Reverse Shoulder Replacement

What is a reverse shoulder replacement?

In a normal shoulder, the ball on the end of the arm bone sits in a shallow socket on the shoulder blade, and the rotator cuff tendons hold the ball centered while the deltoid lifts the arm. If the cuff is torn and cannot be repaired, the ball rides up and the deltoid cannot lift the arm effectively.

In a reverse replacement, the usual anatomy is flipped. A metal ball (the glenosphere) is fixed to the socket, and a plastic-lined cup sits on a stem in the arm bone. This moves the center of rotation inward and lengthens the deltoid, which can then power the arm without help from the cuff.

Who is a candidate?

Reverse replacement is most often used for:

• Cuff tear arthropathy, arthritis that develops after a long-standing large cuff tear
• Massive rotator cuff tears that cannot be repaired, especially when the arm cannot be lifted (pseudoparalysis)
• Shoulder arthritis combined with a damaged or absent rotator cuff
• Complex fractures of the upper arm bone in older patients
• A failed earlier shoulder replacement or failed rotator cuff surgery

It is generally recommended for people aged about 65 or older, though it is sometimes used in younger patients with no other good option.

What symptoms lead to this surgery?

Typical symptoms are deep aching pain, especially at night, a weak arm that is hard to raise, a shoulder that is stiff or grinding, and trouble with everyday tasks like combing hair, reaching a shelf or getting dressed. Many people have lived with these problems for years before seeing a surgeon.

What can I try first?

Many people with cuff tear arthritis can keep going with non-surgical care for a long time. Options include activity changes, anti-inflammatory medicine, a physical therapy program focused on the deltoid and the muscles around the shoulder blade, and image-guided cortisone injections for flares. Surgery is considered when pain and loss of function remain after these measures.

What happens in surgery?

Surgery takes about one to two hours under general anesthesia with a nerve block. Dr. Stepanyan removes the ball of the arm bone, prepares the socket, fixes the metal glenosphere to the shoulder blade, and places a stem and cup in the arm bone. Most patients stay one night, and some go home the same day.

What outcomes can I expect?

Pain relief is usually reliable, and most patients regain the ability to lift the arm in front of them and to do everyday tasks.

Rotation, especially reaching behind the back, may be limited afterward. Expectations differ from patient to patient, and Dr. Stepanyan will discuss yours.

What are the risks?

Risks include infection, dislocation of the new joint, fracture of the shoulder blade or the bone around the stem, nerve injury, bone loss at the edge of the socket (scapular notching), and loosening over time. Most are uncommon. Because the operation is larger than a cuff repair, it is reserved for situations where other treatments are unlikely to work.

Should I get a second opinion?

If you have been told you need a shoulder replacement, or that nothing can be done for a large cuff tear, a second opinion is reasonable. Request a visit and bring your X-rays, MRI and any operative notes.

Where can I see Dr. Stepanyan?

Dr. Stepanyan sees shoulder patients in Glendale, East LA and Santa Fe Springs. He operates at Adventist Health Glendale, Glendale Memorial Hospital, Adventist Health White Memorial and White Memorial Montebello, Providence Saint Joseph Medical Center and Avalon Surgery Center.

What does recovery look like?

These are typical stages after a reverse shoulder replacement. Your own plan from Dr. Stepanyan and your therapist may differ.

1. Weeks 0–6

   Protect the joint

   You wear a sling at most times and take it off for exercises and hygiene. Elbow, wrist and hand motion starts right away, with gentle passive shoulder motion guided by your therapist. You avoid reaching behind your back and lifting.

2. Weeks 6–12

   Restore motion

   The sling comes off. You begin active motion and use the arm for light daily tasks at about waist to chest height.

3. Months 3–6

   Build strength

   Strengthening for the deltoid and the muscles around the shoulder blade begins. Most daily activity feels comfortable, and driving is usually resumed once you are off narcotic pain medicine.

4. Months 6–12

   Full recovery

   Strength and motion continue to improve for up to a year. Dr. Stepanyan will give you lifelong lifting guidelines to protect the implant.

Because reverse replacements place different demands on the shoulder, follow the specific restrictions you are given, especially early on.