Anatomic vs. reverse shoulder replacement: which is right for me?

An anatomic shoulder replacement recreates the shoulder’s normal ball-and-socket arrangement and relies on a functioning rotator cuff.

A reverse shoulder replacement changes that arrangement so the deltoid muscle can take on a greater role in lifting the arm. Dr. Horner recommends a reverse replacement when the rotator cuff is compromised. He is also more likely to recommend it when there is substantial socket wear or bone loss, or for older patients with lower activity demands. Age alone does not determine the choice.

In patients with shoulder arthritis and an intact rotator cuff who could receive either implant, studies often report similar improvements in pain and overall function.

Some studies suggest that anatomic replacement provides better rotational movement, particularly turning the arm outward. Some comparisons also report a lower likelihood of revision surgery—another operation to replace or modify the implant—after reverse replacement. These findings vary with the patients studied and the length of follow-up; neither implant is universally better.

Dr. Horner reviews your examination, imaging, health, and priorities to recommend the option best suited to your shoulder.

A 2024 registry cohort compared anatomic and reverse shoulder replacement in adults 60 and older with arthritis and intact rotator cuffs. Read the study.

A 2022 systematic review found better external rotation with anatomic replacement and similar functional scores between the two approaches. Read the study.

For details on the procedure, recovery timelines, and returning to activity, see the shoulder replacement page. Dr. Horner sees patients at clinics in Chicago (Little Village), Oak Brook, and St. Charles.