When the reverse shoulder replacement first arrived in the U.S., it was used for a narrow group of patients with massive, irreparable rotator cuff tears. Today it has become the workhorse of shoulder replacement. In the American Academy of Orthopaedic Surgeons' shoulder registry, reverse replacements now make up 52.7% of shoulder replacements, compared with 35.1% for anatomic replacements.1
How fast it's growing
A national study found that reverse shoulder replacements in the U.S. nearly tripled in five years, from about 22,800 in 2012 to about 62,700 in 2017. Over the same period, anatomic replacements grew more slowly, and partial replacements (hemiarthroplasty) fell by more than half.2 The trend is similar abroad: in Australia's national registry, reverse designs now account for about three in four primary total shoulder replacements.3
Why surgeons choose it
A normal shoulder depends on the rotator cuff to keep the ball centered. Many older adults with shoulder arthritis also have worn or torn cuff tendons. A reverse replacement switches the ball and socket so the large deltoid muscle can lift the arm, even when the rotator cuff can't.
- It works without a healthy rotator cuff. That makes it the go-to option for cuff tear arthropathy, irreparable cuff tears and many complex fractures.
- Predictable results. Because it doesn't depend on the cuff, it avoids one of the common reasons anatomic replacements fail over time: the cuff wearing out years later.
- Durable. In a long-term study, 93% of reverse implants were still in place at an average of 12.5 years.4 In Australia's registry, 10-year revision rates for stemmed reverse implants ranged from 3.4% to 6.7%.3
- An option for arthritis with an intact cuff, too. In patients 70 and older with osteoarthritis and a healthy cuff, outcomes after reverse replacement were similar to anatomic replacement in a matched comparison.5 A 2024 analysis of ten studies found similar motion and patient-reported outcomes, with fewer revisions after reverse replacement, although the reverse patients were older.6
The trade-offs
No operation is perfect, and reverse replacement has its own considerations:
- Reaching behind your back can be more limited than after an anatomic replacement.7
- Return to sports is somewhat lower: about 75% after reverse replacement compared with about 93% after anatomic replacement.8
- Stress fractures of the shoulder blade occur in about 3% of patients.9
Which is right for you?
For a younger, active patient with arthritis and a healthy rotator cuff, an anatomic replacement is often still the best fit. For many older patients, and anyone whose rotator cuff is torn or worn, a reverse replacement can reliably restore a pain-free, functional shoulder. I'll help you decide based on your exam, imaging and goals, and I plan every shoulder replacement in 3D from a CT scan of your shoulder. Read more about total and reverse shoulder replacement, or request a consultation.
- American Academy of Orthopaedic Surgeons. Shoulder & Elbow Registry 2026 Annual Report (fact sheet), September 2026.
- Best MJ, et al. Increasing incidence of primary reverse and anatomic total shoulder arthroplasty in the United States. J Shoulder Elbow Surg. 2021;30(5):1159–1166.
- Australian Orthopaedic Association National Joint Replacement Registry. 2025 Lay Summary, Supplementary Report.
- Bacle G, et al. Long-term outcomes of reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2017.
- Wright MA, Keener JD, Chamberlain AM. Comparison of clinical outcomes after anatomic total shoulder arthroplasty and reverse shoulder arthroplasty in patients 70 years and older with glenohumeral osteoarthritis and an intact rotator cuff. J Am Acad Orthop Surg. 2020;28(5):e222–e229.
- Vij N, et al. TSA versus RSA in primary glenohumeral osteoarthritis with intact rotator cuffs: a meta-analysis. Cureus. 2024;16(4):e57866.
- The functional internal rotation scale. JSES International. 2020.
- Liu JN, et al. Return to sport after shoulder arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):100–112.
- King JJ, et al. Acromial and scapular spine fractures after reverse shoulder arthroplasty. Bone Joint J. 2019;101-B(6):627–634.
This article is for general education and is not medical advice. Talk with your surgeon about your own situation.