Reverse Shoulder Replacement Surgery 101: In-depth Guide

You reach for something high, but you’re met with significant pain in your shoulder. Your friend who invited you to play golf this weekend? Forget about it. And the discomfort makes it hard to sleep sometimes.

If your shoulder has been a source of significant pain as well as loss of mobility and function, reverse shoulder replacement surgery may be the next best step for pain relief. But did you know there’s more than one type of this surgery?

More surgeons are turning to reverse shoulder replacement surgery to lessen pain and restore function. Learn more about what this is (and why it’s called “reverse”), the surgical benefits, questions to ask your surgeon, and more in this article.

What is Reverse Shoulder Replacement Surgery?

Although reverse shoulder replacement surgery may sound like the surgeon is going to flip your arm around, don’t fret. That won’t happen. Reverse shoulder replacement surgery is one of two types of shoulder replacement surgeries. It is effective in reducing or eliminating pain and helping people regain shoulder function. Better yet, the benefits may last for decades in some cases. 

Reverse shoulder replacement surgery has become popular due to its ability to address complex shoulder problems and favorable results. The number of reverse shoulder replacement surgeries has skyrocketed in recent years, increasing by 191 percent between 2011 and 2017, according to data published in the Journal of Shoulder and Elbow Surgery in 2020. In 2017, 62,845 reverse shoulder surgeries were performed. 

Types of Shoulder Replacement

Shoulder replacement is a surgery where damaged shoulder tissues and structures are removed and replaced with artificial implants. To get a sense for how this works, consider how your shoulder is built. Your shoulder is a ball-and-socket joint. You’re able to lift your arms overhead, pick things up, and hug loved ones due to the shoulder anatomy. 

According to the American Academy of Orthopedic Surgeons, the shoulder is made up of:

• The humeral head, aka the “ball” that is on the upper arm bone
• The socket, or glenoid, in the shoulder blade
• And the rotator cuff, a group of muscles and tendons that keep these structures in place

If your doctor has recommended a shoulder replacement, there are two main options for surgery–regular shoulder replacement and reverse shoulder replacement. 

Regular shoulder replacement

Regular shoulder replacement is used to treat arthritis, which is the deterioration of cartilage. When cartilage degrades, “there’s bone-on-bone impact, causing disabling and painful symptoms,” says Eric S. Millstein, MD, medical director and sports medicine orthopedic surgeon at Commons Clinic. During regular shoulder replacement surgery, the ball (humeral head) is replaced with metal, and the socket (the glenoid) is replaced with plastic. “There is no longer any pain because you have metal rubbing on plastic,” Dr. Millstein says.

Reverse shoulder replacement

Reverse shoulder replacement surgery was FDA approved in 2004. “Over the last 20 years, it’s become a brilliant feat of engineering,” says Dr. Millstein. 

Instead of adding a metal ball (humeral head) to the top of the arm bone (as is anatomically correct) where it will “pop into” the socket, this surgery flips that around. Instead, a half metal ball is attached to the “socket side” of the body, with a plastic socket attached to a metal stem that is inserted into the humerus bone. The two parts are then connected. 

Who is a Candidate for Reverse Shoulder Replacement Surgery?

“Reverse shoulder replacement restores the stability of the shoulder. We use it when there is a concern for rotator cuff problems or poor bone quality,” says Patrick Denard, MD, a shoulder specialist at the Oregon Shoulder Institute in Medford, Oregon.

There are a few common scenarios where reverse shoulder replacement surgery is chosen, explains Dr. Millstein. These are:

• When you have osteoarthritis along with an unhealthy rotator cuff, making regular shoulder replacement less likely to be successful.
• When there is an inability to fit a plastic socket into the shoulder due to misshapen/deteriorated bone.
• Rotator cuff arthropathy, a degenerative condition of the shoulder where arthritis is associated with significant tearing of the rotator cuff.

Benefits of Reverse Shoulder Replacement Surgery

For people who have shoulder arthritis,  rotator cuff problems and certain structural issues of the shoulder, a reverse shoulder replacement can bring significant pain relief and help restore function and movement of the shoulder. This surgery is becoming more popular because it’s found to be so effective, although it’s not the right choice for everyone.

