Your doctor has recommended a reverse total shoulder replacement — but what is it, exactly? And how can it make your shoulder pain go away?

Here’s a bit of bad news: Depending on your shoulder injury, a total shoulder replacement won’t necessarily eliminate your pain. In traditional total shoulder replacement surgery, the shoulder socket and upper arm bone are replaced with artificial replicas that work just like a normal shoulder socket. However, if you suffer from a large rotator cuff tear, or rotator cuff tear arthropathy, this type of surgery may not help your pain, and it can further limit your range of motion.

But here’s the good news: A reverse total shoulder replacement may be able to help.

What is a reverse total shoulder replacement?

A reverse total shoulder replacement involves reversing the implants so that the socket and metal ball switch places. The ball is implanted into the socket and the plastic is cemented to the upper end of the arm bone.

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“For reverse shoulder replacement surgery, we reverse the components,” said Reza Omid, MD, who is an associate professor of clinical orthopaedic surgery at the Keck School of Medicine of USC and an orthopaedic surgeon at Keck Medicine of USC. “When the rotator cuff is nonfunctional, this prosthesis has to have a different radius of curvature to overcome the loss of rotator cuff function. It is usually used in more severe diagnoses.”

Who needs a reverse total shoulder replacement?

In most cases, patients with severely torn rotator cuffs that cannot be repaired are ideal candidates for this surgery. If you’re a candidate, your doctor will make the diagnosis with the help of a physical exam and X-rays.

Factors that can indicate the need for a total reverse shoulder replacement include:

  • Complex fracture or tumor at the shoulder joint
  • Previously unsuccessful shoulder replacement surgery
  • Severe shoulder pain caused by lifting your arm over your head or away from your side
  • Rotator cuff tear arthropathy
  • Chronic dislocation at the shoulder joint
  • Failed treatments such as physical therapy, medications and cortisone injections

How is the procedure performed?

During a reverse total shoulder replacement, your doctor will remove damaged tissue and bone surfaces and replace them with a plastic socket and metal ball that is attached to a stem. In most cases, the socket is implanted and secured with cement.

Is total reverse shoulder surgery followed by therapy?

Unlike total shoulder replacement surgery, which requires intensive physical therapy, the reverse surgery is more of a salvage procedure, so physical therapy is not as effective and the amount of rotation regained is less than that regained after a total shoulder replacement.

By Heidi Tyline King

Considering surgery? Consult with the specialists at USC Orthopaedic Surgery at Keck Medicine of USC. To schedule an appointment, call (800) USC-CARE (800-872-2273) or visit ortho.keckmedicine.org/patient-information/request-an-appointment.