Understanding Reverse Shoulder Replacement Surgery: Benefits and Recovery

Shoulder pain and limited movement can severely affect daily life, especially when caused by complex joint problems. Reverse shoulder replacement surgery offers a solution for those with severe shoulder damage, particularly when the rotator cuff is compromised. This procedure changes the mechanics of the shoulder, allowing patients to regain function and reduce pain.

What Is Reverse Shoulder Replacement Surgery?

Reverse shoulder replacement surgery involves switching the normal anatomy of the shoulder joint. In a healthy shoulder, the ball is on the top of the upper arm bone (humerus), and the socket is part of the shoulder blade (scapula). In this surgery, the positions are reversed: the ball is attached to the scapula, and the socket is placed on the humerus.

This design helps patients with damaged or torn rotator cuff muscles, which normally stabilize and move the shoulder. When these muscles fail, traditional shoulder replacements often do not work well. The reverse design allows other muscles, mainly the deltoid, to take over shoulder movement.

Who Is a Candidate for This Surgery?

Reverse shoulder replacement is usually recommended for people who have:

• Severe rotator cuff tears that cannot be repaired

• Arthritis combined with rotator cuff damage (rotator cuff arthropathy)

• Complex fractures of the shoulder joint

• Failed previous shoulder replacement surgeries

  
  

Doctors evaluate candidates through physical exams, imaging tests like X-rays or MRIs, and discussions about pain levels and mobility. This surgery is often a last resort after other treatments such as physical therapy, medications, or injections have failed.

Benefits of Reverse Shoulder Replacement Surgery

Patients who undergo reverse shoulder replacement often experience several benefits:

• Pain relief: Many report significant reduction in shoulder pain after recovery.

• Improved shoulder function: The surgery restores the ability to lift the arm and perform daily activities.

• Increased stability: The reversed joint design provides more stability, especially when rotator cuff muscles are weak.

• Long-lasting results: Modern implants and surgical techniques offer durability, with many lasting 10 to 15 years or more.

• Better quality of life: Patients often regain independence in tasks like dressing, cooking, and reaching overhead.

  
  

For example, a 68-year-old patient with rotator cuff arthropathy was unable to lift her arm above shoulder height before surgery. After reverse shoulder replacement and rehabilitation, she could comfortably reach shelves and participate in gardening again.

What to Expect During Surgery

Reverse shoulder replacement surgery typically takes 1 to 2 hours and is performed under general anesthesia. The surgeon makes an incision near the shoulder to access the joint. Damaged bone and cartilage are removed, and the new implant components are secured in place.

The reversed ball and socket parts are carefully positioned to restore joint mechanics. Surgeons use specialized tools and imaging to ensure proper alignment. After the implant is in place, the incision is closed with sutures or staples.

Recovery and Rehabilitation

Recovery from reverse shoulder replacement surgery requires patience and commitment to rehabilitation. The process usually follows these stages:

• Hospital stay: Most patients stay 1 to 2 days in the hospital for pain management and monitoring.

• Immobilization: The arm is placed in a sling for 4 to 6 weeks to protect the joint.

• Physical therapy: Gentle exercises begin soon after surgery to maintain flexibility. Strengthening exercises start after the sling is removed.

• Gradual return to activities: Patients can expect to resume light daily tasks within 6 to 12 weeks. Full recovery may take 6 months or longer.

  
  

Physical therapy focuses on improving range of motion and strengthening the deltoid muscle to compensate for the damaged rotator cuff. Following the therapist’s guidance is crucial to avoid complications and achieve the best outcome.

Risks and Considerations

Like any surgery, reverse shoulder replacement carries risks. These include:

• Infection

• Implant loosening or failure

• Nerve or blood vessel injury

• Shoulder stiffness or limited motion

• Dislocation of the implant components

  
  

Patients should discuss these risks with their surgeon and understand the realistic outcomes. Not everyone regains full shoulder strength, but most experience meaningful pain relief and improved function.

Living with a Reverse Shoulder Replacement

After recovery, patients should avoid heavy lifting and high-impact activities that could damage the implant. Regular follow-up visits help monitor the implant’s condition. Many people return to hobbies like swimming, golf, or gardening with modified techniques.

Maintaining a healthy weight and staying active supports long-term joint health. If pain or stiffness returns, early evaluation can prevent further problems.

