REVERSE TOTAL SHOULDER REPLACEMENT

What is reverse total shoulder replacement?

Reverse total shoulder replacement is an advanced surgical procedure specifically designed for patients with rotator cuff tear arthropathy, a condition in which shoulder arthritis occurs together with a large, irreparable rotator cuff tear. Unlike a conventional shoulder replacement, this procedure is uniquely suited to cases where the rotator cuff can no longer function to stabilise the joint.

The shoulder is a ball-and-socket joint formed by the head of the upper arm bone (humerus) and the shoulder socket (glenoid) of the shoulder blade (scapula). The rotator cuff is a group of four tendons that connect the humerus to the deeper shoulder muscles, providing stability and movement to the joint.

When the rotator cuff is torn, the shoulder may become unstable, leading to progressive joint damage and arthritis. In these cases, conventional shoulder replacement surgery is often less effective, as it relies on an intact rotator cuff to function properly.

In a standard shoulder replacement, the metal ball is placed on the humerus and the socket is replaced with a plastic component in the scapula. However, in the presence of a torn rotator cuff, this configuration may lead to implant loosening and poor outcomes.

Reverse total shoulder replacement was developed to overcome this limitation. In this procedure, the positions of the joint components are reversed: the metal ball is placed on the shoulder blade (glenoid), and the plastic socket is placed on the upper arm bone (humerus). This design allows the deltoid muscle to take over the function of the damaged rotator cuff, restoring movement and improving shoulder function.

How is reverse total shoulder replacement different from a standard shoulder replacement?

Reverse total shoulder replacement differs from a conventional shoulder replacement in that the positions of the joint components are reversed. Instead of placing the metal ball on the upper arm bone (humerus), the ball is placed on the shoulder blade (glenoid), and the socket is placed on the humerus. This design allows the deltoid muscle to take over the function of the damaged rotator cuff, making it especially suitable for patients with rotator cuff tear arthropathy.

What are the symptoms of rotator cuff arthropathy?

Patients with rotator cuff arthropathy commonly experience:

• Shoulder pain, often worse at night
• Weakness of the affected shoulder
• Difficulty lifting the arm above shoulder level
• Reduced ability to perform overhead activities
• A history of previous rotator cuff tears or failed repairs

Who is an ideal candidate for reverse total shoulder replacement?

Reverse total shoulder replacement may be recommended for patients with:

• A completely torn rotator cuff that cannot be repaired
• Rotator cuff tear arthropathy
• Severe shoulder pain affecting daily activities
• Difficulty performing overhead movements
• Previous unsuccessful shoulder replacement surgery
• Persistent symptoms despite conservative treatment such as physiotherapy, medication, or injections

How does Dr van Niekerk perform reverse total shoulder replacement?

The procedure involves the following steps:

• Incision – For the injured joint to be seen, Dr van Niekerk will create an incision in the front of the shoulder.
• Removal of damaged bone and tissue – The humeral ball and any weakened or injured rotator cuff muscles will be removed from the shoulder joint by Dr van Niekerk along with other damaged bone and tissue.
• Preparation of the scapula – In order to prepare the scapula, Dr van Niekerk will use screws or bone cement to connect a prosthetic socket to the bone.
• Placement of the humeral component – The prosthetic ball will then be attached to a stem that has been placed inside the humerus. After that, the humeral component will be put into the socket of the scapula.
• Closing the incision – Dr van Niekerk will use sutures or staples to close the incision when the components are appropriately positioned.

What is recovery like after reverse total shoulder replacement?

Patients are usually encouraged to mobilise early and may get out of bed on the day of surgery or the following day. A hospital stay of 1–2 days is typical.

Post-operative recovery includes:

• Use of a sling for several weeks to protect the shoulder
• Pain management with prescribed medication
• Early, guided physiotherapy to restore movement
• Gradual strengthening and mobility exercises
• Avoiding lifting, pushing, or overhead activities during early recovery
• Follow-up appointments with Dr van Niekerk

Full recovery requires patience and structured rehabilitation to achieve the best functional outcome.

What are the benefits of reverse total shoulder replacement?

• Improved shoulder function in complex cases
• Reduced pain
• Restored ability to lift the arm
• Improved quality of life
• Effective option when rotator cuff is not repairable

What are the risks and complications of reverse total shoulder replacement?

As with all surgical procedures, reverse total shoulder replacement carries potential risks, including:

• Infection
• Dislocation or instability of the implant
• Fracture of the humerus or scapula
• Nerve or blood vessel injury
• Blood clots (deep vein thrombosis)
• Wound irritation or delayed healing
• Differences in arm length
• Wear or loosening of the prosthetic components