I take my sling off to sleep? ›

So, it's okay to take it off when you are sitting at home with the arm at your side. You can take the arm out of the sling and place it on a pillow, mimicking the position that it would be in with the sling. When you are up moving around, when you are sleeping, and especially when driving the sling MUST be on.

What is the fastest way to recover from shoulder surgery? ›

8 Tips to Speed Recovery After Rotator Cuff Surgery
  1. Wear a sling. To speed recovery, it is important to keep your shoulder immobilized initially after surgery so your tendon can heal. ...
  2. Sleep carefully. ...
  3. Ask for help. ...
  4. Watch for complications. ...
  5. Do the physical therapy. ...
  6. Keep comfortable. ...
  7. Be mindful of your movement. ...
  8. Pace yourself.

How do you go to the bathroom after shoulder surgery? ›

How to Use the Toilet after Shoulder Replacement | Rotator Cuff Repair ...

When do you start physical therapy after reverse shoulder replacement? ›

For the best reverse shoulder replacement recovery you will need to be diligent with your strengthening exercises. Light strengthening exercises begin 6 to 8 weeks after your surgery. Again, the focus is on improving the strength of your deltoid muscle and the muscles that attach to your shoulder blade.

What are the symptoms of a failed shoulder replacement? ›

Symptoms of Failed Shoulder Surgery
  • Continued pain.
  • Stiffness.
  • Limited range of motion.
  • Weakness.
  • Instability.
  • Crepitus (cracking sound)

How long do you stay in the hospital after shoulder replacement surgery? ›

Typically, you will stay in the hospital for two to three days, but this depends on each individual and how quickly he or she progresses. After surgery, you may feel some pain that will be managed with medication to make you feel as comfortable as possible.

How long after shoulder replacement surgery can I lift my arm? ›

The better you do with your rehab exercises, the sooner you will get your strength and movement back. Depending on your job, you may be able to go back to work as early as 2 to 3 weeks after surgery, as long as you avoid certain arm movements, such as lifting. It takes at least 6 months to return to full activity.

Who is the best shoulder replacement surgeon in the United States? ›

REUBEN GOBEZIE, M.D. Orthopedic Surgeon, Reuben Gobezie, MD, is a nationally recognized leader in the care of shoulder and sports injuries. A graduate of Harvard Medical School, Dr. Gobezie was named one of the top 25 shoulder specialists in the US as ranked by leaders in the field.

Is shoulder replacement harder than knee replacement? ›

Finding the right surgeon

The very thing that gives the shoulder its amazing range of motion also makes replacing it more complicated than the equivalent surgery for a hip or knee: Shoulder movement depends more on muscles and tendons than other major joints.

Which shoulder replacement is best? ›

Traditional shoulder arthroplasty, commonly known as total shoulder replacement surgery, is considered to be the most reliable surgical option for those looking to regain movement and function from a severely injured or damaged shoulder condition.

What is the most painful type of shoulder surgery? ›

Rotator cuff repair is the most painful surgery in the first postoperative days. The main risk factor for pain is a work related accident or occupational disease, associated with higher VAS values from D1 to 1 year and greater morphine intake.

Can your body reject a shoulder replacement? ›

The results of shoulder joint replacement are often excellent, but failure of shoulder arthroplasty can result because of persistent pain, stiffness, infection, component loosening, fracture, component malposition, instability, rotator cuff failure or other causes.

What type of anesthesia is used for reverse shoulder replacement? ›

Anesthesia is administered. Most patient receive general anesthesia (are put to sleep). Some patients also receive regional anesthesia in the shoulder, so the shoulder and arm may be numb when the patient wakes up from the general anesthesia.

What is the most common complication following reverse total shoulder arthroplasty? ›

The most common complications of RSA include instability, infection, notching, loosening, nerve injury, acromial and scapular spine fractures, intra-operative fractures and component disengagement.