Patient Handout:

Ben Williams, MD

Comprehensive Orthopedics and Sports Medicine

801-533-2002

benwilliamsmd.com

Reverse Shoulder Replacement Surgery

What to expect before surgery

• Dr. Williams and/or Sean Kendall, PA-C will go over the surgery and associated risks of surgery and pick a date

• We will obtain authorization from your insurance for the surgery

• The hospital will call the afternoon before with instructions for the day of surgery such as when to stop eating and drinking, what medications to stop, and when to arrive

• All GLP-1 agonists (Ozempic, Wegovy, Mounjaro, etc.) will need to be stopped at least a week before surgery). Most blood thinners need to be stopped 5 days before surgery

• If you have any dental work (more than just routine cleanings) that needs to be addressed in the near future, it is better to take care of this first and wait at least 30 days after this to have surgery. Dental work can introduce bacteria into the bloodstream that can cause a joint infection. You should also take antibiotics one hour before major dental procedures for the first 2 years after surgery

What to expect the day of surgery

• The anesthesiologist will discuss a nerve block

• The surgery will take approximately 1-2 hours

• You will wake up with a sling and an ice machine. The nurses will show you how to get dressed and how the sling and ice machine work before you leave.

What to expect the first few days after surgery

• You will be prescribed narcotic pain medication. If you get a nerve block, your arm will likely be numb for around 20 hours. Take 600-800mg of ibuprofen (unless you cannot take NSAIDs) on the evening after surgery. Take this every 8 hours for the first few days and supplement with the narcotic pain medication as needed.

• Remove the sling only to change your clothes. Wear your sling at all times, including while sleeping, for 6 weeks

• Use the ice machine as long as needed. 

• Keep your incisions dry. You can cover up the dressing with Glad Press-n-Seal in order to shower.

• Call and make an appointment for 10-14 days after surgery to remove your sutures.

Reverse Total Shoulder Replacement: Patient Recovery Guide

This handout outlines what to expect following your shoulder replacement surgery and the different phases of recovery. Please follow your surgeon's specific instructions, as individual recovery may vary.

Phase 1: Protection, Passive and Early Active Motion (0-6 weeks)

• Wear your sling at all times, including while sleeping, for the first 2 weeks

• Remove sling only for showering and prescribed exercises

• Focus on pain reduction and tissue healing

• After your first appointment 10-14 days after surgery, you will be given some exercises and can begin moving your arm and using the sling as needed for comfort

• Begin formal physical therapy 2-3 times per week at 2 weeks postop

Phase 2: Active Motion (6-12 weeks)

• Gradually return to active movements and functional range of motion exercises

• Avoid lifting more than 5 pounds until week 8

Phase 3: Strengthening (12-22 weeks)

• Focus on strengthening exercises

• Use light resistance bands or weights as directed by your therapist

• Continue stretching exercises to maintain and improve range of motion

Phase 4: Full Activity (4-6 months and beyond)

• Gradual return to full activities and sports, as approved by your surgeon

• Continue home exercise program to maintain strength and flexibility

• Full recovery may take 4-6 months, with maximum improvement up to 9-12 months

Important Reminders:

1. Follow your surgeon's and physical therapist's instructions carefully

2. Attend all scheduled follow-up appointments and therapy sessions

3. Be patient with your recovery; healing takes time

4. Contact your healthcare provider if you experience increased pain, fever, or other concerning symptoms

Remember, everyone's recovery is unique. Your healthcare team will guide you through each phase based on your individual progress and needs.

Reverse Shoulder Replacement

Reverse shoulder replacement is ideal for patients with cuff tear arthritis and advanced shoulder joint arthritis with significant glenoid wear. Many patients with shoulder arthritis can be managed without surgery; however, when nonoperative treatment has been exhausted surgery is a reliable option to restore function and relieve pain. Patients over age 70 are good candidates for a reverse shoulder replacement as well, because the rotator cuff quality is usually diminished by this age and an anatomic replacement is likely to fail over time.

The latest advances with 3D planning and printing, computer navigation, and patient-specific instrumentation allow for accurate placement of components leading to improved outcomes for patients.

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What is a Total Shoulder Replacement?

A reverse shoulder replacement involves replacing the arthritic shoulder joint surfaces with a highly polished metal ball on the socket side (glenoid) and a plastic socket on the arm side (head of the humerus). 

Essentially the abnormal surfaces (where the cartilage has worn away resulting in arthritis) are removed and replaced with a prosthesis (artificial joint). The normal anatomical arrangement and biomechanics of the shoulder are reversed – hence this is called a reverse shoulder replacement. The greatest advantage of the reverse shoulder replacement is that it does not require an intact rotator cuff to function; however, it does require a well functioning deltoid muscle. 

A reverse shoulder replacement is used for those who have:

• Massive rotator cuff tendon tears that are irreparable

• Established cuff tear arthritis (where the ball sits under the acromion)

• Previous failed rotator cuff repair with significant loss of function

• Severe osteoarthritis causing abnormal glenoid wear pattern and bone loss

• Complex fracture and/or dislocation of the shoulder in older patients

Who is a candidate for a Reverse Shoulder Replacement?

