Upper Limb — Arthroplasty
Reverse Shoulder Arthroplasty (RSA)
Reverse shoulder arthroplasty is a type of shoulder replacement designed for cuff-deficient shoulders. When the rotator cuff cannot be repaired, the implant design allows the deltoid muscle to lift the arm and restore useful function.
When is Reverse Shoulder Arthroplasty Recommended?
This procedure is usually recommended when pain and loss of function persist despite physiotherapy, medicines, or injections, and scans show a rotator cuff that cannot be repaired reliably.
- Cuff tear arthropathy (arthritis with rotator cuff deficiency)
- Irreparable rotator cuff tear with weakness or pseudoparalysis
- Failed prior shoulder surgery or failed anatomic shoulder replacement
- Complex fractures of the proximal humerus in older adults
- Revision surgery where stability and cuff function are poor
If the rotator cuff is intact, patients may do better with anatomic total shoulder arthroplasty. For a broader overview, see our main page on shoulder replacement surgery.
How the Reverse Design Works
In a normal shoulder, the rotator cuff centers the ball in the socket during movement. When the cuff is irreparable, the joint can become unstable and weak. Reverse shoulder replacement changes the geometry so the deltoid has better leverage.
- The ball is placed on the glenoid side
- The socket is placed on the humeral side
- The center of rotation is shifted to improve deltoid efficiency
What patients usually care about: the goal is not “perfect normal,” but predictable pain relief and the ability to raise the arm for daily tasks.
Procedure Overview
- Pre-op evaluation with X-ray/CT; assessment of bone and cuff
- Implant planning to match anatomy and stability needs
- Placement of reverse components, followed by stability testing
- Early physiotherapy with a stepwise rehab protocol
How long does surgery take?
Often around 2–3 hours, depending on complexity (primary vs revision, fracture vs arthritis).
Hospital stay
Many patients stay 1–3 nights, based on pain control and early physiotherapy progress.
Recovery and Rehabilitation Timeline
| Phase | Timeline | Focus |
|---|---|---|
| Protection | 0–3 weeks | Sling, pain control, gentle guided movement |
| Motion | 4–6 weeks | Active-assisted to active range of motion |
| Strength | 6–12 weeks | Deltoid and scapular strengthening |
| Function | 3–6 months | Daily activities; gradual return to light work |
Rehab is deltoid-focused. Your exact timeline depends on diagnosis (arthritis vs fracture vs revision) and bone quality.
Risks and Realistic Expectations
Every major surgery has risks. The key is careful patient selection, precise technique, and rehab compliance.
- Infection, bleeding, or nerve irritation
- Dislocation (especially early if precautions aren’t followed)
- Fracture risk in fragile bone
- Implant loosening over time
- Residual weakness with heavy overhead work
For general patient education, you can also read AAOS information on shoulder replacement here: AAOS — Shoulder Joint Replacement.
Reverse Shoulder Arthroplasty FAQs
Who is a good candidate for reverse shoulder replacement?
Patients with irreparable rotator cuff tears, cuff tear arthropathy, complex fractures in older adults, or failed prior shoulder surgery.
Will I be able to lift my arm overhead?
Most patients regain functional overhead use, but heavy overhead lifting may remain limited.
How long do implants last?
Many implants function well beyond 10 years; longevity depends on bone quality, activity level, and overall health.
Is it better than anatomic shoulder replacement?
It’s better for cuff-deficient shoulders. If the cuff is intact, anatomic TSA may give more natural motion.
When can I return to work?
Desk work may be possible in 2–4 weeks. Physical work typically needs longer and depends on recovery progress.
Book a Consultation
If you’re considering reverse shoulder arthroplasty, a consultation helps confirm diagnosis, implant choice, and a clear recovery plan.