X-Ray showing a reverse total shoulder replacement.

X-Ray showing a reverse total shoulder replacement implant overlying a shoulder X-Ray

What is a reverse total shoulder?

Picture of a reverse total shoulder arthropalsty implant. Notice the ball is where the socket used to be and the socket is where the ball used to be.

A reverse total shoulder replacement is a procedure performed in which the surgeon changes the "ball" and "socket" and reverses them.  Although it sounds odd, the procedure is designed for patients who have severe arthritis in the setting of a chronic or irreparable rotator cuff tear. 
The implant is effectively a "backwards" shoulder replacement.  It has become a major staple in the treatment of shoulder arthritis over the last 15 years and will likely remain that way for the years to come.

Who can get a reverse total shoulder replacement?

Seems odd. Take a well designed ball and socket design and alter it.  Well, luckily, there is a pretty good explanation as to why we do this procedure.  With a massive rotator cuff tear, the arm is commonly unable to be abducted (lifted up from the side).  This is due to the fact that the rotator cuff muscles elevate the arm.  When the rotator cuff is torn, chronically, it becomes non functional.  The normal head of the humerus (shoulder ball) starts to "ride" upwards, making it lose its central position on the socket and migrate superiorly (upwards).  By doing this, the arm loses its normal leverage ability to lift and no longer functions properly.  Over a long time frame, this rotator cuff tear leads to a severe form of arthritis called rotator cuff arthropathy. 

Picture displaying rotator cuff arthropathy. Notice how the ball is sitting adjacent to the acromion and there is no space (white arrow). to allow mobility of the shoulder.

How do I know if I am a candidate?

Picture identifying patient selection criteria for a reverse total shoulder replacement.

There are many patients who are candidates for the reverse total shoulder replacement.  The ideal candidate is someone aged over 60 years old with a chronic, irreparable rotator cuff that has severe arthritis of the shoulder.  This ideal patient has been identified through significant amounts of research and is the most likely to have an excellent result from the surgery.
It is important to know that routine total shoulder replacement differs from reverse total shoulder in that patients with regular shoulder replacements must have rotator cuff function.
There are people who are not candidates for reverse shoulder replacement which include younger patients, patients with infections and people who have severe bone loss in which fixation of the implants is likely to fail.

What to expect after surgery.

Sample picture of a high end sling commonly used for first 6 weeks after shoulder replacement.

So you have decided to undergo a reverse total shoulder replacement.  Now it is time to recover.
While the reverse shoulder replacement provides very early pain relief, the post-operative time period is long and arduous.  Expectations must be managed especially in the early postoperative period. 
For the first 4-6 weeks after surgery, expect to be in a sling with limitations in mobility.  Although surgeon preference, most surgeons prefer to let the implant heal into place prior to placing patients into strenous therapy.
After your first 4-6 weeks in the sling, our doctors will remove the sling and allow you to start formal physical therapy.  The therapy process can last several months as you begin to recover and restore your mobility.

Why so much therapy?

A patient undergoing kinesotaping after reverse total shoulder replacement.

Physical therapy after shoulder replacements is very difficult, especially with reverse shoulder replacements.  Why so difficult?
In order to be a candidate for this procedure, you must understand that the muscles that were used your entire life to lift you arm don't work.  The procedure changes the muscles used to lift the arm and so you must retrain these muscles to lift your arm.