Who Gets Reverse Shoulder Replacement?

Typically, reverse shoulder replacement is an elective surgery, which means that a person chooses to have it. Most people who choose to undergo reverse replacement have both:

• Significant shoulder joint damage, often from either osteoarthritis or rheumatoid arthritis
• Irreparable rotator cuff tear(s) or damage

A rotator cuff may be damaged by an acute injury or gradually, over many years of wear and tear. Gradual cuff degeneration that leads to joint instability, friction between the shoulder’s natural ball and socket, and eventually shoulder arthritis is sometimes called rotator cuff arthropathy.

See What Is Shoulder Osteoarthritis? and What Is Rheumatoid Arthritis (RA)?

Other people who undergo reverse shoulder replacement may have:

• A severe rotator cuff tear that cannot be repaired and significantly affects shoulder movement. The shoulder may feel paralyzed or partially paralyzed.
• A traditional shoulder replacement that has failed (for example, the artificial components have loosened from the natural bone) and a damaged rotator cuff.

  See Total Shoulder Replacement Risks and Complications

• A fractured shoulder that needs to be repaired and/or a damaged rotator cuff.

In addition to physical signs of joint or tissue damage, patients often report pain and other symptoms, including:

• Moderate to severe pain during activity and, in many cases, also during sleep
• Weakness in the affected shoulder that makes it difficult to perform daily tasks, such as washing hair
• Stiffness and pain when lifting the arm overhead
• Inadequate pain relief from non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, steroid injections, or other non-surgical treatments

  See Pain Medications for Arthritis Pain Relief and Cortisone Injections (Steroid Injections)

People considering shoulder replacement may have already had other surgeries, such as arthroscopic shoulder surgery, but did not get adequate relief from symptoms.

Factors That May Rule Out Reverse Replacement

A doctor must consider many factors before recommending reverse shoulder replacement surgery. Factors that may rule out surgery include:

Nicotine use
Smokers and other tobacco users who undergo joint replacement surgery have increased rates of post-surgical complications, such as delayed healing and infection. Quitting or cutting back on tobacco use prior to surgery can help lower post-surgical risks. Infection
Doctors want to reduce patients’ risk of post-surgical infection, which is considered a serious complication. A patient may need to postpone surgery or consider non-surgical treatment options if he or she has:

• Systemic infections
• Predisposition to infection
• Skin problems that can limit wound healing or increase the risk of infection

Osteoporosis
Brittle bones may not adequately support and adhere to a joint prosthesis, so people with severe osteoporosis may not be eligible for shoulder replacement. People with mild to moderate osteoporosis may still be eligible, but surgeons may plan for surgery differently. For example:

• A surgeon might attach the prosthetic(s) to the natural bone with a fast-acting cement instead of using a cementless fixation method.
• The patient might be advised to take steps to improve bone density before and after surgery. These efforts can increase the lifespan of the shoulder replacement.

Damaged shoulder socket
A healthy shoulder socket is just 1 inch (2.7 cm) across and 1.7 inches (4.2 cm) high. If this area is significantly worn down and damaged from arthritis, the surgeon might have difficulty attaching prostheses.

Irreparably damaged deltoid muscle
Damage to the shoulder’s large deltoid muscle limits the chances for successful rehabilitation and recovery for any shoulder replacements. This surgery requires a functioning deltoid muscle with an intact nerve supply.

Nerve damage
If the nerves traveling from the spinal cord to the affected shoulder, arm, and hand are damaged, the patient may not be eligible for surgery.

Inability to follow post-surgical instructions
A doctor may advise against surgery if a patient is unable or unlikely to follow pre- and post-surgical instructions. For example, people who suffer from dementia or alcoholism are more prone to dangerous falls, putting them at a higher risk of complications such as bone fractures and shoulder joint dislocations.

A person considering reverse shoulder replacement surgery is encouraged to be honest with his or her doctor about smoking, drinking, drug use, and other factors that can affect the surgery’s success.

Age and Weight Requirements

Advanced age or obesity alone does not rule out reverse shoulder replacement surgery, and doctors will consider each patient on a case-by-case basis.

See Preparing for Shoulder Replacement Surgeries

Some experts believe that this surgery is best performed on patients older than 70, because older patients tend to be less active and will put less strain on their new shoulder joints. In general, patients aged 85 or older who are in good general health can still have shoulder replacement surgery. ¹ Churchill RS. Elective shoulder arthroplasty in patients older than ninety years of age. J Shoulder Elbow Surg. 2008 May-Jun;17(3):376-9. doi: 10.1016/j.jse.2007.09.005. Epub 2008 Feb 14. PubMed PMID: 18276166. Likewise, there is no upper weight limit for who can have the surgery. ² G. Walch et all Joint Bone Spine 77 (2010) 501-505.

Although experts have not set definitive age and weight limits for patients, advanced age and obesity can increase the risk for infection and other post-surgical complications. ³ Linberg CJ, Sperling JW, Schleck CD, Cofield RH. Shoulder arthroplasty in morbidly obese patients. J Shoulder Elbow Surg. 2009 Nov-Dec;18(6):903-6. doi: 10.1016/j.jse.2009.02.006. Epub 2009 May 22. PubMed PMID: 19464930. ^{, 4} Jain NB, Guller U, Pietrobon R, Bond TK, Higgins LD. Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop Relat Res. 2005 Jun;(435):232-8. PubMed PMID: 15930944. If appropriate, a doctor may encourage a patient to lose weight before surgery.