About This Procedure
A reverse total shoulder replacement is not a normal shoulder. Its goals are to reduce pain and improve function. Motion and strength vary from person to person. The procedure reverses the ball-and-socket anatomy: a metal ball is placed on the shoulder socket and a plastic cup on the upper arm bone. This design allows the deltoid muscle — instead of the rotator cuff — to power the arm.
Dr. Jay Levin is experienced in reverse shoulder arthroplasty, serving patients in Durham, Cary, and across North Carolina through Duke Health. He uses advanced 3D preoperative planning to precisely position components and optimize outcomes for each patient's unique anatomy.
Candidates include those with irreparable rotator cuff tears, cuff tear arthropathy, severe arthritis with poor rotator cuff function, complex fractures, chronic instability with bone loss, failed prior shoulder replacement, severe glenoid bone loss or deformity, limited ability to raise the arm, or persistent pain despite nonsurgical treatment.
The Procedure
Reverse shoulder replacement is performed under nerve block and general anesthesia. The surgery typically takes 1–2 hours. Dr. Levin makes an incision along the front of the shoulder, carefully identifying and protecting the axillary nerve and surrounding structures.
A metal baseplate with a ball (glenosphere) is fixed to the shoulder blade (glenoid). The upper arm bone (humerus) receives a stem fitted with a polyethylene socket. The components are assembled to create a stable, pain-free joint that relies on the deltoid for motion.
Most patients go home the same day. Dr. Levin uses intraoperative fluoroscopy and real-time assessment to confirm component positioning and joint stability before closing.
Recovery at Duke Health
Most patients undergoing reverse shoulder replacement at Duke Health are discharged home the same day. The nerve block typically reduces pain for 1–4 days; most patients need minimal or no opioids.
Your arm will be in a sling for approximately 3 weeks, including while sleeping. Gentle motion exercises begin shortly after surgery. Formal physical therapy usually starts 1–2 weeks after surgery. Full recovery typically takes 3–6 months.
Do: Use the sling as instructed. Follow your home exercise program. Use your legs to push up from chairs.
Don't: Lift more than 2 pounds for the first 6 weeks. Forcefully reach behind your back. Push up with the operated arm. Do heavy repetitive lifting long-term.
Follow-up visits are typically scheduled at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and yearly thereafter. Dr. Levin provides individualized care, adjusting your rehabilitation program based on your progress and goals.
Risks
As with any surgery, reverse shoulder replacement carries risks, including infection, nerve injury, instability or dislocation, fracture, stiffness, implant problems, and blood clots. Dr. Levin discusses these and any patient-specific concerns during your consultation.