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, which is why 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, giving the deltoid a longer lever. The deltoid then lifts the arm by itself, and the missing cuff stops mattering. It is a genuinely clever piece of engineering, and it restores overhead function to shoulders that had none.
Who it is for
- Cuff tear arthropathy, arthritis in a shoulder with a long-standing, irreparable rotator cuff tear
- 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 tends to be an operation for older patients, and the age matters: the implant has a finite life and reversed shoulders are harder to revise than standard ones.
What the operation involves
It takes roughly one and a half to two and a half hours, under general anaesthesia usually combined 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.
Hospital stay is typically two to four days, and the arm is protected in a sling for the first few weeks.
This was a substantial part of Dr. Khanna's shoulder fellowship at Seoul National University Bundang Hospital, Seoul.
What to expect afterwards
Pain relief is generally excellent and arrives early, and it is usually the first thing patients notice. Raising the arm forwards and out to the side improves considerably.
Rotation is the honest limitation. Reaching behind your back, and rotating 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 remain 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 permanently, typically nothing much above five kilograms with that arm, because loading the implant hard shortens its life.
Risks worth knowing about
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 are the main concerns. Revision surgery, if it is ever needed, 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 has not responded to anything else.
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, and that is expected rather than 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 genuinely extends it.
Can I sleep on that side afterwards?
Not for the first several weeks. Most patients can return to it later, though some find it stays uncomfortable.
Not sure whether you need this?
That is the right question to bring to a consultation. Second opinions on surgery already advised elsewhere are a routine part of the practice. Bring your imaging and any plan you have been given.
Not sure this is your problem?
These start from the symptom rather than the operation, and cover what else can cause it and what gets tried first.