Reverse Shoulder Arthroplasty

Reverse Shoulder Arthroplasty (RSA) is a surgical procedure used to treat severe shoulder joint damage, particularly when the rotator cuff muscles are torn or non-functional. Unlike traditional shoulder replacement, RSA reverses the normal anatomy of the shoulder: the ball and socket parts of the joint are switched. A metal ball is attached to the shoulder blade (scapula), and a plastic socket is attached to the upper arm bone (humerus). This configuration allows the deltoid muscle to take over the function of the damaged rotator cuff, enabling improved shoulder movement and pain relief.

The need for RSA usually arises in patients with complex shoulder problems, such as massive, irreparable rotator cuff tears, severe shoulder arthritis (cuff tear arthropathy), failed previous shoulder surgeries, or complex fractures in the shoulder. These conditions can result in pain, weakness, and a significant loss of shoulder mobility. When conservative treatments like physical therapy, medications, or injections fail to provide relief, and traditional shoulder replacement is not viable due to rotator cuff deficiency, RSA becomes the preferred option to restore function and reduce pain.

RSA is the treatment of choice for certain shoulder conditions where conventional shoulder replacement is ineffective. During the procedure, the surgeon removes the damaged joint surfaces and reverses the ball-and-socket anatomy to enable the deltoid muscle to power the arm. This approach provides better joint stability and function in the absence of a healthy rotator cuff. RSA helps reduce chronic shoulder pain, improve range of motion, and enhance the quality of life, particularly in elderly or low-demand patients with rotator cuff arthropathy or complex fractures.

Prior to surgery, patients undergo a comprehensive evaluation, including X-rays, CT scans, or MRI to assess joint damage and surrounding tissue condition. The surgeon will discuss the procedure, expected outcomes, and potential risks. Preoperative instructions may include discontinuing certain medications (especially blood thinners), strengthening shoulder and arm muscles through physical therapy, and planning for post-surgery care. Emotional and physical preparation is essential, as recovery requires commitment to rehabilitation for optimal results.

Reverse Shoulder Arthroplasty is typically performed under general anesthesia or regional nerve block. The surgeon makes an incision over the shoulder to access the joint. Damaged bone and cartilage are removed, and the joint is reshaped. A metal ball is fixed to the shoulder blade, and a plastic socket is attached to the top of the humerus. The reversed anatomy shifts joint movement responsibility from the damaged rotator cuff to the deltoid muscle. The procedure generally takes 1.5 to 2 hours. After implant placement, the incision is closed with sutures or staples, and a sterile dressing is applied.

After surgery, patients are monitored in a recovery room before being discharged with specific care instructions. Pain is managed with medications, and the arm is usually placed in a sling for a few weeks. Physical therapy begins within a few days, focusing initially on gentle passive movements. Most patients can perform light activities by 6 weeks, though full recovery may take several months. Driving, lifting, and overhead activities are restricted during the early recovery phase. The recovery timeline can vary depending on patient age, overall health, and the extent of the original shoulder damage.

Rehabilitation is crucial for regaining shoulder strength and function after RSA. Physical therapy progresses from passive to active range of motion exercises, eventually focusing on strengthening the deltoid and other compensatory muscles. Over 3–6 months, patients gradually return to daily activities, with most experiencing significant pain relief and improved shoulder function. Long-term, patients are advised to avoid heavy lifting and activities that strain the shoulder joint. Routine follow-ups are necessary to monitor implant position, joint health, and overall recovery. With proper rehabilitation and care, RSA provides excellent long-term outcomes and patient satisfaction.