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

Total shoulder replacement and reverse total shoulder replacement are two prosthetic procedures often indicated to relieve severe pain or improve compromised mobility. The shoulder is a ball-and-socket joint with the highest range of motion in the body, but it is also particularly vulnerable to injuries. Over time, it can deteriorate due to previous trauma or conditions like osteoarthritis. Both procedures are among the most common replacement surgeries for this joint and require a complex surgical approach.

What is Total Shoulder Replacement?

Total shoulder replacement involves replacing the arthritic parts of the joint with a prosthesis that replicates its natural anatomy. It is performed when the joint is compromised by arthritis, but the rotator cuff is intact, without tears. In these cases, the patient is usually still able to move the shoulder but experiences persistent and deep pain, similar to a toothache that pounds at the center of the shoulder.

During the procedure, the surgeon inserts a metal ball fixed to a stem and a plastic socket, reconstructing the original joint. The socket is positioned in the scapula, while the ball is fixed to the end of the humerus. Prostheses are available in various sizes to ensure the best fit and can be secured with a press-fit technique or bone cement. Since the rotator cuff is intact, it is essential to balance the joint carefully to optimize movement and stability.

Total shoulder replacement has a high success rate, with many prostheses lasting 10 years or more.

What is Reverse Total Shoulder Replacement?

Reverse total shoulder replacement gets its name because, instead of replicating the natural anatomy, it reverses the structure: the metal ball is fixed to the scapula, while the plastic socket is attached to the upper part of the humerus. This requires special attention to the adaptation of the components to ensure stability and functionality.

This procedure is generally indicated for patients with a severely damaged and irreparable rotator cuff, those suffering from severe arthritis, shoulder fractures that cannot be treated with plates and screws, or those who have previously undergone a failed total replacement.

Often, those with a compromised rotator cuff have very limited mobility or are completely unable to move the shoulder. When they try to lift it with the other arm, it tends to fall immediately.
In these cases, reverse total shoulder replacement generally offers better results in terms of mobility and functional recovery.

Should I Undergo Shoulder Replacement Surgery?

If you experience any of the following symptoms, it is important to consult a specialist:

• Moderate to severe shoulder pain.
• Difficulty sleeping due to pain.
• Limited movement, with reduced joint mobility.
• Inability to perform daily activities, such as throwing a ball or lifting your arm above your head.

However, surgery is not always the first treatment option. Non-surgical therapies such as physical therapy, medications, and lifestyle changes can be helpful in alleviating symptoms.

Shoulder replacement is recommended for those who suffer from significant pain or have compromised functionality that does not improve with other treatments. The surgery lasts about two hours, and in most cases, the patient can go home the same day. After the procedure, a brace may be necessary for several days or weeks to protect the joint.

Recovery involves a physical therapy process, which is essential for restoring strength and mobility to the shoulder.

Learn more about our Center of Orthopaedic Prosthetic Surgery.