Reverse shoulder replacement may be considered when shoulder pain and loss of function are significantly affecting your ability to perform everyday activities, particularly when the rotator cuff is no longer functioning effectively.
Tears that cannot be repaired due to size, retraction, or poor tissue quality
Particularly where fracture patterns or bone quality limit reconstruction options
Including unsuccessful rotator cuff repairs or prior shoulder replacements
Where both joint surfaces and supporting soft tissues are compromised
Careful assessment and detailed pre-operative planning play an important role in reverse shoulder replacement surgery. The aim is to understand the structure of your shoulder, the condition of the bone and surrounding muscles, and how these factors may influence both the surgical approach and expected outcomes.
Your shoulder function is assessed through a detailed physical examination. This includes evaluating:
Imaging is used to assess the underlying anatomy and guide surgical planning. This may include:
In some cases, more advanced planning techniques may be considered as part of shoulder replacement surgery. This can include the use of detailed 3D imaging and, in selected situations, custom-designed surgical guides or implants tailored to your individual shoulder anatomy. These approaches may be helpful where there is significant bone loss, deformity, or previous surgery that has altered the normal structure of the joint.
Not all patients require this level of planning. The decision to use customised techniques depends on your individual anatomy and the complexity of your condition.
Pre-operative planning involves determining the size, position, and orientation of the implant components based on your individual anatomy.
This process may include:
Each reverse shoulder replacement is planned individually. Factors such as your anatomy, previous surgeries, and the condition of your rotator cuff and bone will influence:
Pre-operative planning involves determining the size, position, and orientation of the implant components based on your individual anatomy before the actual surgery. More accurate implantation can reduce complications such as early wear or dislocation and achieve a higher range of motion.
3D computer-based planning of an individual’s shoulder replacement has been standard of care in Mr. Dallalana’s practice since 2013, and this was one of the first centres in the world where this was being conducted.
Data from the CT scan is used in a 3D computer design program to create a digital image of the patient’s shoulder on which the surgery is completely performed. From this result, tools are available to guide the surgery so that the position of the prosthesis and the bone cuts are millimetre perfect. They help replicate during the surgery the images of the prosthetic component position created on screen.
Tools to help accurately execute the surgery include:
These are single-use instruments to guide the bone cuts and preparation for shoulder replacement component implantation, and then discarded.
Small cameras are placed on the bones and on the surgical tools such as drills and saws to guide the procedure in real time according to the previously planned component position.
In these cases, a robotic arm is used to make some of the cuts in the bone required.
These advanced technologies also allow fashioning of shaped bone grafts if required in advanced cases and, are the basis of fully customised prosthetic implant manufacture in very complex cases.
Motion studies of the digital images can predict a patient’s movement range after the surgery.
Reverse shoulder replacement and anatomic shoulder replacement are both procedures designed to address shoulder pain and dysfunction however, they are used in different clinical situations and rely on different biomechanics to restore movement.
In an anatomic shoulder replacement, the prosthesis replicates the natural anatomy of the shoulder:
This approach relies on a functioning rotator cuff to stabilise and move the joint.
In contrast, a reverse shoulder replacement changes the orientation of the joint:
This reversed configuration allows the shoulder to function differently, particularly when the rotator cuff is no longer able to perform its role.
The key distinction between the two procedures is how the shoulder generates movement.
This makes reverse shoulder replacement a more suitable option in cases where the rotator cuff is severely damaged or irreparable.
Each procedure is typically recommended for different conditions:
Anatomic shoulder replacement may be considered when:
Reverse shoulder replacement may be considered when:
Selecting the appropriate type of shoulder replacement is important in achieving a stable and functional outcome. Using an anatomic replacement in the absence of a functioning rotator cuff may result in ongoing weakness or instability, whereas a reverse shoulder replacement may provide improved function in these situations.
The decision between these procedures is based on a combination of structural findings, muscle function, and overall shoulder mechanics.
On the day of your reverse shoulder replacement, you will be admitted to hospital and prepared for theatre.
This typically includes:
You will be guided through each step by the hospital team to ensure you are comfortable and well-informed.
Reverse shoulder replacement is usually performed under a general anaesthetic, often combined with a regional nerve block.
This combination may help reduce discomfort in the early post-operative period and support a more comfortable initial recovery.
Following the procedure, you will be taken to the recovery area where your condition will be closely monitored as you wake from anaesthesia.
You can expect:
Once stable, you will be transferred to your hospital room.
