The key difference: an anatomic (conventional) replacement mimics the normal shoulder — ball on the arm bone, socket on the shoulder blade — and needs a healthy rotator cuff, while a reverse replacement swaps them, placing the ball on the shoulder blade and the socket on the arm bone, so it relies on the deltoid and works when the tendons are damaged.
What a shoulder implant looks like
- Stem: a metal part fixed inside the arm bone (short or stemless in some designs).
- Head or cup: a round metal head in the anatomic implant, or a polyethylene-lined cup in the reverse.
- Shoulder-blade component: a polyethylene socket in the anatomic, or a metal ball (glenosphere) fixed with screws in the reverse.
The types compared
| Reverse | Anatomic (total) | Hemiarthroplasty | |
|---|---|---|---|
| Design | Ball on shoulder blade, cup on arm bone | Ball on arm bone, socket on shoulder blade | Metal head on the arm bone only |
| What lifts the arm | Deltoid | Rotator cuff with deltoid | Rotator cuff with deltoid |
| Suits | Damaged tendons, complex fractures in older adults, failed surgery | Arthritis with healthy tendons and good bone | Selected cases |
| Expected result | Major pain relief and better elevation; rotation may stay limited | Major pain relief with near-normal motion | Variable |
| Early restrictions | No pushing up with the arm or reaching behind the back | Protecting the subscapularis repair | Per surgeon |
How does the surgeon choose?
- The state of the rotator cuff — the most important factor.
- The amount and quality of shoulder-blade bone on CT.
- The cause: arthritis, fracture or failed surgery.
- Age, activity and expectations.
Comparative studies show both relieve pain well when each is used for the right patient, while the anatomic design usually gives better rotation. There is no single “best” — only what suits your tendons and bone.
Video: success rate of arthroscopic rotator cuff repair
Frequently asked questions about shoulder replacement types
What is the difference between reverse and anatomic shoulder replacement?
The anatomic design mimics the normal shape and needs healthy tendons; the reverse swaps ball and socket and relies on the deltoid, so it suits damaged tendons.
Which is better, reverse or anatomic?
Neither is better overall; the right choice depends on your rotator cuff, shoulder-blade bone and the cause of the problem.
What is a shoulder implant made of?
A stem or component in the arm bone, a head or cup, and a shoulder-blade component, made of metal alloys and highly durable polyethylene.
Does a reverse replacement limit movement?
It usually improves lifting clearly, but internal rotation — such as reaching behind the back — may stay limited.
Can an anatomic replacement be converted to a reverse?
Yes. If an anatomic replacement fails because the tendons later tear, it can be converted to a reverse in revision surgery.
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Medically reviewed by Prof. Dr. Ibrahim Shaarawi, Professor of Orthopaedic Surgery. This article is general medical education and does not replace an examination or the plan your surgeon sets for you. See our medical disclaimer.
Related shoulder replacement guides
For the operation itself see reverse shoulder replacement, and read:
- Reverse shoulder replacement
- Shoulder replacement complications and success rate
- Rotator cuff tear arthropathy
References
- Kiet TK, et al. Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. J Shoulder Elbow Surg. 2015;24(2):179-85.
- Craig RS, et al. Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy. Cochrane Database Syst Rev. 2020;4(4):CD012879.
- American Academy of Orthopaedic Surgeons (OrthoInfo). Shoulder Joint Replacement.
- American Academy of Orthopaedic Surgeons (OrthoInfo). Reverse Total Shoulder Replacement.