Anatomic vs Reverse Shoulder Arthroplasty

Shoulder arthroplasty (replacement) is a surgical procedure that replaces damaged parts of the shoulder joint with artificial components. There are two main types: anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA). The choice between them depends on the condition of the rotator cuff, bone quality, and the specific pathology.

In an anatomic TSA, the natural anatomy of the shoulder is replicated. A metal ball replaces the humeral head, and a plastic socket replaces the glenoid. This procedure is ideal for patients with an intact, functioning rotator cuff and is most commonly performed for osteoarthritis with preserved muscle function.

In a reverse TSA, the positions of the ball and socket are switched—a metal ball is attached to the glenoid, and a plastic socket is placed on the humerus. This design allows the deltoid muscle to power the arm, bypassing the need for a functioning rotator cuff. It is indicated for rotator cuff arthropathy, massive irreparable rotator cuff tears, and certain fracture patterns.

Both procedures have excellent long-term outcomes, with most patients experiencing significant pain relief and improved function. Recovery typically involves a period of immobilization followed by a structured physical therapy program. Most patients see substantial improvement within 3 to 6 months, with continued gains up to a year after surgery.