Total Shoulder Replacement Vs. Reverse Total Shoulder Replacement: What’s the Difference?

Total shoulder and reverse total shoulder are two shoulder replacement surgery options that may be offered to people with shoulder pain or limited range of motion. If you need shoulder replacement surgery, your specific situation will determine which surgical option you’ll need.

The shoulder is a ball-and-socket joint that has a higher range of motion than any joint in your body. Whether you’re lifting your arms above your head, reaching for something, or throwing an object, your shoulder makes it possible.

While your shoulder helps you do a lot, it also is prone to many different types of injuries.

Over time, the joint can become deteriorated due to a prior shoulder injury or a condition like osteoarthritis. You may need shoulder replacement surgery to relieve pain or restore function in your shoulder. About 53,000 Americans get shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality.

Total shoulder and reverse total shoulder are two of the most common replacement procedures.

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What Is Total Shoulder Replacement?

Total shoulder replacement surgery swaps out the arthritic parts of your shoulder joint with prosthetics. You can get the surgery if your joint has arthritis but you have no damage to your rotator cuff.

“The total shoulder is for those patients who have significant arthritis in their shoulder but have a rotator cuff that’s intact and has no tears,” says Ron Campbell, MD, orthopaedic surgeon and interim director, Sports Medicine, UPMC in North Central Pa.

Typical total shoulder replacement procedures involve a metal ball attached to a stem and a plastic socket. The surgeon fits the socket into the shoulder socket and attaches the ball to the top of the upper arm bone (humerus) to match the shoulder’s original anatomy.

The prosthetics come in different sizes to provide the best fit. A surgeon can secure the prosthetic joint either with a press fit or by using bone cement.

Total shoulder replacements have a high rate of success, with many lasting for 10 years or longer.

What Is Reverse Total Shoulder Replacement?

Reverse total shoulder replacement gets its name because instead of replicating the shoulder’s normal anatomy, it does the opposite. Surgeons fix the metal ball to the socket and attach the plastic socket to the top of the humerus.

People with damaged rotator cuffs, fractured shoulders, or a failed prior total shoulder replacement may be candidates for the reverse procedure.

“A reverse is for patients who have bad arthritis with no rotator cuffs, patients who have rotator cuffs we can no longer repair, or patients who unfortunately break their shoulders and cannot be put back together with plates and screws,” Dr. Campbell says.

People with severe rotator cuff damage or a fractured shoulder still may not be able to move their shoulder normally after a typical total shoulder replacement. A reverse total shoulder procedure works better for these people because it relies on different muscles to move the arm afterward.

Total Shoulder Replacement Vs. Reverse Total Shoulder Replacement

Both total shoulder replacement and reverse total shoulder replacement are usually successful in relieving pain and restoring function. Both use metal and plastic prosthetics to replace the arthritic joint. And both have a short recovery time.

How do they differ?

  • The candidates: People with arthritic shoulder joints and intact rotator cuffs get total shoulder replacement surgery. People with severely damaged rotator cuffs, no rotator cuffs, or shoulder fractures get reverse total shoulder replacement.
  • The anatomy: The total shoulder replacement imitates the shoulder’s natural anatomy. The reverse total shoulder replacement flips the anatomy. The ball and socket are reversed.

“The procedures are different, but the complexity varies,” Dr. Campbell says. “With a total shoulder, the rotator cuff is intact, so you have to do a lot of balancing. Whereas with a reverse, you have to do a lot more of deciding how well the components fit together. So it’s a little bit nuanced for both, but that’s why it’s different. But I think both of them are still complex.”

Do I Need Shoulder Replacement Surgery?

You should talk to your doctor about seeing a specialist if:

  • You have moderate to severe shoulder pain or discomfort.
  • Pain is affecting your ability to sleep.
  • You have limited range of motion with your shoulder.
  • You can’t perform typical tasks involving your shoulder, like throwing a ball or lifting your arm above your head.

“A lot of patients with arthritis in their shoulder but who have an intact rotator cuff will have pretty decent motion,” Dr. Campbell says. “But they get this grinding sensation, this deep-seated pain, like a toothache, that just keeps pounding and pounding away in the center of their shoulder.”A lot of times, patients who don’t have a rotator cuff will have limited mobility about their shoulder. They can’t move it, and when they try to move it or lift it up with the other arm, it just drops right back down.”

Shoulder surgery is often not the first treatment option for patients. Nonsurgical options may include physical therapy, medications, and activity modifications.

If you do choose surgery, the procedure lasts for about two hours. Many patients go home the same day. You may need to wear a sling for a few days or weeks after your surgery to avoid putting stress on your shoulder.

As your rehab goes on, physical therapy can help restore the strength and range of motion in your shoulder.

“For my particular patients, a lot of them, they’re just in a sling for a week and after a week they start physical therapy,” Dr. Campbell says. “Physical therapy usually lasts about three months or so, and then they’re back doing most of their activities that they like to do.”

Shoulder replacement surgery isn’t for everyone, but it can be a helpful option for people with significant pain or who can’t function.

UPMC Orthopaedic Care and UPMC Sports Medicine provide care for many different bone, joint, and muscle conditions.

Sources

American Academy of Orthopaedic Surgeons, Shoulder Joint Replacement. Link

American Academy of Orthopaedic Surgeons, Reverse Total Shoulder Replacement. Link

Arthritis Health, Total Shoulder Replacement Surgery. Link

Arthritis Health, The Ins and Outs of a Reverse Shoulder Replacement. Link

About UPMC Orthopaedic Care

When you are dealing with bone, muscle, or joint pain, it can affect your daily life. UPMC Orthopaedic Care can help. As a national leader in advanced orthopaedic care, we diagnose and treat a full range of musculoskeletal disorders, from the acute and chronic to the common and complex. We provide access to UPMC’s vast network of support services for both surgical and nonsurgical treatments and a full continuum of care. Our multidisciplinary team of experts will work with you to develop the treatment plan that works best for you. Our care team uses the most innovative tools and techniques to provide better outcomes. We also are leaders in research and clinical trials, striving to find better ways to provide our patients care. With locations throughout our communities, you can find a provider near you.