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  • Karen Hayter DPT

Total Shoulder Arthroplasty vs Reverse Total Shoulder Arthroplasty

Every year, thousands of people get a conventional total shoulder arthroplasty (TSA). This is also known has a shoulder replacement. This type of procedure is usually done due to severe osteoarthritis of the shoulder joint (glenohumeral joint). However, this type of procedure is not always appropriate for those whom have sustained a large rotator cuff tear and developed a type of shoulder arthritis secondary to the tear or injury.  For those patients a reverse total shoulder replacement is the better option.

Total Shoulder Arthroplasty (TSA)

In any total joint replacement an implant is placed to mimic the normal joint mechanics of the joint that is being replaced. In a TSA, the implant will mimic the normal anatomy of the shoulder. The surgeon will place a plastic cup will into the shoulder socket (glenoid) and a metal ball is attachment to the top of the upper arm bone (humerus). In a healthy shoulder, the rotator cuff muscles help position and stabilize the shoulder joint. Conventional total shoulder replacements are usually performed on those that have a healthy rotator cuff, as the replacement device uses the rotator cuff muscle to help the shoulder function properly.

Reverse Total Shoulder Arthroplasty (rTSA)

A reverse total shoulder is differs from the conventional total shoulder in that the socket and the metal ball are switched. The surgeon will fix the metal ball into the socket (glenoid) and the plastic cup is fixed to the upper end of the arm bone (humerus).  The rTSA is the best option for those whom have no repairable rotator cuffs, because the “switched” joint mechanics no longer rely on the rotator cuff muscles to stabilize and move the shoulder joint. Reverse total shoulders may be recommended if you have:

  • A completely torn rotator cuff that cannot be repaired

  • Cuff tear arthropathy

  • A previous shoulder replacement that was unsuccessful

  • Severe shoulder pain and difficulty lifting your arm away from your side or over your head

  • A complex fracture of the shoulder joint

  • A chronic shoulder dislocation

  • A tumor of the shoulder joint


Both TSA and rTSA are surgical interventions that require physical therapy to help with the post-op rehabilitation. Physical therapy generally is started in the first week after surgery with the main goal of trying to regain range of motion (ROM). As the healing process continues and the surgeon’s protocol allows, gentle strengthening is introduced. The main goal is to regain normal function and strength of the shoulder joint. Patients generally participate in physical therapy for 2-3 months based off their status and progress with rehab. Most people who get a TSA or a rTSA report in the long-term, improved function and decreased pain after surgery.

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