Shoulder
Reverse Shoulder Replacement
A reverse replacement swaps the shoulder's geometry around: the ball is fixed to the shoulder blade and the socket to the arm. That change lets the deltoid muscle lift the arm on its own. So it works in shoulders where the rotator cuff is beyond repair and a standard replacement would fail.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
Why reverse the joint at all
A standard shoulder replacement relies on a working rotator cuff to centre the ball in the socket. Without one, the ball rides upwards and the replacement fails, often quickly.
Reversing the components moves the centre of rotation inwards and downwards, which gives the deltoid a longer lever. The deltoid then lifts the arm by itself, and the missing cuff no longer matters. It is a clever piece of engineering, and it restores overhead movement to shoulders that had none.
Who it is for
- Cuff tear arthropathy: arthritis in a shoulder with a long-standing rotator cuff tear that cannot be repaired
- Massive cuff tears that cannot be repaired, in a shoulder that can no longer be lifted
- Complex fractures of the upper arm bone in older patients, where the bone will not reliably heal
- A previous shoulder replacement that has failed
- Severe arthritis with badly worn or deformed bone
It is mostly an operation for older patients, and age matters here. The implant has a limited life, and a reverse shoulder is harder to revise than a standard one.
What the operation involves
It takes roughly one and a half to two and a half hours, under general anaesthesia, usually with a nerve block for pain relief afterwards. A baseplate and metal ball are fixed to the socket side on the shoulder blade, and a stem with a plastic socket goes into the upper arm bone.
Most people are in hospital for two to four days, and the arm is protected in a sling for the first few weeks.
This was a substantial part of Dr. Ishan Khanna's shoulder fellowship at Seoul National University Bundang Hospital, South Korea.
What to expect afterwards
Pain relief is generally excellent and comes early; it is usually the first thing patients notice. Raising the arm forwards and out to the side improves considerably.
The limitation is rotation. Reaching behind your back and turning the arm outwards often stay restricted, because the muscles that do that work are the ones that were missing to begin with. Fastening a bra, tucking in a shirt or reaching a back pocket may stay awkward.
- Week 0 to 3. Sling, with gentle assisted movement as directed.
- Week 3 to 6. Out of the sling, active movement below shoulder height.
- Week 6 to 12. Raising the arm overhead, light strengthening.
- Month 3 to 12. Steady improvement in strength and function.
Heavy lifting is restricted for good: as a rule, nothing much above five kilograms with that arm. Loading the implant hard shortens its life.
Risks
The main concerns are dislocation of the components, infection, loosening of the baseplate over time, fracture around the implant, nerve injury, and notching of the shoulder blade bone where the arm component contacts it. If revision surgery is ever needed, it is more complex than for a standard replacement.
Set against that, this operation is often done for shoulders that have no other option, and for pain that nothing else has helped.
Common questions
How is this different from a normal shoulder replacement?
The ball and socket are swapped. A standard replacement needs a working rotator cuff; a reverse one does not, because it lets the deltoid do the lifting instead. That is the whole reason it exists.
Will I get full movement back?
Lifting the arm forwards and sideways usually improves a great deal. Rotation (reaching behind your back, turning the arm outwards) often stays limited. This is expected and is not a complication.
How long does the implant last?
Commonly ten to fifteen years or more, depending on age, activity and bone quality. Following the lifting restrictions does make it last longer.
Can I sleep on that side afterwards?
Not for the first several weeks. Most patients can go back to it later, though some find it stays uncomfortable.
Not sure this is your problem?
These pages start from the symptom. They cover what else can cause it and what is usually tried first.
Not sure whether you need this?
Ask it at a consultation, and bring your imaging and any plan you have already been given. Second opinions on surgery advised elsewhere are routine. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.