My good shoulder was a total and it's brilliant, now the other one needs a reverse and it feels like the consolation prize. Is a reverse a downgrade?

Some of you know my first shoulder from earlier threads. Anatomic total, cuff was fine, and it has been genuinely brilliant, felt like my own arm again by about three months. So I walked into the appointment for my OTHER shoulder, which has been grumbling for a year, basically expecting them to say we will do the same again.

They will not. The cuff on this side is torn and not worth repairing apparently, so this time it is a reverse. And I have come away feeling oddly cheated, like I am being given the budget version because my shoulder did not qualify for the good one. Which I know might be daft but it is honestly how it landed.

So can people be straight with me. Is a reverse actually a worse operation than a total, or does it just get used when the total will not work? Does it wear out quicker? Is it more likely to go wrong? And the one that is really nagging me, why can they not just do another total like the one that worked so well on my left? I am 64 and I would rather have two good years of understanding this than turn up resenting the operation.

Speaking as someone whose only option ever was a reverse, I would gently take the word downgrade off the table. It is not the total with bits missing, it is a completely different design built for a shoulder whose cuff has gone. Mine gave me back an arm I thought I had lost. The reason you are not getting another total is the whole thing: a total leans on the cuff to move and steady the joint, and your cuff on that side is not there to lean on. Put a total on a gone cuff and it fails early. So it is not the good one being withheld, it is the wrong tool for that shoulder.

I was in your exact headspace six months ago, convinced reverse was the second rate emergency version and total was the one everyone actually wants. It is not a ladder with total at the top. Once someone explained that my cuff being shot meant a total would have loosened off on me, the reverse stopped feeling like a demotion and started feeling like the only thing that made sense. Few months into mine and I would not swap it for a total I was never a candidate for.

This is the exact knot I started this whole site to untangle, because I had a reverse myself and I remember the same nagging feeling that I had somehow drawn the short straw. So let me lay it out properly, patient to patient.

A reverse is not the lesser cousin of a total. It is now the most commonly performed type of shoulder replacement in several national registries, precisely because it solves the problem your left shoulder never had, a cuff that is gone. On durability you are not trading much away at all: registry and long term figures put shoulder replacements around 90 percent still in place at 10 years, anatomic totals a touch higher and primary reverses over 90 percent too, with the risk of needing a revision running at roughly 1 percent a year once you are past the first decade. So it is not a joint that wears out faster in any meaningful way. Where the honest trade sits is complications, and I will not soften it: a reverse carries a somewhat higher overall complication rate than an anatomic total, dislocation is a bit more common, and the inward reach behind your back tends to stay limited. That is the price of an operation that works without a cuff, not evidence it is worse. Our walk through of an anatomic versus a reverse sets that fork out fairly, and the belief that a reverse is simply the worse option is one we take on head first in the myths and facts piece.

So the reframe I would offer is the one that finally landed for me. You are not being denied the good operation. You are being matched to the operation your second shoulder actually needs, the same principle that got you the right one first time. Take the complication question straight to your surgeon and let the person examining your scans weigh it for your shoulder, not me.

The line that fixed this for me when I was reading obsessively before mine was simple. There is no gold medal operation, there is the one that fits the joint in front of the surgeon. You already lived that once, your left cuff was intact so a total was right, this cuff is not so a reverse is right. Same logic, different answer. That is not you being downgraded, that is them getting it right twice.

Coming back to close this off. Went back in and asked the complication and dislocation question straight out, and having read this first I actually understood the answer. He was pleased I asked. The way he put it, the reverse is the one that will give this particular shoulder a working arm, and the slightly higher complication side is a known trade he manages. I have stopped seeing it as the cheap version. Booked. Cheers all, this board is worth its weight.