Reverse Total Shoulder Replacement

Shoulder replacement is one of the most recommended surgical procedures for patients who have arthritis or shoulder fractures. However, conventional shoulder replacement surgery is not as effective for patients with complex rotator cuff tears. This is because of an increased risk of pain and limited shoulder motion for the patients.

Dr. Christopher R. Sforzo recommends reverse total shoulder replacement as an alternative for rotator cuff tear and arthritis. Read on for an overview of our procedure, our shoulder replacement protocol, potential complications, and frequently asked questions about the procedure.

What Is a Total Reverse Shoulder Replacement?

It is a surgical procedure involving a reverse of the socket and shoulder ball from their natural position. In the reverse shoulder replacement, the metal ball goes into the socket of the shoulder joint while they attach the plastic cup to the humerus (bone of the upper arm). Dr. Christopher R. Sforzo is board-certified, fellowship-trained, in diagnosing and treating such types of shoulder replacement problems.

When Is a Reverse Shoulder Replacement Needed?

A reverse replacement of the shoulder joints is essential for patients with an extreme tear of the shoulder muscles. This includes cuff tear arthropathy, or where surgery for arthritis or fracture management cannot yield a positive outcome. The rotator cuff normally holds the shoulder in place.  If the torn shoulder is unstable a traditional replacement will not work.

In a normal shoulder replacement, the muscles and tendons attach to the shoulder blade to make the shoulder joint intact. But sometimes, the tendons are extremely torn and they can barely attach to the shoulder bone. This causes severe destruction of the shoulder joints and irreparable loss of the rotator function that requires a reverse operation.

In addition, you may require a reverse shoulder surgery if you have the following symptoms:

  • A chronic dislocation on your shoulder
  • Severe pain on your shoulder or difficulty when you lift your arm above your head
  • An unsuccessful shoulder replacement
  • A tumor on your shoulder joints
  • Failed medications, injections, or physical therapy to relieve shoulder pain

Reverse Shoulder Replacement Protocol

A reverse surgery is like a normal shoulder operation, with only a few differences regardless of the condition, your surgeon will guide you through the process. Below are the basic steps followed by our proficient doctors during the procedure of reverse shoulder replacement:

Medical Evaluation

Dr. Sforzo first medically reviews your physical, mental, and general health. This determines if you are healthy enough for the surgery and able to walk through the recovery process. Chronic conditions such as cardiovascular complications may require review by our specialist.

Medication Review

Before your surgery, Dr. Sforzo will discuss with you any medications you currently take. You may stop using certain medications 2 weeks before the surgery since they may lead to excessive bleeding. They include medication for arthritis, blood thinners, and non-steroidal medications such as ibuprofen and aspirin.

Preoperational Preparation

On the appointed day,  you will arrive at the hospital or surgery center. Then, you will be taken to the preoperational room, where you will be advised on the best anesthesia to use. The anesthesiologist will administer general anesthesia, regional, or a combination of both, to reduce pain during the procedure. Regional anesthesia puts just the arm to sleep.  The patient then can have very mild anesthesia so they don’t remember but makes the procedure very safe.

Surgical Procedure

During the procedure, our seasoned surgeon makes an incision in front of your shoulder. The surgeon then separates the muscles.  This enables the surgeon to remove the damaged part and fix the new components to restore your shoulder mobility.

The replacement parts are fixed solidly to your bones to allow for early motion.  The incision is then closed and you are on your way to recovery.

Reverse Shoulder Replacement Surgery Rehabilitation

Rehabilitation and recovery after the surgical operation is a gradual process that may last a few months before you have complete comfort and regain full muscle function. Upon discharge from the hospital, you will wear a sling on your arm to relieve pressure from the surgical site and promote soft tissue healing.

Although the process is home-based, our doctor may still recommend occasional X-rays and office visits to monitor your healing progress. In addition, our surgeon may recommend simple motion exercises to enhance your shoulder mobility and increase endurance.

