Reverse Shoulder Replacement

In a normal shoulder, the ball sits on the upper arm bone and the socket on the shoulder blade. In this procedure the two are swapped: a metal ball component is attached to the shoulder blade (glenoid) and a socket component is placed on the upper arm bone (humerus). This reversed design allows the deltoid muscle to take over the work of the damaged rotator cuff muscles.

A conventional shoulder replacement depends on a working rotator cuff to move and stabilise the joint. When the rotator cuff is massively torn or irreparably damaged, that design cannot function properly. The reverse configuration bypasses the problem by shifting the workload to the deltoid muscle, which is why it is specifically indicated for arthritis combined with rotator cuff damage.

Restoring the ability to lift the arm is one of the main goals of the procedure, achieved by allowing the deltoid muscle to take over the function of the damaged rotator cuff. How much movement returns varies between patients and depends on factors such as the condition of the shoulder before surgery, bone quality and commitment to the rehabilitation programme. Dr. Ansari will discuss what is realistically achievable in your case during consultation.

Recovery generally includes shoulder immobilisation using a sling, pain management, guided physiotherapy, gradual shoulder mobility exercises, strengthening exercises and regular follow-up consultations. Most patients begin gentle rehabilitation soon after surgery under the supervision of the orthopaedic team and physiotherapist.

It is commonly recommended for rotator cuff tear arthropathy, severe shoulder osteoarthritis with rotator cuff damage, massive irreparable rotator cuff tears, rheumatoid arthritis affecting the shoulder, complex shoulder fractures particularly in older adults, failed previous shoulder replacement, shoulder joint degeneration, chronic shoulder instability in selected cases, and avascular necrosis of the shoulder joint.

Digital X-rays and an MRI scan are standard. A CT scan is used for surgical planning, and blood investigations are carried out before surgery. Imaging also informs implant selection, implant size, implant positioning, bone quality assessment, joint alignment and the surgical approach.