Shoulder arthroplasty, or shoulder replacement surgery, is a proven solution for patients suffering from severe shoulder arthritis or rotator cuff-related joint damage. The procedure involves replacing the damaged shoulder joint with a metal and plastic prosthesis. At Texas Orthopaedic Associates, we commonly perform two types of shoulder arthroplasty: anatomic total shoulder replacement and reverse total shoulder replacement.
While both surgeries aim to relieve pain and restore function, the mechanics, indications, and expected outcomes differ. Choosing the correct procedure is critical—selecting the wrong type of implant for a patient’s anatomy or condition can lead to poor function and premature failure of the replacement. Below, we explain the key differences in geometry, indications, function, and recovery.
Understanding the Basics: Geometry & Indications
Anatomic Total Shoulder Replacement
The goal of anatomic shoulder replacement is to replicate the natural shape of the shoulder joint. This involves replacing the ball (humeral head) and socket (glenoid) with implants that match the pre-arthritic anatomy.
For a successful outcome, two major requirements must be met:
- An intact and healthy rotator cuff
- Sufficient bone stock in the glenoid (socket)
Anatomic shoulder arthroplasty is typically indicated for patients with:
- Primary osteoarthritis (wear-and-tear arthritis)
- Well-preserved rotator cuff function
- Minimal glenoid bone loss
If either the rotator cuff is torn or the glenoid is too eroded, this procedure may lead to instability or early implant failure.
Reverse Total Shoulder Replacement
Reverse shoulder replacement changes the geometry of the shoulder entirely—placing the ball on the socket side and the socket on the arm side. This design increases stability and allows the deltoid muscle to compensate for a damaged or torn rotator cuff.
Reverse arthroplasty is best suited for patients with:
- Massive or irreparable rotator cuff tears
- Severe glenoid wear or deformity
- Rotator cuff arthropathy
- Failed previous shoulder replacements
Modern reverse implants use a stable metal baseplate with screws that promote bone integration, reducing the risk of loosening over time.
Comparing Shoulder Replacement Outcomes
Goal #1: Pain Relief
Both anatomic and reverse shoulder arthroplasties are highly effective in reducing pain. Studies show that patients often report pain levels of 1/10 or less following successful surgery, regardless of implant type.
Goal #2: Range of Motion
Anatomic replacements generally offer greater freedom of motion—especially in:
- Forward elevation
- External rotation
- Internal rotation behind the back
Reverse replacements are slightly more limited due to their constrained design. For example, internal rotation behind the back may be limited to beltline level, which can affect activities like dressing or hygiene for some patients. However, most patients are still highly satisfied with their range of motion—especially those who had stiffness before surgery.
Goal #3: Strength
Anatomic shoulder arthroplasty typically results in greater strength, but this is partly due to the presence of a healthy rotator cuff. Since reverse arthroplasty is often performed in the absence of a functional rotator cuff, the deltoid muscle must take over, resulting in slightly reduced overall strength. Despite this, reverse shoulder replacement allows patients to lift and use the arm comfortably in most daily activities.
Goal #4: Cosmetic Appearance
A lesser-known difference is that reverse shoulder replacement lengthens the arm by 2–3 cm to optimize implant function and stability. This may cause the shoulder to appear more “stretched” in thinner individuals. Both procedures use the same incision location, so there is no difference in visible scarring.
Which Shoulder Replacement Is Right for You?
The best shoulder replacement for you depends on several factors, including:
- Rotator cuff integrity
- Severity and type of arthritis
- Bone structure and joint anatomy
- Functional goals and activity level
- Commitment to postoperative rehabilitation
In some cases, both anatomic and reverse arthroplasty may be viable options. In those situations, your orthopedic surgeon will help you understand the advantages and limitations of each, using imaging and 3D planning tools to customize your surgical plan.
At Texas Orthopaedic Associates, our shoulder specialists are highly trained in both procedures and will guide you in making the best choice for long-term shoulder function and quality of life.
Ready to Learn More?
If you’re dealing with shoulder arthritis, rotator cuff issues, or have been told you may need a shoulder replacement, schedule an appointment with one of our shoulder surgeons.
About the Author
Dr. Eric Sanders is a fellowship-trained orthopedic surgeon specializing in shoulder and elbow surgery at Texas Orthopaedic Associates. He is committed to helping patients understand their options and make informed decisions about their care. Dr. Sanders brings advanced surgical expertise and personalized treatment to each case, helping patients return to the activities they love.