Below are common physical therapy exercises that are recommended by our doctors after a reverse total shoulder replacement:

Passive Shoulder Flexion

To begin this exercise, put your hands on top of a chair or bench at waist level. While keeping your arms straight and stepping a little backward, slightly bend until you feel a stretch on your shoulders. Hold this position gently for at least 10 seconds and repeat it five times.

Passive Pendulum

In this workout, you allow your operated arm to fall from your body with your waist bent slightly forward. For better results, aim for an angle of 90 degrees between your arm and body. Try to maintain this position for at least ten seconds and repeat the whole procedure five times.


This exercise allows you to stretch your shoulders and your back after removing the sling. The workout involves rolling your shoulders gently and squeezing the shoulder blades together for some time. You can hold the position for at least 10 seconds and repeat each procedure at least five times.

Passive External Rotation

In this workout, you bend your elbows at a 90-degree angle while keeping your arms across the front part of your waist. You can then use a stick or the other arm to push the operated arm away from the body until you feel a gentle stretch. Hold this position for at least five seconds and have five repetitions.

Reverse Shoulder Replacement Risk and Complications

Reverse shoulder replacement is a highly technical procedure performed by specialized orthopedic surgeons at Sforzo, Dillingham, Stewart Orthopedics + Sports Medicine. Despite this, significant risks and complications may still occur after the surgery. Here, our surgeon will help you understand the risks or complications before surgery.

You may experience the following complications after a shoulder replacement:


An infection may occur in the operated area, prompting the removal of the prosthesis. Sometimes our medical practitioners may use antibiotics or surgical cleansers to disinfect the affected area. In rare situations, chronic infection may require further surgery to achieve relief.


A dislocation of the prosthesis can occur if the humerus separates from the ball after the surgery. This means the two parts of the prosthesis become detached from each other, hence require immediate fixing by the surgeon.

Other rare complications include blood clotting on the legs, anesthetic reaction, numbness, tingling sensation, nerve damage, and injury to the blood vessels. Complications do occur but the likelihood of a complication is extremely low.

Reverse Shoulder Replacement Surgery Prevention

You can enhance your health before and after surgery by observing important precautions. This is because, after the surgery, you will wear a sling that will limit your normal arm function.

Simple home adjustments will also come in handy to help you resume a normal life. For instance, you may need help in doing routine activities like bathing, cooking, and laundry. It is only for a few weeks after the surgery, so you shouldn’t worry about it.

Below are major precautions Dr. Sforzo suggests to observe after a surgery:

  • In the first six weeks after surgery, avoid arm positions that may put pressure on your operated shoulder. An example is when you stretch your arm to the side of your body.
  • If you can do some strenuous activities, do not overdo to extremity
  • Ensure you follow the physical therapy program prescribed by your doctor
  • During the first six weeks after your surgery, do not lift a load weighing over five pounds
  • Do not use your arm for support when rising from the bed or chair, as it may contract your shoulder muscles

Reverse shoulder replacement therapy is one of the most effective procedures to help patients find relief from chronic shoulder pain. With an 80%-90% success rate, its benefits cannot be overemphasized. If you have persistent chronic pain in your shoulder joints, consult our doctor, Dr. Christopher R. Sforzo for advice on reverse shoulder replacement.


How long does it take to recover from reverse shoulder replacement?

The path to a full recovery after a surgical replacement may be fairly long; hence it requires patience and care. Many patients go directly home after surgery or stay just one night in the hospital.  

Two weeks later, you’ll easily perform gentle, routine activities using your operated arm. However, you may not drive a vehicle until after being cleared by your doctor.  Typically this is about 4 weeks after surgery.  With your doctor’s consent, you may resume additional activity after 3 months. However, full recovery may come after 6-9 months.

What is the difference between a shoulder replacement and a reverse shoulder replacement?

