Reverse Shoulder Replacement

Shoulder replacement surgery is the third most common form of joint replacement in the United States. While total shoulder replacement is often the solution for shoulder pain, patients with rotator cuff damage may benefit from a different procedure: reverse shoulder replacement.

As part of our commitment to providing the highest standard of care for you, orthopedic specialists at Summit Orthopedics in the Minneapolis/St. Paul area offer both total shoulder replacement and reverse shoulder replacement. This allows us to truly provide personalized care by recommending the procedure that best suits your specific needs.

What Is Reverse Shoulder Replacement?

During total shoulder replacement surgery, damaged bone and cartilage are removed from your shoulder joint and replaced with plastic and metal components. The shoulder’s anatomy remains in place, with a metal ball and plastic socket placed in the same positions as the damaged parts that were removed.

That means that the top of your upper arm bone (humerus)—the ball—fits into the socket in your shoulder blade (scapula), also called the glenoid.

As the name reverse total shoulder replacement suggests, this type of shoulder replacement flips things around. After the surgeon removes the damaged parts of your shoulder joint, they reverse the positions of the replacement ball and socket.

Because the positions are reversed, the ball sticks out from the scapula and fits into the socket at the top of the humerus. Flipping the joint around in this way, with the ball attached to the socket, allows patients to use the deltoid muscle at the top of the shoulder rather than an injured rotator cuff, providing shoulder stability.

Is Reverse Shoulder Replacement Right for Me?

You may benefit from reverse shoulder replacement if you have life-disrupting upper shoulder pain and haven’t experienced relief from nonsurgical treatment options such as physical therapy, activity modification, medications or cortisone injections.

This type of shoulder replacement is recommended for patients who have shoulder problems related to an injury to the rotator cuff, including:

A completely torn rotator cuff
Rotator cuff arthropathy, also called cuff tear arthropathy, a type of severe shoulder arthritis that occurs after a rotator cuff tear or other rotator cuff injury
Shoulder instability or shoulder dislocation as a result of rotator cuff damage

Reverse shoulder replacement may also be recommended for those who have previously undergone a total shoulder replacement that failed.

Why might you need a reverse shoulder replacement? Traditional shoulder joint replacements work best when other parts of the shoulder, such as the muscles and tendons, are in good condition. When the rotator cuff or other parts of the shoulder are damaged, total shoulder replacement may not provide full relief from pain and other symptoms.

Reverse shoulder replacement, in comparison, can be a better option for those with shoulder structural damage because it helps stabilize the shoulder.

What Can I Expect Before Surgery?

If a surgeon recommends you have reverse shoulder replacement, you’ll need to complete several steps before surgery.

For one, you’ll undergo presurgical testing that ensures you’re healthy enough to have surgery. This testing, performed by your primary care provider, may include blood work, cardiovascular tests such as an electrocardiogram and imaging scans.

If you are cleared for surgery, your medical team provides you with instructions to help you prepare in the days leading up to surgery. These guidelines outline details such as when to begin fasting before surgery, whether to discontinue medications you’re taking and what time to arrive at the surgical center or hospital on the day of surgery.

If you’re having surgery at one of Summit Orthopedic’s surgical centers, you’ll also receive one-on-one joint replacement education to help you know what to expect before, during and after surgery.

What Can I Expect on the Day of Surgery?

When you arrive at the surgical center or hospital, nurses check your vital signs and may run other minor tests. You’ll meet with an anesthesiologist, who talks with you about the type of anesthesia you’ll receive, which may include a regional nerve block and general anesthesia.

You’ll also be given antibiotics before surgery to lower the risk of infection. Someone from your treatment team meets with you before you go into surgery to answer any questions or address any concerns you have.

Your family can stay with you until you’re taken back for surgery. Reverse shoulder replacement typically takes between one and three hours to complete.

What Can I Expect After Surgery?

Immediately after surgery, you’ll be moved into a recovery room for careful monitoring as the anesthesia wears off. Your family is notified that the surgery is complete and you’re in recovery.

After a few hours, you will move to a regular room or one of our Care Suites, where your family can visit with you. A physical therapist will also come to your room to begin working with you.

Patients who undergo reverse shoulder replacement at a surgical center often go home on the same day as surgery. If you undergo the procedure in a hospital setting, you may need to stay in the hospital overnight and be discharged the next day.

Recovering at Home

Before you are discharged from the surgical center or hospital, a member of your treatment team talks with you about how to continue your recovery at home. This includes recognizing signs of infection and other complications, managing pain and knowing when to contact your provider.

In the days and weeks after surgery, you’ll need to participate in intensive physical therapy sessions to help you build strength and regain range of motion. You’ll attend these sessions at our physical therapy center twice a week.

Potential Complications of Reverse Shoulder Replacement

Reverse shoulder replacement is largely a safe and effective procedure, but complications can occur with any type of surgical procedure. Potential complications may include:

Blood clots
Damage to the surrounding nerves
Dislocation of the artificial joint
Excessive blood loss
Fracture of a shoulder bone
Infection
Reactions to anesthesia

Contact your specialist immediately if you develop a fever or chills, have pain that isn’t relieved by medication, have excessive unrelenting drainage or calf pain or if you fall. Call 911 immediately if you experience any shortness of breath or develop chest pain.

Your First Follow-up Appoinment

Within a week or two after reverse shoulder replacement, you’ll have a follow-up appointment with your care team. At this appointment, we’ll remove any remaining surgical staples, take X-rays to get a good look at your shoulder and provide you with instructions for the next month or two of your recovery.

How Long Does It Take to Recover After Reverse Shoulder Replacement?

Recovery varies from person to person, depending on several factors. Your surgeon will talk with you about what to expect after surgery, but consider recovery a marathon rather than a sprint. With the help of physical therapy, you’ll make steady progress over the coming weeks and months.

Limitations After Reverse Shoulder Replacement

While you’ll experience reduced pain and improved shoulder stability following reverse shoulder replacement, you’ll need to avoid certain movements and activities moving forward. Your care team can advise you about specific restrictions, which typically include:

Avoiding heavy overhead lifting
Not lifting anything heavier than 25 pounds
Not reaching behind your back on the side of the affected shoulder

Your surgeon may recommend additional restrictions, such as avoiding contact sports or high-impact exercise, to reduce the risk of dislocation and shoulder fracture after surgery.