Two Operations, One Goal: Less Pain, Better Function
When arthritis, a massive rotator cuff problem, or a fracture damages the shoulder joint beyond repair, shoulder replacement (arthroplasty) can relieve pain and restore function. There are two main designs: anatomic total shoulder replacement and reverse total shoulder replacement. They look different, work differently, and are chosen for different shoulders.
How a Healthy Shoulder Works
The shoulder is a ball-and-socket joint. The rounded top of the upper arm bone (humeral head) sits in a shallow socket on the shoulder blade (glenoid). The rotator cuff, a group of four tendons, holds the ball centered in the socket and helps lift and rotate the arm.
Rebuilding the Joint as Nature Designed It
In an anatomic replacement, the damaged ball is replaced with a smooth metal ball and the worn socket is resurfaced with a durable plastic cup. The joint keeps its natural geometry, so it depends on a healthy, working rotator cuff and enough socket bone to support the implant.
Some anatomic replacements are stemless: the humeral component sits in the top of the arm bone without a stem running down the bone canal, which preserves bone. Stemless designs are intended for patients with good bone quality, and Dr. Boubekri chooses between stemless and stemmed implants based on your bone and anatomy.
Reversing the Ball and Socket
In a reverse replacement, the positions are swapped: a metal ball is fixed to the socket side of the shoulder blade, and a cup is placed on the upper arm bone. This changes the mechanics so the large deltoid muscle can lift the arm, which is why the operation works even when the rotator cuff is torn or no longer functions.
A common misunderstanding: reverse replacement is not just a last resort for the very oldest patients. It is a well-established operation with a growing list of indications, and it is the right choice for many shoulders that an anatomic replacement could not reliably help.
What the Implants Look Like
© Stryker
© StrykerImages © Stryker, used with permission. Tornier® and Perform™ are trademarks of Stryker. Examples shown are one manufacturer's systems; the implant chosen for you depends on your anatomy.
Side-by-Side
| Anatomic | Reverse | |
|---|---|---|
| Design | Metal ball on the arm bone, plastic cup in the socket | Ball and socket swapped: metal ball on the shoulder blade, cup on the arm bone |
| Rotator cuff | Needs a healthy, working rotator cuff | Does not rely on the rotator cuff; the deltoid powers the arm |
| Commonly used for | Osteoarthritis with an intact cuff and good socket bone | Cuff tear arthropathy, arthritis with a damaged cuff, certain fractures, and failed prior replacements |
| Recovery focus | Protecting the repaired front tendon (subscapularis) early, then restoring motion and strength | Protecting stability early, then building deltoid and shoulder blade strength |
Choosing the Right Replacement for You
Dr. Boubekri's recommendation is individualized. He considers:
- Rotator cuff condition, assessed by exam and MRI
- Socket (glenoid) shape and bone loss, assessed by CT scan and 3D planning
- Your age, activity level, and goals, including golf, pickleball, and daily tasks
- Prior shoulder surgery and overall health
Modern 3D planning software lets him study your individual anatomy before surgery and plan implant size and position. His research includes work on using machine learning to predict implant component size for both anatomic and reverse replacement.
Robotic assistance: for primary reverse replacement, Dr. Boubekri offers Mako® robotic-assisted glenoid preparation. Learn how it works →
What to Expect Before and After
Dr. Boubekri operates at the Intercoastal Medical Group (IMG) Surgery Center, Sarasota Memorial Hospital, Lakewood Ranch Medical Center, and HCA Florida Sarasota Doctors Hospital. Where your surgery takes place depends on the procedure, your overall health, and your insurance.
Evaluation & Planning
Exam, X-rays, MRI and often a CT scan. Non-surgical options such as therapy and injections are reviewed first when appropriate.
Sling & Gentle Motion
Your arm is protected in a sling while the joint heals. Early, guided motion begins as directed.
Physical Therapy
Progressive motion and strengthening. Most patients resume light daily activities.
Strength & Return to Activity
Continued gains in strength and function, with a gradual return to recreation as cleared by your surgeon.
Every operation carries risks, including infection, stiffness, instability or dislocation, implant loosening or wear, nerve injury, fracture, and blood clots. Dr. Boubekri reviews these with you in detail before surgery.
Frequently Asked Questions
Is reverse shoulder replacement only for rotator cuff tears?
No. It is often used when arthritis occurs together with a torn or non-functioning rotator cuff (cuff tear arthropathy), but it is also used for certain complex fractures, for some patients with severe bone loss on the socket side, and when a previous shoulder replacement has failed.
Which type of shoulder replacement is better?
Neither is better for everyone. The right choice depends mainly on the condition of your rotator cuff, the shape and wear of your shoulder socket, and your goals. Dr. Boubekri uses your exam, MRI and CT imaging to recommend the operation that fits your shoulder.
How long does a shoulder replacement last?
Modern shoulder replacements are designed to last many years, but no implant lasts forever. Longevity depends on factors such as your activity level, bone quality, and overall health. Dr. Boubekri will discuss what to expect for your situation.
Can I still golf or play pickleball after a shoulder replacement?
Many patients return to activities such as golf and pickleball, usually in a gradual and modified way. Timing and limits are individualized and depend on the type of replacement, how you heal, and your surgeon's guidance.
How long is recovery?
Most patients wear a sling for several weeks and then progress through physical therapy to restore motion and strength. Everyday activities typically return over the first few months, while strength and function can keep improving for six months to a year. Your exact protocol will be provided by Dr. Boubekri.
This page is for general education and is not a substitute for an evaluation. Every patient is different; your recommendations will depend on your exam, imaging, and goals.