Reverse shoulder replacement is  performed in the same manner as a normal shoulder replacement.  However,  the doctors attach a metal ball to the humerus head while a plastic piece replaces the socket. The major difference is that, unlike a standard shoulder replacement, a reverse procedure changes the position of the shoulder ball and sockets.

How painful is reverse shoulder replacement?

During the actual procedure, you may not feel pain since you’ll have an injection of an anesthetic that causes numbness or induces you to sleep. However, after the procedure, you may feel the pain that forms part of the healing process.

The doctors at Sforzo l  Dillingham l Stewart Orthopedics + Sports Medicine are quite knowledgeable and utilize a multimodial pain approach.  The use of multiple drugs to control pain is very effective and keeps patients very comfortable.  

Is reverse shoulder replacement a major surgery?

A reverse shoulder replacement is a fairly simple procedure that lasts for about two hours.  It is a major surgery that can provide excellent relief of pain for many patients. 

Focusing On You

As healthcare is ever changing, Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, is doing things differently…

  • About Christopher R. Sforzo, M.D. Christopher R. Sforzo, M.D. is a board certified orthopedic surgeon and fellowship trained in hand and upper extremity surgery. He provides expert care in the treatment of problems involving the shoulder, arm, elbow, forearm, wrist and hand. He performs many procedures using mini
  • About Christopher L. Dillingham, M.D. Christopher L. Dillingham, M.D. is a board certified orthopedic surgeon and fellowship trained in hand, shoulder, and arm surgery. He specializes in the treatment of problems with rotator cuff disorders, carpal tunnel syndrome and nerve injury, joint replacement, arthritis sur
  • About Charles E. Stewart, M.D. Charles E. Stewart M.D. is a board-certified, Johns Hopkins fellowship-trained orthopedic surgeon specializing in adult complex reconstruction of the lower extremity.  His specialties include lower extremity sports injuries, meniscal injuries, ACL reconstruction, partial knee replacement,
  • About Philip A. Meinhardt, M.D. Philip A. Meinhardt, M.D. is a board certified orthopedic surgeon and fellowship trained spine surgeon. He specializes in adult spinal surgeries including reconstruction of spinal deformities, minimally invasive/microscopic spinal procedures, decompression, spinal instrumentation, fusion



After tearing my rotator cuff, not only was I experiencing pain but my quality of life was diminished. Playing golf and working out were painful rather than enjoyable. Graci and I sought out Fellowship trained Dr. Christopher Sforzo and the team at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine. I was treated non-surgically and am now pain free, mobile and enjoying everything I did before.

- Dennis and Graci McGillicuddy

As avid golfers and tennis enthusiasts, our rotator cuff injuries left us in pain, and unable to enjoy our sport. In researching for the most qualified surgeons, we found that Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine not only had the highest level of training and experience, but they were also highly recommended by friends and associates who had excellent results. We, too, had outstanding…

- Mike Wilton, Bud Polley and Arnie Vance

I was visiting the area looking at property and considering a full time re-location from Minnesota when I was in a traffic accident. The result was a very painful shoulder injury that would ultimately require bilateral RTC repairs. I was unable to undertake regular day-to-day activities or participate in my favorite sport – tennis. It was essential that I choose a shoulder specialist that could quickly set…

- Pat Cooper

Over the years we had seen several orthopedists in town but were never impressed. They seemed to lack knowledge or compassion or both. Then when Liza was in high school, she went to Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine for a minor sports injury. They not only diagnosed her somewhat obscure problem, but explained things in a way that she understood without being patronizing…

- Liza, John and Betsy Kane-Hartnett

As a very busy business owner in Sarasota, having not one, but two, massive rotator cuff tears had a debilitating effect on both my personal and professional life. From my first consultation with Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, I knew I was in good hands. The surgeons are board-certified and fellowship-trained, which gave me the confidence in achieving a successful outcome. More importantly,…

- Bob Kirschner

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