- SPECIALIST ORTHOPAEDIC SURGEON | MELBOURNE, VIC | ALBURY NSW |
- 03 9421 6133
Reverse Shoulder Replacement
Restoring shoulder function when traditional replacement isn’t suitable
Reverse shoulder replacement (also known as reverse total shoulder arthroplasty) is a specialised type of joint replacement surgery used to treat complex shoulder conditions. It is most commonly recommended when there is severe or irreparable rotator cuff damage, rotator cuff arthropathy (a combination of arthritis and cuff tearing), or a previously failed shoulder surgery.
The procedure is called a “reverse” because it changes the position of the joint components: the ball-shaped implant is placed where the shoulder socket (glenoid) once was, and the socket is positioned where the humeral head used to be. This reversed design shifts the mechanics of the shoulder, allowing the deltoid muscle to take over much of the work normally done by the rotator cuff. By relying on the deltoid instead of the torn rotator cuff, reverse shoulder replacement may help restore shoulder movement, improve stability, and significantly reduce pain in patients who are no longer candidates for conventional anatomical replacement.
The information here is designed to help you understand everything involved in reverse shoulder replacement surgery, including symptoms to look out for, how the procedure works, what recovery involves, and how Dr Jason Hockings personalises care based on your needs.
Common signs and symptoms of rotator cuff arthropathy or severe shoulder damage
Rotator cuff arthropathy and complex shoulder degeneration often develop gradually, with symptoms that may be mistaken for general ageing or minor injury. Over time, damage to the rotator cuff and surrounding joint structures can significantly affect shoulder function and quality of life.
Some signs and symptoms to be aware of include:
- Ongoing shoulder pain, particularly at night or when lying on the affected side
- Difficulty lifting the arm, reaching overhead, or performing everyday tasks like brushing hair or dressing
- Weakness, especially during lifting or rotating movements
- Grinding, catching, or a feeling of instability in the shoulder joint
- Loss of shoulder motion or stiffness
- Noticeable decline in function after previous shoulder surgery
If these symptoms persist or worsen, especially in the context of a known rotator cuff tear, arthritis, or prior shoulder intervention, it may indicate more advanced shoulder joint damage requiring specialist assessment.
Are you a candidate for reverse shoulder replacement surgery?
The primary reason to consider a reverse shoulder replacement is to relieve ongoing pain caused by supporting muscles and tendons no longer functioning effectively. Dr Hockings may discuss reverse shoulder replacement with you if you are experiencing severe shoulder pain, weakness, or loss of motion due to:
- Rotator cuff arthropathy – a type of shoulder arthritis caused by long-standing rotator cuff tears
- Massive, irreparable rotator cuff tears
- Shoulder fractures that are not amenable to repair (often in older patients)
- Failed previous shoulder replacement or surgeries
- Chronic shoulder instability or pseudoparalysis (inability to lift the arm despite an intact nerve supply)
It is typically considered when non-surgical treatments such as physiotherapy or injections have not provided adequate relief, and other surgical options are not appropriate and patients who are most likely to benefit are typically aged over 65, although younger individuals with complex shoulder conditions may also be considered.
When a reverse shoulder replacement might not be the right option for you
This procedure may not be recommended if:
- You still have an intact, functional rotator cuff and could benefit from a different surgical option (e.g. anatomical shoulder replacement or rotator cuff repair)
- You have a severe or uncontrolled shoulder infection
- There is significant nerve damage that may impair recovery
- Bone quality or soft tissue support is inadequate for implant fixation
In such cases, Dr Hockings will discuss alternative treatments tailored to your situation.
The surgical approach Dr Hockings uses for Reverse Shoulder Replacement
Dr Hockings performs reverse shoulder procedures using either a deltopectoral or superior approach, depending on your anatomy and clinical needs. During surgery, he also incorporates augmented reality surgical platform called NextAR that uses smart glasses to provide live visual feedback based on your personalised anatomical plan.
NextAR Shoulder enhances accuracy by overlaying live metrics such as:
- Glenoid inclination and version
- Baseplate positioning and screw trajectory
- Offset and depth measurements in real time
A recent study showed exceptional alignment accuracy, with deviations from the pre-op plan as low as ~0.6° in angle and less than 1 mm in position, demonstrating superior execution of the surgical plan.
How personalised imaging and surgical planning guide your shoulder replacement
Before surgery, a CT scan is used to build a precise 3D virtual model of your shoulder. Dr Hockings uses a MyShoulder™ preoperative planning platform to simulate implant position, size, alignment, and biomechanics tailored to your anatomy. This planning helps to reduce variability, improve surgical outcomes, and support the longevity of the implant.
