Anatomic vs. Reverse Shoulder Replacement

Think back to the golf ball analogy.

The golf ball represents the ball of your upper arm.

The tee represents the socket.

In an anatomic shoulder replacement, we simply replace the worn ball with a smooth metal ball and replace the worn socket with a new plastic socket.

Everything stays in its normal position.

This operation works extremely well when the rotator cuff is healthy because those tendons continue balancing the shoulder exactly as nature intended.

In a reverse shoulder replacement:

• The ball is attached to the shoulder blade
• The socket is attached to the upper arm bone

This completely changes the mechanics of the shoulder.

Instead of depending on a damaged rotator cuff, the operation allows the large deltoid muscle to lift the arm.

That is why reverse shoulder replacement has been one of the biggest advances in modern shoulder surgery.

A reverse shoulder replacement is commonly recommended for:

• Rotator cuff arthropathy
• Massive irreparable rotator cuff tears
• Complex shoulder fractures
• Certain revision shoulder replacements
• Some failed previous shoulder surgeries

If the rotator cuff cannot reliably stabilize the shoulder, an anatomic replacement often will not function well.

The reverse design solves that problem by allowing the deltoid muscle to become the primary elevator of the arm.

Many patients become worried when they hear the word "reverse."

They assume it means, "My shoulder must be terrible."

That isn't true.

Reverse shoulder replacement was specifically designed for shoulders that cannot be successfully treated with a traditional replacement.

In those situations it often produces outstanding pain relief and function.

The goal is not to perform the simpler operation.

The goal is to perform the correct operation.

Modern shoulder replacements are expected to function well for many years.

Longevity depends on:

• Implant positioning
• Bone quality
• Activity level
• Overall health
• Surgical technique

For most patients, both operations provide many years of pain relief and improved function.

Pain relief is the most predictable benefit of shoulder replacement.

Motion often improves dramatically.

However, the amount of motion depends on:

• Preoperative stiffness
• Rotator cuff function
• Muscle strength
• Bone quality
• Commitment to rehabilitation

The goal is functional motion.

Not perfect motion.

Most patients return to:

• Light weight training
• Resistance bands
• Fitness activities
• Golf
• Swimming
• Gardening

Heavy repetitive overhead lifting should generally be avoided to maximize implant longevity.

Potential risks include:

• Infection
• Stiffness
• Fracture
• Instability
• Nerve injury
• Implant loosening
• Persistent pain
• Need for future revision surgery

Fortunately, serious complications are uncommon.

Before surgery we'll discuss your individual risks and answer every question you have.

Choosing between anatomic and reverse shoulder replacement requires evaluating:

• Your X-rays
• Your MRI or CT scan when appropriate
• Your rotator cuff
• Bone quality
• Motion
• Age
• Goals

The operation is individualized.

There is no one-size-fits-all solution.