How long do reverse total shoulders last? ›

On the whole, reverse shoulder replacement is a successful surgery—90% of reverse shoulder replacements last at least 10 years. But like any surgery, there are risks and complications from the procedure.

Can you damage a shoulder replacement? ›

The group of muscles and tendons that surround the shoulder joint (the rotator cuff) occasionally wear out after a partial or total anatomic shoulder replacement. Nerve damage. Nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness and pain.

Does shoulder replacement qualify for disability? ›

Most applications for SSD benefits based on a shoulder replacement don't qualify for benefits under the major dysfunction of a joint listing in the Blue Book. If this is true in your claim, you may still be found eligible for SSD benefits, if you meet the requirements for a “medical vocational allowance”.

How long do you have to wear a sling after reverse shoulder replacement? ›

Patients undergoing Total Shoulder Replacement or Reverse Total Shoulder Replacement surgery will be required to wear their sling for 4 to 6 weeks postoperatively. Those patients undergoing Arthroscopic Bankart Repair or Arthroscopic Latarjet Surgery will be required to wear a sling for 6 weeks after surgery.

How much weight can you lift after a total shoulder replacement? ›

Typically, the boundaries have been set by the surgeon, with many patients cautioned or even prohibited from overhead sports, weight training, or heavy work responsibilities. A typical set of guidelines may include no repetitive overhead sports, except for recreational swimming, and no lifting over 20 pounds.

When do you start physical therapy after reverse shoulder replacement? ›

For the best reverse shoulder replacement recovery you will need to be diligent with your strengthening exercises. Light strengthening exercises begin 6 to 8 weeks after your surgery. Again, the focus is on improving the strength of your deltoid muscle and the muscles that attach to your shoulder blade.

How painful is reverse shoulder replacement? ›

Even though reverse shoulder arthroplasty is a very successful procedure, painful complications occur. During the initial postoperative years, the most common reasons for pain are instability, postoperative fracture of the acromion or spine, and periprosthetic infection.

What is the success rate of a reverse shoulder replacement? ›

A recent study showed an 85 percent success rate for reverse shoulder arthroplasty, with success being defined as the percentage of patients who returned to one or more sporting activities within five months after surgery.

How long should you sleep in a recliner after shoulder surgery? ›

Sleeping on an incline for 4-6 weeks after surgery is best. For the first week or two, a recliner may be the most comfortable option. Purchasing a 45 degree wedge from a medical supply store can also provide a stable base to prop yourself up in the bed. Wear your sling.

Why do reverse shoulder replacements fail? ›

The most common modes of failure for reverse shoulder replacements are: dislocation, infection, implant loosening from bone, and dissociation (meaning the implant comes apart). Our recent cases demonstrate most of these problems. In the first case, the implant had come loose from the bone.

What muscles are cut during a reverse total shoulder replacement? ›

The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm. It essentially re-creates the function of the torn rotator cuff. This surgery was originally designed in the 1980s in Europe.

What is the average age for a shoulder replacement? ›

How old are your shoulder replacement patients? The typical age group for a shoulder replacement patient is 60-80 years old. I have performed shoulder replacements on patients as old as 88 and as young as the mid-40s.

Is shoulder replacement more painful than knee replacement? ›

In fact, the Johns Hopkins researchers say, their study shows that patients who undergo shoulder arthroplasty to relieve chronic and significant pain can expect significantly fewer complications, much shorter hospital stays and less costs than patients undergoing hip or knee replacement.

How much disability is shoulder surgery? ›

Rotator cuff surgery is rated based on the severity of the pain and the thickness of the rotator cuff tear. Most often, VA rates this condition as 10 or 20 percent disabling.

How long after shoulder replacement surgery can you drive? ›

Six weeks after surgery, when you regain full shoulder movement, you can probably resume driving. At this time, your surgeon also may allow you to return to work, depending on how much physical activity is involved in your occupation. You will also start to strengthen your shoulder up with physical therapy.

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