Surgical Considerations

The needs of patients vary widely, so it’s important to have a thorough discussion with your surgeon about their surgical approach and the anesthesia you can expect. A careful evaluation of your particular situation is needed for the safest and most successful outcomes. 

In terms of questions to ask your surgeon, here are five to start out with:

1. Is reverse shoulder replacement surgery recommended for my situation–and why?
2. What type(s) of anesthesia do you recommend, and why?
3. How is pain management handled post-procedure?
4. What will my lifestyle limitations be during recovery?
5. What are the long-term outcomes expected if I have reverse shoulder replacement surgery?

Understanding all aspects of your upcoming surgery helps ensure you’re well-prepared and confident in your decision. Taking time to discuss these questions with your surgeon creates a foundation for successful surgery and recovery.

Preparing for Reverse Shoulder Replacement Surgery

Although you have surgery ahead of you, there isn’t much prep needed, says Dr. Millstein. He asks patients to stop medications that can cause bleeding, including aspirin or NSAIDs. You may need to stop other medications if you have other conditions like  arthritis or if you use blood thinners. Give your surgeon a full list of current medications, including prescriptions, over-the-counter meds, and supplements you are taking. If you are stopping a medication, speak to your prescribing provider about the best way to do this. 

Most medical centers will also have people wash their skin with a benzoyl peroxide or other antimicrobial solution to decrease the risk of infection, prep that’s started at home two days before surgery. Make sure you follow the full instructions for doing this as provided by your surgeon.

Also, have a conversation with your surgeon about ways you can prepare your home before surgery, as you will have some mobility limitations as you recover. Those may include moving often-used items within reach, asking friends or family members to help you with daily tasks, or scheduling recovery in a rehabilitation facility, depending on your needs. 

In addition, you may want to consider purchasing special clothing, such as shirts, that are designed to make it easier to get dressed following shoulder or arm surgery. These products are available online at a variety of price points.

The Surgical Procedure

Reverse shoulder replacement surgery takes about two hours, though that time may vary depending on your individual case. 

Before surgery begins, you will need general anesthesia. In many cases, the anesthesiologist will give you a nerve block to numb your arm, says Dr. Millstein. This approach reduces postoperative pain and cuts down on the need for pain medication post-surgery. 

According to Dr. Millstein, during surgery: 

1. The surgeon will create an incision on the shoulder by your armpit. 
2. The muscles are spread apart, allowing access to the bone. (If the rotator cuff is still intact, it will be cut.) 
3. The surgeon uses a surgical saw to remove the ball.
4. They will then grind down the socket.
5. In the socket, the surgeon uses drills and screws to place a round metal plate that’s been specifically sized to the patient. They will also connect a half-ball made of stainless steel. (This means the ball is placed on the socket side.)
6. At the top of the arm (or “arm side”), the surgeon will connect a metal rod that will go down the arm bone, grabbing onto the bone. They will also place a plastic socket.
7. The shoulder is put back in place so that the socket fits perfectly with the metal ball. 

Once all components are in place, the surgeon will test the shoulder’s range of motion and stability to ensure proper alignment and function. The incision is then closed with sutures or surgical staples, and the shoulder is wrapped in sterile dressing. Your medical team will closely monitor you in the recovery room as the anesthesia wears off.

Post-Operative Care and Recovery

Reverse shoulder replacement surgery can be an outpatient procedure for qualified patients, though some will be advised to stay overnight in the hospital. Once you’re discharged, you’ll be able to head home. Here’s what you’ll need:

Have help at the ready: “I advise all of my patients to have someone to stay with them for three to four days. It’s not a good idea to be alone after any surgery,” Dr. Millstein says. 

Rest in a semi-seated position: This can be achieved by sitting in a recliner chair, using a wedge pillow, or laying in an adjustable bed. The idea is to keep the shoulder supported. The hand may also become swollen, so keeping the arm elevated can reduce swelling. Because you won’t be able to put weight on your arm for the first few weeks post-surgery, you’ll need to be able to maneuver without leaning on your elbow. Sitting reclined but upright will make this more doable, Dr. Millstein says. 

Use cold therapy: Ice decreases pain, swelling, and inflammation. You can use cold in several ways, based on your budget:

• Use an ice pack.
• Purchase an ice pack shoulder pad, which is specially designed to wrap around your shoulder.
• Use an ice machine system, which circulates cold water around your shoulder.

