Reverse Shoulder Replacement


To view a surgical video of reverse shoulder replacement, click here.

Reverse shoulder replacement (also known as reverse shoulder arthroplasty) is a surgical procedure designed for patients who have non-repairable damage to their rotator cuff in conjunction with arthritis. This condition is commonly termed cuff tear arthropathy. Arthritis is damage to the shiny white surfaces on the end of the bone, called articular cartilage. The rotator cuff is a group of 4 muscles that work to stabilize the ball on the socket and help to raise your arm. The indications (reasons) for reverse shoulder arthroplasty continue to expand and include failed shoulder replacement, fractures, malunions (deformed but healed fractures) and nonunions (non-healed fractures) of the shoulder.

Fig 1. Reverse shoulder replacement prosthesis.

Reverse shoulder replacement is a full replacement that replaces the ball and socket of the shoulder joint with new metal and plastic parts. A reverse is similar to an anatomic shoulder replacement because both involve replacing the arthritic or worn out shoulder joint. However, a reverse places the rounded “ball” part on the socket and the hollowed out socket on the arm bone, or humerus. The main reason to have a shoulder replacement, whether a primary total shoulder placement or a reverse, is to relieve pain. Reverse shoulder replacement may also improve range of motion overhead, but this is not always possible.

Fig 2. Beach chair position.     Fig 3. Healed incision after shoulder replacement.

Reverse shoulder replacement is done through an incision on the front part of your shoulder that is typically a few inches long. Dr. Burns uses the delto-pectoral approach. This approach is between the deltoid and the pectoral muscles on the front of your shoulder. You are will be positioned in a reclined position on your back, as if you were sitting in a beach chair. That’s why this is called the beach chair position. During the surgery, the arthritis is removed and replaced with specially designed artificial parts called the prostheses, described above. The rotator cuff is not repaired, but any remaining cuff tissue is preserved and closed around the prosthesis. In a reverse shoulder replacement, the parts are snugly fit together like a true ball and socket. The surgery generally takes 1 to 2 hours. Some of this time is used to put you to sleep and properly position you in the beach chair position.

Fig 4. X-ray of a reverse shoulder replacement.