Reverse Total Shoulder Arthroplasty
Reverse total shoulder arthroplasty (rTSA) is a specialized shoulder replacement procedure that fundamentally redesigns the mechanics of the joint. Unlike a conventional total shoulder replacement — which requires an intact rotator cuff to function — reverse shoulder arthroplasty is specifically engineered to restore shoulder function in patients who have both severe arthritis and an irreparable rotator cuff tear or other conditions that make a standard replacement unsuitable.
How Reverse Shoulder Replacement Works
In a normal shoulder, the ball sits on the humerus (upper arm) and the socket is on the scapula (shoulder blade). In a reverse replacement, this geometry is inverted: a metal ball (glenosphere) is fixed to the scapula, and a polyethylene socket (humeral cup) replaces the top of the humerus. This reversal shifts the center of rotation of the joint medially and inferiorly, dramatically changing the leverage of the deltoid muscle. The deltoid — which remains intact in most patients — can then power shoulder elevation even without a functioning rotator cuff.
Indications
Reverse shoulder arthroplasty is indicated for rotator cuff arthropathy (massive rotator cuff tear combined with glenohumeral arthritis), failed conventional shoulder replacement, complex proximal humerus fractures in older patients, severe glenohumeral arthritis with significant bone loss, and certain tumors of the proximal humerus. It has become one of the most commonly performed shoulder procedures in the United States due to its reliable outcomes.
The Surgical Procedure
Dr. Cooper performs reverse shoulder replacement through a standard anterior deltopectoral approach. The worn joint surfaces are removed and precisely prepared, and the implant components are secured in the scapula and humerus. Component positioning — particularly glenosphere placement and humeral version — is critical to optimizing range of motion and preventing complications such as scapular notching or instability. Dr. Cooper uses advanced pre-operative planning tools and, when indicated, intraoperative guides to achieve ideal implant positioning.
Recovery
Patients wear a sling for four to six weeks following surgery. Physical therapy focuses initially on passive and active-assisted range of motion, then progresses to strengthening exercises. Most patients achieve significant pain relief within weeks of surgery and functional use of the arm for daily activities within three to four months. Maximum benefit is typically reached at six to twelve months post-operatively.
Reverse shoulder arthroplasty consistently delivers excellent pain relief and functional improvement for appropriately selected patients. Contact Dr. Cooper's office to learn whether this procedure may be right for you.