Your hospital stay will vary depending on your progress, but most patients remain in hospital for two nights
During this time:
The aim during this phase is to ensure you are comfortable, medically stable, and confident with early post-operative care before returning home. Transition to inpatient rehabilitation can be arranged if supports at home are lacking and self-care remains difficult.
It is normal to experience some discomfort following surgery, particularly as the nerve block wears off.
Pain management may include:
Pain levels vary between individuals, and your care team will adjust your pain management plan as needed to support your recovery.
In the initial phase after surgery, the focus is on pain control, wound protection and development of initial movement and basic use of the arm
During this time, you may need assistance with some daily activities such as dressing, bathing, and household tasks.
Rehabilitation focuses on gradually restoring movement and beginning to rebuild strength.
This phase includes:
In the later stages of recovery, the aim is to improve strength, coordination, and functional use of the shoulder.
Gradual ongoing improvement in function and general comfort is seen up to 12 months following surgery.
Heavier lifting, repetitive overhead activity, or high-impact use of the shoulder may need to be modified or avoided, depending on your individual circumstances.
Most patients are able to return to many everyday activities following reverse shoulder replacement, although the level of function achieved can vary.
Activities that may gradually resume include:
Heavier lifting, repetitive overhead activity, or high-impact use of the shoulder may need to be modified or avoided, depending on your individual circumstances.
Reverse shoulder replacement is a well-established procedure that may help improve shoulder function and reduce pain in appropriately selected patients. As with all surgical procedures, there are potential risks and complications that should be understood before proceeding. During your consultation, Dr Dallalana will discuss these risks in the context of your individual shoulder condition, overall health, and treatment goals to support informed decision-making.
Risks associated with most surgical procedures include:
Measures are taken before, during, and after surgery to reduce these risks, including sterile surgical techniques, peri-operative antibiotics, and careful medical assessment.
Reverse shoulder replacement is typically performed under general anaesthesia, often combined with a regional nerve block.
Complications related to anaesthesia are uncommon and are influenced by overall health and medical history. A pre-operative medical assessment is usually undertaken to help optimise your condition prior to surgery.
Specific risks related to anaesthesia or nerve blocks can be discussed with the anaesthetist before or on the day of surgery.
Infection may occur early after surgery or, less commonly, at a later stage. Management may involve antibiotics or further procedures depending on severity.
Injury to surrounding nerves is very uncommon but may result in temporary or, rarely, persistent weakness or altered feeling in the arm or hand.
Some patients may experience ongoing stiffness or limitations in shoulder movement despite surgery. Rehabilitation plays an important role in optimising outcomes. Significant limitation is uncommon and usually only when the condition of the shoulder before the surgery was very severe.
While many risks are similar to other joint replacement procedures, some considerations are more specific to reverse shoulder replacement due to the altered biomechanics of the joint.
Compared to anatomic shoulder replacement, reverse shoulder replacement has a higher risk of dislocation, particularly in the early post-operative period. This risk may be reduced by implant positioning, soft tissue balance, and adherence to movement restrictions during recovery.
Over time, implant components may wear out or loosen from the bone. Modern implant designs and materials aim to reduce this risk, however long-term outcomes can depend on factors such as activity levels and bone quality.
Fractures of the humerus or scapula may occur during or after surgery, particularly in patients with reduced bone quality. This can be the result of a fall.
Occasionally a stress fracture of the acromion (upper part of the shoulder blade) can occur due to relative thinning of the bone due to prior disuse. This can cause pain and lead to reduced movement, but does not usually require further surgery
Factors that may influence complication risk
The likelihood of complications can vary between individuals and may be influenced by:
Optimising your health prior to surgery and following post-operative guidance may help reduce risk.
Recognising potential complications after surgery
You should seek medical review if you experience:
Early assessment allows timely management if complications arise.
For many patients, reverse shoulder replacement may provide meaningful improvements in shoulder function and daily activity when carefully selected. The decision to proceed with surgery involves balancing the potential benefits with the risks, based on your individual condition. Dr Dallalana will discuss expected outcomes, potential risks, and alternative treatment options with you to support a considered and informed decision.
Pain relief is reliable, to either a totally pain-free shoulder, or one with a mild ache or a catching sensation in certain positions. Night pain should resolve.
The degree of movement achieved can vary, and while many patients regain excellent elevation and rotation of the arm, full restoration of normal shoulder movement is not always expected. Reaching behind the back is a difficult shoulder movement to regain, and this is not always possible after reverse replacement.
Patients with more complex conditions or previous surgeries may have different expectations compared to those undergoing a more simple procedure.
Modern reverse shoulder replacement implants are designed to be durable and perform well over time. Implant longevity varies and may be influenced by:
While many implants function well for many years, some patients may require further surgery in the future due to wear, loosening, or other factors.