Wear a sling: A sling will protect your shoulder. If you’re at home, Dr. Millstein says you won’t need to use it, but one should be worn if you go out, such as to dinner or the movies. Your surgeon will let you know how long to wear the sling, but it’s generally about four weeks.

Maximize your nutrition: “I encourage patients to optimize their nutrition going in and after surgery to improve their recovery,” says Dr. Denard. He recommends focusing on increasing protein intake to support muscles and tendons, as well as vitamin C and D. Vitamin C is important for collagen formation, which is a protein that makes up tendons, while vitamin D supports bone density and health.

Risks and Complications 

Any surgical procedure carries a risk of side effects and complications. Approximately 15 to 24 percent of patients may experience a complication after reverse shoulder replacement surgery, according to one review published in Clinics in Shoulder and Elbow. Those include:

• Infection around the implant
• Dislocation
• Fracture around the implant
• Nerve injury
• Shoulder blade injury
• Loosening of the implant 
• Scapular notching (bone erosion on the scapula)

Talk to your surgeon about signs you should watch for during recovery that could indicate a complication and what to do in the event they occur.

Results and Outcomes 

Reverse shoulder surgery should make you feel more comfortable, endure less pain, and have better strength, function, and mobility in your shoulder than before. Here’s a deeper examination of these main goals. 

Reduction in pain

Daily, lingering, and disabling pain may have led to a shoulder evaluation and surgery in the first place. Luckily, reverse shoulder replacement surgery effectively treats this type of pain.

“This surgery is incredible for reducing or eliminating pain,” says Dr. Millstein. “I never say it’s 100 percent, but I’m confident that patients will be out of pain or have minimal pain after this surgery.” 

Restoration of motion and function

Although everyone’s recovery journey is different, you can generally expect to be able to lift your arms overhead or do light workouts at the gym after surgery. You may be able to resume normal sports after the surgery, such as playing golf or tennis, though that’s not guaranteed. 

Rehabilitation and Recovery Timeline 

The recovery for shoulder surgery may surprise you. With proper anesthesia and post-operative pain management protocol, pain can be manageable immediately for most patients.

Patients are often surprised to find out they can move their hand, wrist, and elbow right away. There is variance with what your surgeon will advise you to do in terms of daily activity. Make sure you’re following their guidance. 

However, this doesn’t mean recovery is a breeze. You’ll generally be advised to limit your activity for one month, but this can differ depending on your specific case. 

You will then slowly and progressively return to normal activity level, as advised by your provider. Physical therapy, either done at home or in a clinic, can help you restore strength, range of motion, and functionality in your shoulder. 

Full recovery typically takes about six months. Expect quick gains in function in the beginning, with smaller improvements as time goes on. Talk to your surgeon about what type of activities you can return to after surgery and how to do so safely, especially if you had a preferred sport. You’ll want to have a clear picture of what your abilities and limitations may be.

Prosthesis Longevity and Revision Surgery

Your new shoulder joint should last about 15 to 20 years, says Dr. Millstein. Of course, this depends on your daily life and activity level. According to Dr. Millstein, the implant used in a “78-year-old person who plays cards and goes for walks will last longer than a 60-year-old who goes back to the gym or plays tennis. It’s not a one-sized-fits-all situation.”

Although your life can resume with good function and little to no shoulder pain, there are limitations, of course. Dr. Millstein generally does not recommend heavy weight lifting or weight bearing activities, including combat or contact sports, or activities like skiing that come with a fall risk. 

Research from a systematic review and meta-analysis in The Lancet Rheumatology shows that about 94 percent of patients who received a reverse shoulder replacement reported that the implants were still working as they should (in terms of pain reduction and better function) 10 years after surgery.

In some cases, revision surgery—or a “re-do”—may be needed if there are complications, if there are issues with the implant itself (such as loosening, infection, or dislocation), or symptoms arise again. Although not all of these can be predicted, talk to your surgeon about if your health history or lifestyle may impact the success or longevity of the new joint.

