As the name implies, this procedure reverses the orientation between the ball and socket as shown in the picture. This has the effect of creating a more stable configuration and giving the deltoid muscle more leverage. The reverse shoulder replacement is classically indicated for patients with arthritis in combination with a rotator cuff tear, those with an irreparable cuff tear without arthritis, or those with failed prior rotator cuff tear that is not suitable for re-repair. It is also used in conventional osteoarthritis with an intact cuff in some older patients (>75 years), patients with severe bone erosion from advanced joint degeneration, failed prior shoulder replacements and certain severe shoulder fractures.
As with an anatomic shoulder, reverse shoulder replacement can lead to substantial improvements in strength and function as well as substantial pain relief. This is a highly technical procedure that requires careful consideration of implant choice and placement and should only be done by surgeons with advanced experience in this procedure. Complications can occur and can be limited by choosing a skilled surgeon with a deep understanding of both the art and science behind this procedures.