The Reverse Total Shoulder Procedure

Reverse total shoulder replacement is a specialized surgical procedure designed for individuals with massive rotator cuff tears and a condition known as cuff tear arthropathy, a complex form of shoulder arthritis. In cases where the rotator cuff is severely damaged or nonfunctional, a conventional shoulder replacement may fail to restore motion and can lead to ongoing pain. For these patients, a reverse total shoulder replacement offers a more effective solution.

How The Procedure Works

In a healthy shoulder, the rotator cuff muscles play a critical role in positioning and powering the arm. Conventional shoulder replacements depend on these muscles to function correctly. However, in the presence of a large rotator cuff tear or cuff tear arthropathy, the rotator cuff can no longer provide this support.

A reverse shoulder replacement is uniquely designed to compensate for this loss. It relies on the deltoid muscle, rather than the rotator cuff, to lift and rotate the arm. This shift in mechanics allows patients to regain mobility and function despite significant rotator cuff damage.

Conventional VS. Reverse Shoulder Replacement

Each year, thousands of conventional total shoulder replacements are successfully performed across the U.S. These devices mimic the shoulder’s natural anatomy:

• A cup is inserted into the shoulder socket (glenoid)
• A metal ball is attached to the top of the upper arm bone (humerus)

In a reverse total shoulder replacement, the anatomy is reversed:

• The metal ball is attached to the shoulder socket
• The plastic cup is fixed to the top of the humerus

This reversed design provides greater stability and function for patients who are not candidates for conventional procedures.