Long term data collection in many countries demonstrates that around 5% of patients will require a repeat surgical procedure by 10 years. The vast majority of patients will have a reverse replacement which lasts for 20 years.
Following full recovery, patients are able to return to all normal daily activities, and most recreational activities or sports.
Activities involving heavy lifting, repetitive overhead use, or high-impact forces may need to be modified or avoided to help protect the joint over time. These need to be individually discussed.
Regular follow-up appointments are important to monitor the function of the shoulder and the condition of the implant over time.
These reviews allow:
Usual review times by Dr. Dallalana are at 2 weeks, 3 months and 12 months following surgery.
Reverse shoulder replacement aims to improve comfort and restore functional movement, rather than replicate a completely normal shoulder. Understanding the expected outcomes and limitations of surgery can help support a positive recovery experience and long-term satisfaction with the procedure.
A thorough assessment of your symptoms, shoulder function, imaging findings, and treatment goals helps determine whether reverse shoulder replacement may be appropriate. This procedure is typically considered when the rotator cuff is not functioning adequately, bone stock is diminished, and other treatments are unlikely to restore shoulder movement.
Anatomic shoulder replacement replicates the natural joint and relies on a functioning rotator cuff for stability and movement.
Reverse shoulder replacement changes the joint mechanics such that it is no longer reliant on a functioning rotator cuff, with stability conferred by a more constrained ball and socket articulation, and movement upwards performed by the deltoid muscle.
Neither procedure is universally better. They are primarily designed for different shoulder conditions – anatomic for arthritis with an intact rotator cuff, reverse for a deficient rotator cuff or distorted bone structure. The most appropriate option depends on rotator cuff function, bone quality, and individual goals, age and activity levels.
Non-surgical treatments are usually considered first and may include:
These approaches may help manage symptoms but may not restore function in advanced cases.
In some cases, surgery can be safely delayed while symptoms are managed conservatively. However, progressive muscle changes, joint damage, or stiffness may influence future treatment options. Regular review can help guide the timing of surgery.
Some discomfort is expected after surgery, particularly in the early stages. Pain is managed using a structured approach, often including a nerve block and oral medications. Pain typically improves quite rapidly as healing progresses. Most patients are comfortable by 2 weeks following surgery for daily living.
Hospital stay is usually short, commonly 2 days, depending on your recovery and support at home.
Physiotherapy begins on the first day. Early rehabilitation focuses on gentle, protected movement, with progression guided over time.
Driving is usually resumed once the sling is no longer required and you can safely control the vehicle. This is often around 6 weeks, but timing varies between individuals.
Return to work depends on your role. Sedentary / office work, particularly from home, may be possible within days. Physically demanding roles may require 3 to 6 months of recovery.
Reverse shoulder replacement aims to improve functional movement rather than restore completely normal shoulder motion. Many patients regain the ability to lift the arm high and perform daily activities, although some limitations may remain.
Most daily activities can be resumed over time. However, heavy lifting, repetitive overhead use, and high-impact activities may need to be modified to help protect the joint.
This procedure is commonly performed to improve comfort and the ability to perform everyday activities when shoulder function is significantly limited.
Modern implants are designed for long-term use. Longevity varies depending on factors such as activity level, bone quality, and implant positioning. Revision surgery is needed in only around 5% of cases by 10 years. The majority will last 20 years or more.
Most patients do not require additional surgery, although revision procedures may be needed in some cases due to wear, loosening, or complications over time.
Age alone does not determine suitability, however very young and physically active patients will wear the joint out a little more quickly and as such a higher percentage of young patients will require repeat surgery. Reverse shoulder replacement is more commonly performed in older patients but may be considered in selected younger individuals depending on their condition.
Potential risks include infection, instability or dislocation, implant loosening, nerve injury, and fracture. These risks are discussed in detail prior to surgery.
Patients commonly ask about:
Costs vary depending on hospital, surgeon, prosthesis, anaesthetic, and individual insurance cover. A detailed estimate is provided prior to surgery.
Yes, surgery may be performed as a self-funded procedure in the private system. A detailed cost breakdown, including expected Medicare rebates, is provided in advance.
Consider factors such as:
Support is helpful in the early recovery period, particularly with:
Implants may occasionally activate scanners. You can inform security if required. A letter can be provided for this.
Travel is generally possible once you are comfortable and able to manage the journey. Travel plans should be discussed to ensure they align with your recovery. After the first few days there is no medical reason not to travel, including by plane. There is no additional risk of blood clots after the first few days.
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