The prosthetic implants used in reverse shoulder replacement surgery
Reverse shoulder replacement implants are specifically designed to change the way your shoulder functions, particularly when the rotator cuff is no longer working effectively. In this type of surgery, the traditional ball-and-socket structure is reversed:
- A glenosphere (ball) is secured to the shoulder blade (scapula)
- A polyethylene cup (socket) is attached to the top of the arm bone (humerus)
- A metal stem is inserted into the humerus to provide secure fixation and support
These implants are engineered to:
- Provide greater stability, even in the absence of healthy soft tissue
- Offer strong fixation in different bone qualities, including osteoporotic bone
- Support long-term durability with designs aimed at reducing dislocation and loosening over time
- Include standard or short stem options to suit your anatomy and preserve more bone
- Allow customisation of the joint angle, with inclination choices such as 145° or 155° for reverse arthroplasty
- Offer a range of glenosphere sizes and stem configurations to optimise joint mechanics
Importantly, these implant systems also offer intraoperative flexibility, meaning if there’s a need to transition from an anatomical to a reverse configuration (or during a future revision), some components may be retained rather than removed entirely. This approach supports a more efficient surgery and helps preserve as much of your natural bone and soft tissue as possible.
What are the potential risks of reverse shoulder replacement surgery?
As with any major surgery, there are potential risks, although complications are relatively uncommon. These may include:
- Infection
- Dislocation of the implant
- Fracture around the implant
- Loosening or wear over time
- Nerve or blood vessel injury (rare)
- Stiffness or reduced range of motion
Dr Hockings will discuss these risks with you and how they may apply to your individual health and surgical history.
What to expect before, during, and after reverse shoulder replacement surgery
Bofore Surgery
Your journey typically begins with a referral from your general practitioner (GP) or another healthcare provider. Once referred, you will have an in-depth consultation with Dr Hockings to assess your shoulder condition and determine whether reverse shoulder replacement is appropriate for you.
During this consultation, Dr Hockings will:
- Review your medical history and current symptoms
- Conduct a physical examination of your shoulder
- Request or review advanced imaging, such as X-rays or a CT scan, to assess the extent of joint damage, bone quality, and anatomical structure
If surgery is recommended, you’ll receive a personalised surgical plan, which may include:
- Pre-operative screening tests (e.g., blood tests, ECG)
- A consultation with your anaesthetist to review your medical fitness for surgery
- A physiotherapy assessment to introduce you to early post-operative exercises and ensure you understand your rehabilitation pathway
Detailed information will be provided about how to prepare for surgery, including fasting, medication management, and what to bring to hospital.
During Surgery
Reverse shoulder replacement is performed under general anaesthesia, sometimes combined with a regional nerve block for post-operative pain control. The procedure typically takes around 1.5 to 2 hours.
Key steps in surgery include:
- Removal of damaged joint surfaces
- Precise preparation of the humerus and glenoid
- Insertion of the prosthetic components in a reversed configuration (ball on the shoulder blade, socket on the arm bone)
Dr Hockings uses advanced implant systems and surgical planning tools to optimise accuracy and implant positioning. In most cases, surgery is performed through a muscle-preserving approach. You’ll usually stay in hospital for one or two nights, depending on your overall health and recovery progress.
After Surgery
Post-operative care is focused on pain management, shoulder protection, and early mobilisation. You can expect:
- Your arm to be placed in a sling to protect the joint and allow healing
- Assistance from the physiotherapy team, who will guide you through gentle passive movements and help prevent stiffness
- Pain relief strategies tailored to your needs, including oral medications and possibly nerve blocks
Recovery timeline at a glance:
- First 4–6 weeks: Sling worn for support; passive physiotherapy begins
- 6–12 weeks: Gradual reintroduction of active movement and gentle strengthening
- 3–6 months: Steady improvement in shoulder function, strength, and range
- 6+ months: Return to light recreational activities; ongoing rehabilitation may be needed for more
Dr Hockings will review your progress at regular post-operative appointments and coordinate your rehabilitation program in close collaboration with your physiotherapy team. Recovery is gradual, and while outcomes vary, many patients experience significant pain relief and improved arm function in the months following surgery.