Choosing a Surgeon and Medical Center

Choose a qualified orthopedic surgeon who has experience in performing reverse shoulder replacement like those at Commons Clinic. To evaluate a potential surgeon and medical center, ask how many of these procedures they perform every year and ask your surgeon about how many reverse versus traditional shoulder replacement surgeries they perform. Talk to a representative at the medical center about how they handle follow-up, potential complications, and post-procedure communication between you and the surgeon. Their responses should be well-informed and reassuring. You can also research online reviews on the surgeon and medical center for more information. 

Cost and Insurance Coverage

The cost of reverse shoulder replacement surgery varies based on a variety of factors, including your surgeon, type of implant used, post-procedure complications, revisions needed, and individual insurance plans. 

Discuss your insurance coverage with your surgical center. Contact your insurance company to determine out-of-pocket costs ahead of scheduling surgery. You may also want to compare prices between surgery centers, choosing the one that combines the expertise you’re looking for and what is most financially feasible for you.

Frequently Asked Questions (FAQs)

What is the downside of a reverse shoulder replacement surgery?

Beyond the risks of any surgical procedure, a reverse shoulder replacement may limit internal rotation, or arm movement behind the joint, says Dr. Denard. “You get stability with the reverse shoulder replacement, but the joint is also more constrained, and as a result, you don’t always have as much rotation,” he explains.

How long does it take to recover from reverse shoulder replacement surgery?

You will wear a sling and limit activities for about a month, though timing depends on your individual case. Full recovery of function may take around six months.

What will I not be able to do after a reverse shoulder replacement surgery?

You may not be able to participate in certain activities, such as tennis, which requires a strong overhand serve. Other activities may be possible, but not advisable, such as contact sports or skiing, where there is an increased risk of injury or falls.

What are the permanent restrictions after reverse shoulder replacement surgery?

Talk to your surgeon about how a reverse shoulder replacement surgery will specifically affect you and impact your return to sports or other activities. There are no restrictions on day-to-day tasks after recovery from this surgery.

Is reverse shoulder replacement surgery a major surgery?

Yes, this is considered a major surgery, as the surgeon is cutting into the body, removing tissue and some bone, and implanting an artificial joint. It requires general anesthesia. Sometimes, regional anesthesia is also used.

What are the limitations after reverse shoulder replacement surgery?

Results vary depending on the individual. You may be able to return to some activities without a problem, such as swimming, while others, like golf and tennis, may be more unreliable. Talk to your surgeon about expectations surrounding surgery to have a clear picture of what you can expect.

Conclusion

Reverse shoulder replacement surgery offers hope for those suffering from shoulder arthritis and rotator cuff problems. By reversing the natural anatomy—placing a metal ball on the socket side and a socket on the arm side—this innovative procedure can significantly reduce pain and restore shoulder stability. For many patients, this treatment option provides a path to improved mobility and better quality of life.
A full evaluation by a qualified orthopedic surgeon specializing in shoulder surgery is key to achieving the best outcome. “This is a big decision. It’s lifestyle surgery, meaning you don’t need joint replacement, but it provides a fantastic option that’s there for you to improve your quality of life,” says Dr. Millstein. Connect with a specialist at Commons Clinic to learn more about the process, if you’re a candidate for this surgery, and how to get the best outcome from your treatment.

Sources

Journal of Shoulder and Elbow Surgery. The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty. December 2020. https://www.jshoulderelbow.org/article/S1058-2746(20)30351-7/abstract 

American Academy of Orthopedic Surgeons (AAOS). Arthritis of the Shoulder. June 2024. https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-shoulder/ 

AAOS. Reverse Total Shoulder Replacement. August 2022. https://orthoinfo.aaos.org/en/treatment/reverse-total-shoulder-replacement/ 

UWHealth. Getting Your Skin Ready for Shoulder Surgery. https://patient.uwhealth.org/healthfacts/8189 

Journal of Shoulder and Elbow Surgery. Outpatient vs. inpatient reverse total shoulder arthroplasty: outcomes and complications. June 2020. https://pubmed.ncbi.nlm.nih.gov/32035819/ 

Clinics in Shoulder and Elbow. Complications of reverse shoulder arthroplasty: a concise review. March 2, 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC7943379/ 

The Lancet Rheumatology. How long does a shoulder replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 10 years of follow-up. September 2020. https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30226-5/abstract