The short version

There are two main types. An anatomic replacement copies the normal ball-and-socket. A reverse replacement puts the ball on the shoulder blade and the cup on the arm bone.
Reverse replacement was designed for shoulders with a badly damaged rotator cuff, because it lets the deltoid muscle do the lifting.
For arthritis with a healthy rotator cuff, reviews of mostly observational studies found similar pain and function with both, and fewer revisions with reverse. Those patients were often older, and the evidence is not from randomized trials.^[1][2][3]
Long-term data for reverse replacement show around 81 to 88% of implants still in place at 10 years, with meaningful complication rates.^[5][6]
For most displaced shoulder fractures in people over 60, surgery of any kind did no better than non-surgical treatment in a Cochrane review.^[7]

When shoulder replacement is used

The most common reasons are:

Osteoarthritis, where the cartilage on the ball and socket wears away.
Rotator cuff tear arthropathy, a pattern of arthritis that develops after a large, long-standing rotator cuff tear.
Massive rotator cuff tears that can't be repaired, in some people, even without arthritis. A review found reverse replacement improved function in these shoulders, but people who had a failed cuff repair beforehand had a higher risk of complications and revision.^[12]
Some severe fractures of the upper arm bone near the shoulder, especially in older adults.
Inflammatory arthritis and other less common conditions.

Volume has grown fast. Between 2011 and 2017, US shoulder replacements roughly doubled, and reverse replacements nearly tripled, a faster growth rate than hip or knee replacement.^[9]

Like hip and knee replacement, it is usually considered after medication, injections and physical therapy are no longer controlling pain and function.

Anatomic or reverse?

	Anatomic	Reverse
How it works	Metal ball on the arm bone, plastic socket on the shoulder blade, like a natural shoulder	Metal ball on the shoulder blade, plastic cup on the arm bone. Shifts the work of lifting to the deltoid muscle
Needs a working rotator cuff?	Yes	No
Typical patients	Arthritis with a healthy rotator cuff, often younger and more active	Cuff tear arthropathy, irreparable cuff tears, some fractures, and increasingly arthritis in older patients
Common reasons for revision	Instability and loosening, including wear of the plastic socket^[4]	Instability and dislocation, infection^[4][5]

Why not just replace the ball?

Replacing only the ball (hemiarthroplasty) avoids putting in a plastic socket that could wear out. In a small randomized trial followed for 10 years, full replacement gave less pain at 2 years, that advantage didn't reverse later, and four of 13 ball-only shoulders were converted to full replacements because of socket wear.^[8] Today hemiarthroplasty is mostly reserved for particular situations.

What the comparisons show

Several reviews have compared the two for arthritis with an intact rotator cuff. One found similar motion and patient scores, with more revisions after anatomic replacement (8.8% vs 0.9%). The reverse patients in those studies were on average about 8 years older.^[1] Another review focused on worn, tilted sockets (Walch B2 and B3) found similar improvements and lower complication and revision rates with reverse, while cautioning that the studies had a real risk of bias.^[2]

In patients over 70 without a full-thickness cuff tear, a review found fewer revisions with reverse but better scores on one function measure (the Constant score) with anatomic.^[3]

In patients under 55 in the Australian national joint registry, reverse replacements had lower revision rates than some hemiarthroplasty types at mid-term follow-up, with no significant difference compared with anatomic total replacement. Long-term data for reverse in young patients are still limited.^[4]

None of these comparisons are from randomized trials, and the people who got each implant often differed. The right choice depends on your cuff, the shape of your socket bone, your age and your activities.

If you broke your shoulder

Fractures of the upper arm near the shoulder are common in older adults. A Cochrane review of randomized trials, mostly in people 60 and over, found high-certainty evidence that surgery did not give better shoulder function at one or two years than non-surgical treatment for displaced fractures, and that surgery may increase the need for further operations.^[7]

For the most complex fractures where surgery is chosen, reverse replacement is often used. Evidence comparing it with other surgical options is very limited.^[7] The review found too little evidence for people under 60 or high-energy injuries to draw conclusions.^[7]

How long does a shoulder replacement last?

A review of reverse replacements with at least 10 years of follow-up found that about 88% were still in place at 10 years. It also found a 36% overall complication rate and a high rate of patients lost to follow-up, so the authors urged caution.^[5]

In one large US single-surgeon series of early reverse designs, 81% of implants were still in place at 10 years. Pain and function stayed stable from mid-term to long-term, and 94% of patients reached for follow-up said they would have the surgery again.^[6]

Implant designs have changed since many of these patients had surgery, so these numbers may not reflect current implants.

What happens in surgery

Shoulder replacement is done through an incision on the front of the shoulder. Many people go home the same day or after one night. A nerve block is usually used to numb the arm for pain control during the first day.

Many people now have shoulder replacement as an outpatient. A meta-analysis of 14 studies found outpatient patients had fewer complications and readmissions than inpatients, though they were also younger and healthier, so the right setting depends on your overall health.^[10]

Surgeons often use CT-based planning software before surgery, especially when the socket bone is worn unevenly. Some also use custom 3D-printed guides made from your scan. A meta-analysis found these guides placed the socket component closer to plan, with far fewer badly placed components, though no randomized trials have shown better long-term results yet.^[11] Ask whether your surgeon uses planning tools and what they show about your shoulder.

