When Reverse Shoulder Replacement is the Best Option

Total shoulder replacement is a procedure to resurface both sides of your shoulder joint with implants meant to feel and function like your natural shoulder.

There are two types of total shoulder replacements – primary and reverse. The primary replacement, which involves replacing the ball and socket sides of the joint with parts that closely resemble the natural shapes of your bones.

While the procedure effectively relieves pain and improves function, it’s not appropriate for every situation. Dr. Dale Snead, an upper extremity injury specialist at Forté, helps break down the differences between a primary and reverse shoulder replacement and how to know when a reverse is the better option.

What is a reverse shoulder replacement?

To understand who benefits from a reverse shoulder replacement, it helps to understand the procedure itself. Like primary shoulder replacement, a reverse involves resurfacing both sides of the joint so that they still fit together like a ball and socket. However, the positions of the implants are reversed.

A metal ball implant is attached to your shoulder blade where the socket used to be, and a plastic socket liner fits at the end of your upper arm bone.

Who may need a reverse shoulder replacement?

While primary shoulder replacement only works for arthritis patients whose tendons are still intact. You may be a better fit for a reverse shoulder replacement if you:

• Suffer from severe arthritis and have a torn tendon.
• Have an irreparable rotator cuff tear.
• Experience a severe fracture in which the bone can’t be reconstructed.
• Need a revision following a primary shoulder replacement.
• Are diagnosed with a tumor of the shoulder joint.

A reverse procedure works well in these cases because you don’t need the full use of your shoulder muscles or tendons to stabilize your shoulder joint and help it function. Additionally, your surgeon doesn’t need as much healthy bone to work with while attaching your implants.

How do surgeons plan for and execute a reverse shoulder replacement?

Like primary shoulder replacements, Forté surgeons performing reverse procedures utilize new technology for patient-specific surgical planning. The first step involves taking a CT scan of your shoulder.

The CT image is used to create a 3D virtual model of your joint that will be used to simulate the surgery prior to your procedure. This enhanced surgical planning enables your surgeon to determine:

• Where cuts should be made for the least invasive procedure.
• The exact amount of damaged bone that needs to be removed from the joint.
• The optimal size and placement of your implants.

Your surgical team will also use the software to create a customized guide to help align the implants as planned during your shoulder replacement surgery.

“These patient-specific guides are vital,” says Snead. “I use them every time, with every patient, so that the components are in the best place for your unique anatomy and provide the best possible outcome.”

What can I expect after reverse shoulder replacement?

Like a primary procedure, patients with a reverse shoulder replacement typically experience complete pain relief; however, a reverse is not as effective at restoring function and strength. That’s because the same engineering that allows your muscles and tendons to work more effectively can also limit range of motion.

“The reverse procedure isn’t as good at restoring function as an anatomic replacement would be, but it’s a better range and quality of movement than the patient would have had,” says Snead.

How do I know when the time is right for a reverse shoulder replacement?

Choosing to move forward with a reverse shoulder replacement is a personal decision. While your surgeon can help you understand what would be appropriate for your situation, only you can decide when the time is right.

“When someone asks, ‘Should I do this?’, my response is to ask how much it affects you,” says Snead. “If pain keeps you up at night or you’re grumpy all the time, and no one wants to be around you, it might be time to try something different.”

“It’s rare to get too far where we can’t help you with your shoulder,” Snead says. “Reverse shoulder replacement allows us to treat patients with conditions that previously had no solution.”

To find out if you are a good candidate for reverse shoulder replacement, call 317.817.1200 to schedule a consultation.

You can also check out our additional resources for shoulder replacements:

• Read our guide to the different types of shoulder replacement surgery.
• Find out how shoulder replacement is evolving with better implants and patient-specific surgical planning.
• Learn about the three steps of the pre-operative process.
• See how long it takes to recover from shoulder replacement surgery.