Pain management after shoulder replacement: what you can expect
Dr Hockings works closely with anaesthetists and your hospital care team to ensure you are as comfortable as possible. Pain relief methods may include:
- Regional nerve blocks during surgery
- Oral pain medications
- Ice therapy and elevation
Pain generally improves significantly within the first 2–3 weeks. Long-term discomfort is often greatly reduced compared to pre-surgery levels.
Your recovery timeline after reverse shoulder replacement surgery
Recovery after reverse shoulder replacement is a structured and gradual process that allows your shoulder to heal safely while regaining function and comfort. While individual timelines may vary, most patients progress through the following phases:
- Regional nerve blocks during surgery
- Oral pain medications
- Ice therapy and elevation
Weeks 0–6: Early protection and passive movement
- Your arm will be supported in a sling at all times, except during supervised physiotherapy sessions or personal care.
- Passive range-of-motion exercises begin under the guidance of your physiotherapist to maintain joint flexibility and prevent stiffness, without straining the surgical repair.
- You should avoid lifting anything heavier than 1–2kg and restrict movements that combine extension with external rotation, as these can place stress on the new joint.
Weeks 6–12: Transition to active movement
- You will begin gentle active movements of the arm without assistance.
- Physiotherapy will gradually introduce exercises to restore mobility and coordination.
- Sling use is typically phased out during this time, depending on your progress and comfort.
3–6 months: Strengthening and functional recovery
- Focus shifts to strengthening the deltoid and surrounding shoulder muscles, which now play a greater role in shoulder function.
- You can expect to resume most low-impact daily activities, such as household tasks, dressing, and light cooking.
- With improved strength and control, many patients return to driving around 6–8 weeks after surgery, provided they have adequate range of motion and are no longer reliant on strong pain medications.
6 months and beyond: Long-term outcomes and activity return
- Range of motion, strength, and shoulder endurance continue to improve well into the second half of the year.
- Recreational activities like swimming, golf, gardening, and travel are often resumed between 3–6 months, with some modifications depending on your shoulder function.
- High-demand or overhead sports may not be advised, particularly if your surgery was performed due to massive cuff damage or instability, but many patients return to active, fulfilling lifestyles with minimal long-term restrictions.
Supporting your recovery: Tailored physiotherapy and ongoing care
Your recovery is supported by a personalised rehabilitation plan, created in collaboration with trusted physiotherapists experienced in shoulder reconstruction. This program is designed to:
- Restore safe shoulder movement
- Rebuild deltoid strength and muscular control
- Improve posture, joint alignment, and shoulder mechanics
- Help you regain confidence and independence in daily life
Throughout your recovery, Dr Hockings will monitor your progress through scheduled follow-up appointments. These reviews allow him to assess healing, adjust your activity restrictions, and address any concerns early. With the right support and commitment to your rehabilitation plan, reverse shoulder replacement can significantly improve shoulder comfort, stability, and functional ability, especially when previous treatment options have not succeeded.
Returning to work, sport, and daily life after shoulder replacement
Regaining independence and returning to your usual activities are key goals following shoulder replacement surgery. Your ability to resume work, sport, and daily tasks will depend on your individual recovery progress, the type of shoulder replacement performed (reverse or anatomical), and the physical demands of your lifestyle or occupation.
Returning to work
When you can return to work will largely depend on the nature of your job:
- Sedentary or desk-based work: Most patients are able to return to light office duties within 4 to 6 weeks, once sling use has been reduced and basic shoulder movement is restored. Driving must also be safely resumed before returning to work that requires commuting.
- Light manual work: Jobs involving light lifting or repetitive arm movements may require a delay of 8 to 12 weeks, depending on your comfort and strength.
- Heavy manual labour or overhead tasks: For occupations that involve lifting, pushing, pulling, or working above shoulder height (e.g. construction, warehouse, trades), return may take 4 to 6 months or longer. These roles may require a tailored return-to-work plan and ongoing rehabilitation.
Dr Hockings will work with you and, if appropriate, your employer or occupational physician to guide a safe and staged return to work based on your functional capacity.
Returning to daily activities
Many patients find that everyday tasks become easier and less painful within 6 to 8 weeks of surgery. You may begin to resume:
- Self-care tasks (dressing, grooming, cooking) by 3 to 6 weeks
- Light household activities (laundry, shopping, washing dishes) by 6 to 8 weeks
- Driving once you can safely control the steering wheel with both hands — typically around 6–8 weeks, depending on your range of motion, comfort, and whether you are off strong pain medications
During this time, your physiotherapy program will support shoulder coordination, muscle activation, and joint protection techniques to help you regain confidence and independence.