Steroid shots and timing: in a national database study, people who had a steroid injection in the shoulder within a month before reverse replacement had a higher risk of joint infection. The authors recommended waiting at least 4 weeks after an injection.^[15]

Recovery

Every surgeon has their own protocol. This is a typical shape:

Weeks 0 to 6Sling for comfort and protection, gentle movement as directed. Anatomic replacements often have more limits early to protect the repaired tendon at the front of the shoulder.
Weeks 6 to 12Out of the sling, active movement, light daily tasks.
Months 3 to 6Strengthening. Most people feel a big difference in pain by this point.
6 to 12 monthsContinued gains in strength and motion.

Ask your surgeon about long-term limits. Many advise against heavy lifting and high-impact activity to protect the implant.

Risks and complications

Infection, one of the leading reasons for revision of reverse replacements.^[5] A skin bacterium called Cutibacterium acnes is the most common germ found in shoulder surgery cultures, and is found more often in men. A positive culture without other signs of infection didn't change outcomes in a review of 22 studies.^[13]
Instability or dislocation, especially early after reverse replacement.^[4]
Loosening or wear of the parts over time.^[4] In a meta-analysis of more than 35,000 anatomic replacements, loosening, mostly of the socket component, was the leading cause of failure, followed by rotator cuff failure, instability and infection.^[14]
Fracture of the bone around the implant.
Nerve injury, usually temporary.
Scapular notching, wear on the shoulder blade under a reverse replacement, seen on X-rays in many long-term patients. Its importance is still debated.^[5]

Questions to ask your surgeon

Is my rotator cuff healthy enough for an anatomic replacement?
Which type do you recommend for me, and why?
What does my socket bone look like? Do you use 3D planning?
How many shoulder replacements do you do each year?
What limits will I have long term?
How long will I be in a sling, and when can I drive?
If I broke my shoulder, what would happen if I didn't have surgery?

Recovery supplies

We're putting together vetted picks at a range of prices. For now, these are the usual categories:

Cold therapy (ice packs or a shoulder cold unit)
Wedge pillow or recliner
Button-front and loose shirts
Slip-on shoes
Long-handled sponge
Reacher grabber
Resistance bands (for later)

Sources

Vij N, et al. Total shoulder arthroplasty versus reverse shoulder arthroplasty in primary glenohumeral osteoarthritis with intact rotator cuffs: a meta-analysis. Cureus. 2024;16:e57866. https://doi.org/10.7759/cureus.57866
Aleisawi H, et al. Outcomes of anatomic versus reverse shoulder arthroplasty for B2 and B3 glenoids with an intact rotator cuff: an updated systematic review and proportional meta-analysis. Shoulder Elbow. 2025;18:425-36. https://doi.org/10.1177/17585732251359590
Dragonas CG, et al. Anatomic total shoulder arthroplasty versus reverse total shoulder arthroplasty in patients aged over 70 without a full-thickness rotator cuff tear: a systematic review and meta-analysis. J Shoulder Elb Arthroplast. 2023;7. https://doi.org/10.1177/24715492231206685
Khoriati AA, et al. Survivorship of shoulder arthroplasty in young patients with osteoarthritis: an analysis of the Australian Orthopaedic Association National Joint Replacement Registry. J Shoulder Elbow Surg. 2023;32:2105-14. https://doi.org/10.1016/j.jse.2023.03.024
Biner M, et al. Long-term outcomes following reverse total shoulder arthroplasty: a systematic review with a minimum follow-up of 10 years. JB JS Open Access. 2025;10(2). https://doi.org/10.2106/JBJS.OA.25.00025
Sheth MM, et al. Patient satisfaction and clinical outcomes of reverse shoulder arthroplasty: a minimum of 10 years' follow-up. J Shoulder Elbow Surg. 2022;31:875-83. https://doi.org/10.1016/j.jse.2021.09.012
Handoll HH, et al. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022;6:CD000434. https://doi.org/10.1002/14651858.CD000434.pub5
Sandow MJ, et al. Hemiarthroplasty vs total shoulder replacement for rotator cuff intact osteoarthritis: how do they fare after a decade? J Shoulder Elbow Surg. 2013;22:877-85. https://doi.org/10.1016/j.jse.2012.10.023
Wagner ER, et al. The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty. J Shoulder Elbow Surg. 2020;29:2601-9. https://doi.org/10.1016/j.jse.2020.03.049
Daher M, et al. Outpatient versus inpatient total shoulder arthroplasty: a meta-analysis of clinical outcomes and adverse events. Int Orthop. 2025;49:151-65. https://doi.org/10.1007/s00264-024-06364-5
Villatte G, et al. Use of patient-specific instrumentation (PSI) for glenoid component positioning in shoulder arthroplasty: a systematic review and meta-analysis. PLoS One. 2018;13:e0201759. https://doi.org/10.1371/journal.pone.0201759
Ardebol J, et al. Reverse shoulder arthroplasty for massive rotator cuff tears without glenohumeral arthritis can improve clinical outcomes despite history of prior rotator cuff repair: a systematic review. J ISAKOS. 2024;9:394-400. https://doi.org/10.1016/j.jisako.2024.02.008
Hodakowski AJ, et al. An evidence-based approach to managing unexpected positive cultures in shoulder arthroplasty. J Shoulder Elbow Surg. 2022;31:2176-86. https://doi.org/10.1016/j.jse.2022.03.019
Lauck BJ, et al. Why do primary anatomic total shoulder arthroplasties fail today? A systematic review and meta-analysis. J Shoulder Elbow Surg. 2025;34:2746-59. https://doi.org/10.1016/j.jse.2025.02.057
Baksh N, et al. Does preoperative corticosteroid injection increase the risk of periprosthetic joint infection after reverse shoulder arthroplasty? J Shoulder Elbow Surg. 2023;32:1459-64. https://doi.org/10.1016/j.jse.2023.01.008

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Shoulder replacement, explained