The decision to have shoulder replacement surgery is unique to each patient. It is a shared decision between you (patient), your family, your local doctor, and your orthopaedic shoulder surgeon. 

There are several reasons why you may be a good candidate and be recommended a shoulder replacement: 

• Severe shoulder pain that interferes with activities of daily living, such as self care, reaching up to shelf, and driving, etc.

• Moderate to severe pain at rest; night pain waking you from sleep on a regular basis

• Loss of motion and/or shoulder weakness leading to loss of independence 

• Failure of nonoperative treatment (i.e. steroid injections)  to manage your pain

Blueprint software for 3D surgical planning

Computer navigation and 3D planning has revolutionised shoulder replacement surgery. It provides improved accuracy and precision during surgery.  In most cases, Dr. Williams will order a CT scan in order to plan your surgery using state of the art software.

Dr Williams will upload your recent CT scan to a special planning software program. 3D measurements are taken of your shoulder, the exact wear pattern is analysed, the correction is planned and the “virtual” prosthesis can be implanted on the computer. 

Essentially the shoulder replacement is done on the computer first. Because the operation has already been done virtually, most of the workflow during the case is more efficient and predictable. Surgery time and blood loss are reduced, and the implant position is more accurate and reproducible, leading to better functional results.

How is a Reverse Shoulder Replacement performed?

• The procedure is performed under a General Anesthetic and a regional nerve block

• Using the pre-operative x-rays and CT scan is carefully reviewed On the day of surgery – most of the components that will be required have already been selected to streamline your operation. 

• An approximately 6 inch incision is made over the front of the shoulder and the shoulder joint arthritis opened

• The biceps tendon is released from the shoulder joint and later re-anchored to the pectoralis tendon

• The Subscapularis tendon is then elevated to allow access the shoulder joint

• The Humerus (ball) is delivered and resected; The pre-operative planning will guide the appropriately sized implants for you will need. 

• The Glenoid (socked) is exposed. The new socket (plastic) is then implanted as sized by the 3D planning. 

• The subscapularis tendon is then repaired

• The wound is finally closed in layers, a waterproof dressing is applied, and your arm is placed in a sling. 

• You will follow up in 10-14 days to check your wound and obtain x-rays and begin a home exercise program

What is the rehabilitation after a Reverse Shoulder Replacement?

There are three essential components to a good outcome from surgery:

• Your surgeon

• You as a patient

• Your physical therapist

Post-operative physical therapy

Dr Williams utilizes the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.

The JPL pathway allows for self-directed, early passive shoulder range of movement: 

• Passive = assisted with your other arm

• Active = you move the affected arm independently

Therapy overview 

After the first two weeks of recovery, you will begin physical therapy. The length of therapy varies from patient to patient. It is generally a much quicker recovery than a rotator cuff repair.

The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. As the shoulder begins to heal you will be able to progress to exercises that strengthen your shoulder muscles. Shoulder strengthening is commenced at 9 weeks post Reverse Shoulder Replacement surgery. 

Sling

A sling is used most of the time for the first 6 weeks after your surgery; the sling is worn for a further 6 weeks outside of the house (to remind others you have had shoulder surgery). The type of sling is selected specific to you and your shoulder surgery:

• Reverse Shoulder Replacement – Abduction sling. You can use this with or without the abduction pillow based on which feels more comfortable

Driving after shoulder surgery

• It is not advisable to drive while you are wearing the sling (first 6 weeks). However, some patients do drive a limited amount after they are off of the narcotic pain medication. 

Showering and getting dressed

• You may take the sling off to shower

• Lean forward and allow your arm to “dangle” to wash under your arms

• Keep the dressings dry for the first 4 days.

• When getting dressed, you may use your good arm to move your affected (operated arm) to place your arms through the sleeves carefully

Sleeping after Shoulder Surgery

• Most patients find it difficult to lie flat after shoulder surgery.

• Consider using a recliner or few pillows to prop yourself up and sleep at a slight incline; this may be necessary for 4-6 weeks after surgery. You should keep your sling on while asleep.

Elbow and hand movement

• Keep your elbow and hands joints moving and supple for the duration of time you are in the sling. The best time to move your elbow (into full extension and flexion) is when you are in the shower, just out of the shower and about to get dressed.

What are the risks of a Reverse Shoulder Replacement?

Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications. 

The risk of complications after a Reverse Shoulder Replacement in the published literature is around 5%: 

• Infection

• Bleeding

• Wound healing problems

• Damage to blood vessels or nerves

• Sensory changes around the surgical scar

• Fracture

• Dislocation

• Prosthesis failure

• Continued pain

Patients who smoke, use tobacco products, have diabetes, or are elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing. Most healthy patients, however, cope well with shoulder replacement surgery and are unlikely to have complications.