Reverse Shoulder Replacement is an operation that eases pain and restores shoulder movement when the rotator cuff (the group of tendons that lift and rotate the arm) is torn beyond repair or when severe arthritis has worn away the joint.
- In astandard replacement the natural ball-and-socket layout is copied.
- In areverse replacement the positions are switched: the surgeon places a metal ball on the shoulder blade and a smooth cup on the top of the upper-arm bone.
This change lets the deltoid muscle (the large muscle on the outside of the shoulder) take over the lifting work normally done by the damaged rotator cuff.
Who Might Benefit?
Reverse replacement is usually offered when:
- Rotator cuff arthropathy– arthritis caused by long-standing tendon tears.
- Pseudoparalysis– you cannot lift your arm despite it being moved easily by someone else.
- Complex upper-arm fracturesin older adults, where the bone will not mend reliably.
- Failed previous shoulder surgeryor recurrent dislocation.
- Rheumatoid or other inflammatory arthritisif bone quality is adequate.
Most patients are over 70, but younger people with massive cuff loss may also be considered if symptoms are severe and the deltoid and its nerve (axillary nerve) remain healthy.
Who May Not Be Suitable?
The operation is usually avoided when:
- The deltoid muscle or axillary nerve is damaged.
- There is an active infection in or around the shoulder.
- Large parts of the shoulder-blade socket are missing or too weak.
- The skeleton is still growing.
- Severe muscle-control disorders affect the arm.
- The top edge of the shoulder blade (acromion) is already badly fractured.
A full assessment, including X-rays, scans and sometimes nerve tests, guides the decision.
How the Implant Works
Modern reverse implants aim to maximise movement while protecting bone:
Design Feature | Why It Matters |
Lateralised glenosphere | Moves the ball slightly outwards, reducing bone wear and improving balance. |
Optimised neck angle | Helps outward rotation and lowers the risk of the ball rubbing on the blade. |
Short-stem / stemless options | Preserve bone for any future surgery. |
Advanced plastics and coatings | Cut down on wear particles and lengthen implant life. |
These refinements reduce problems such as “scapular notching”, where the ball erodes the edge of the shoulder blade.
00Expected Results
- Pain relief:85–90 % report dramatic pain reduction within a few weeks.
- Arm lift:Average overhead reach improves by 50–60 degrees; many people can reach a shelf or comb their hair again.
- Daily tasks:Most regain independence in dressing, eating, and light household chores by three months.
- Rotation (twisting the arm):Often improves but rarely returns fully to normal.
Risks and Possible Complications
Issue | How Common | Notes |
Scapular notching | Up to 25 % on X-ray | Usually mild and painless. |
Dislocation | 2–5 % | Higher if the joint is very loose or positioning is sub-optimal. |
Implant loosening | 3–6 % over 10 yrs | More often on the socket side. |
Infection | 1–2 % | Risk rises with prior surgery or immune illness. |
Fracture of acromion or arm bone | 1–5 % | May need rest or further surgery. |
Nerve irritation | <1 % | Usually temporary pins and needles. |
Your surgeon will explain your personal risk profile in detail.
Recovery Timeline
Phase | Time-frame | Typical Activities |
Protect & Heal | 0–4 wks | Sling for comfort; hand, wrist, elbow exercises; assisted shoulder moves below shoulder height. |
Early Movement | 4–8 wks | Gradual increase in reach; start light table-top tasks; avoid lifting more than a mug of tea. |
Strength Build | 8–12 wks | Theraband and pulley exercises with physiotherapist; driving often resumes. |
Return to Function | 3–6 mths | Gardening, swimming, golf putting, light DIY; no heavy lifting above shoulder height. |
Long-term Conditioning | 6–12 mths | Continued gains in power and flexibility; cleared for most low-impact sports. |
Every recovery is individual—your physiotherapist will adjust goals to suit your progress.
Long-Term Outlook
National joint registries show:
- >90 % of reverse implantsare still working well at 10 years.
- Younger, very active patients have slightly higher re-operation rates.
- Staying active, controlling weight, and following physio advice help protect the joint.
If the implant ever wears out, modern short-stem designs leave more bone for an easier revision.
Frequently Asked Questions
Will my pain disappear completely?
Most people experience major pain relief; occasional night ache may persist.
Can I lift my arm afterwards?
Yes. The deltoid muscle powers the lift, even if your rotator cuff no longer works.
How long does the implant last?
Many last 15 years or more; materials keep improving.
Can I return to sport?
Yes—for walking, swimming, bowls, and golf (gentle swings). Heavy weights and contact sports are discouraged.
Will airport metal detectors beep?
Possibly. Ask for an implant ID card before discharge.
Need More Help?
- Website:TheArmDoc.co.uk
- Phone:020 3384 5588 (Mon–Fri, 09:00–17:00)
- Email:Info@TheArmDoc.co.uk
Disclaimer
This guide is for general education. It does not replace personalised medical advice. Always consult a qualified orthopaedic specialist to decide if reverse shoulder replacement is right for you.