Returning to sport and recreation
Most people return to recreational activities gradually from 3 to 6 months post-surgery. Activities that do not involve high loads on the shoulder joint or forceful overhead movement are typically encouraged once strength and mobility allow. These may include:
- Walking and light cardio (stationary bike) from early recovery
- Swimming (gentle freestyle or breaststroke) after 3 months
- Golf and social tennis from 4–6 months, depending on your technique and joint control
- Gardening, light DIY, and travel typically resume between 3–6 months
Activities to avoid or modify
Certain high-impact or high-risk activities may need to be permanently avoided or modified after shoulder replacement to protect the joint and reduce the risk of implant wear or dislocation. These include:
- Heavy lifting (especially repetitive or overhead)
- Contact sports (rugby, wrestling, competitive basketball)
- High-speed racquet sports (e.g. squash) or throwing sports
Dr Hockings will provide specific guidance based on the type of implant used, your surgical outcome, and your goals. Most patients enjoy a significant improvement in quality of life and return to a wide range of enjoyable, low-impact activities with long-term joint protection.
Frequently asked questions about reverse shoulder replacement surgery
How long does a reverse shoulder replacement last?
Modern implants used in reverse shoulder replacement have demonstrated good durability, with many lasting 10–15 years or longer, depending on activity levels and overall health. Advances in implant design and surgical technique continue to improve outcomes for suitable patients.
Will I regain full range of motion?
You may not regain full overhead range, but most patients regain enough motion for daily tasks. The goal after total shoulder replacement surgery is to have a shoulder joint that feels like a normal functioning shoulder and most patients have no pain in their shoulders and have improved function after surgery.
What’s the difference between Reverse vs anatomical shoulder replacement
Anatomical shoulder replacement and reverse shoulder replacement are two different types of shoulder joint reconstruction, each designed for specific conditions.
- Anatomical shoulder replacement mimics the natural structure of your shoulder. A smooth metal ball replaces the head of the upper arm bone (humerus), and a plastic socket is placed in the shoulder blade (glenoid). This option relies on a healthy rotator cuff to move and stabilise the joint, so it’s typically recommended for patients with intact rotator cuff tendons and osteoarthritis.
- Reverse shoulder replacement is used when the rotator cuff is severely torn, irreparable, or no longer functioning. In this procedure, the positions of the ball and socket are reversed: the ball is attached to the shoulder blade, and the socket is placed on the top of the arm bone. This design allows the deltoid muscle (rather than the rotator cuff) to lift and move the arm, making it a better option for conditions like rotator cuff arthropathy, massive rotator cuff tears, or failed previous shoulder surgeries.
Is reverse shoulder replacement more common than anatomical replacement?
It depends on the condition being treated. Reverse replacement is more commonly used when the rotator cuff is not functional.
Can I have a reverse replacement after a failed conventional one?
Yes, this is one of the most common indications for reverse shoulder arthroplasty.
What does reverse shoulder replacement surgery involve?
Reverse shoulder replacement is performed under general anaesthesia, often with a nerve block to assist with pain control after surgery. The key steps include:
- Incision and exposure of the shoulder joint through a deltopectoral or superior approach.
- Removal of the damaged bone and cartilage, including the arthritic humeral head and worn glenoid surface.
- Preparation and placement of the implants, with a baseplate and glenosphere on the shoulder blade and a stemmed socket on the upper arm bone.
- Securing the joint and restoring alignment, ensuring that the new joint allows deltoid-driven function.
- Closure and application of a dressing, followed by post-operative monitoring in recovery.
The procedure usually takes 1.5 to 2 hours and may require a 1–2-night hospital stay depending on your health and support at home.
Are there risks or potential complications?
As with any major surgery, reverse shoulder replacement carries some risks. These include:
- Infection
- Dislocation of the prosthetic joint
- Nerve or blood vessel injury (rare)
- Stiffness or limited range of motion
- Loosening or wear of the implants over time
- Periprosthetic fracture
- Ongoing weakness, especially with overhead movement
During your consultation, Dr Hockings will explain the most appropriate surgical approach based on your condition, anatomy, and individual needs. Many people experience a significant improvement in pain, function, and mobility following hip replacement surgery. Recovery timelines vary depending on the surgical approach and your overall health, but most patients gradually return to walking, driving, and normal activities over the course of several weeks to months.
If you’re living with hip pain or stiffness that’s affecting your quality of life, a thorough assessment can help determine the cause and guide the right treatment path.
