The reverse total shoulder replacement is recommended for patients with one or more of the following:
Painful rotator cuff tear arthropathy in older patient
Failed fracture repair with loss of rotator cuff in older patient
Failed prior shoulder replacement surgery
The reverse total shoulder replacement changes the orientation of the shoulder so that the normal socket (glenoid) now is replaced with an artificial ball, and the normal ball (humeral head) is replaced with an implant that has a socket into which the artificial ball rests. This type of design completely changes the mechanics of the shoulder and enables the artificial joint to function when the rotator cuff is either absent or when there is significant bone loss.
The benefit of the reversal of the shoulder joint is that it allows the deltoid muscle to lift the shoulder instead of the rotator cuff, which cannot lift due to irreparable tear. Reversing the ball and socket changes the mechanics of the shoulder to improve active range of motion and strength. The result is that the patient can raise his/her arm higher and even sometimes overhead.