What is reverse shoulder replacement?
A reverse shoulder replacement swaps the positions of the joint’s ball and socket: a metal ball is fixed to the shoulder blade, and a socket is placed on the arm bone. This clever reversal changes the mechanics so the large deltoid muscle can lift the arm — even when the rotator cuff is gone.
It is designed for shoulders where the rotator cuff is torn beyond repair, often combined with arthritis (cuff-tear arthropathy), where an anatomic replacement would not work.
Who is it for?
- Arthritis with a large, irreparable rotator cuff tear.
- Cuff-tear arthropathy with pain and loss of lift.
- A failed previous shoulder replacement, in selected cases.
- Certain complex fractures of the top of the arm bone.
How the procedure works
The worn surfaces are removed, a metal ball is anchored to the shoulder blade, and a matching socket is fixed to the top of the arm bone. By moving the centre of rotation, the deltoid muscle gains the leverage to raise the arm, taking over the work the rotator cuff can no longer do.
Reversing the ball and socket lets the powerful deltoid muscle lift the arm without relying on the rotator cuff — which is exactly why it works for cuff-deficient shoulders.
Recovery timeline
Protect
A sling supports the shoulder; gentle guided movement begins early.
Restore motion
Progressive range of motion, with the deltoid learning its new role.
Strength & function
Strengthening and a return to comfortable daily activities.
Risks & outcomes
Reverse replacement reliably relieves pain and restores the ability to lift the arm in cuff-deficient shoulders, with high satisfaction. Overhead range may be more modest than after an anatomic replacement, which is discussed beforehand. Risks — including infection, dislocation, nerve irritation and implant issues over time — are uncommon and minimised through technique, prophylaxis and rehabilitation.
An anatomic replacement needs an intact rotator cuff; the reverse design works without it by letting the deltoid power the shoulder.
Most patients regain comfortable functional reach and, crucially, pain relief; overhead range varies between individuals.