Told it's a total OR a reverse depending on my rotator cuff, not my age. Can someone explain why the cuff decides?

Right, trying to get my head round this before I go back in three weeks. I'm 61, left shoulder is bone on bone according to the X-ray, and I walked in assuming a shoulder replacement was a shoulder replacement. Turns out no.

The surgeon spent a good ten minutes on whether I'd get a total (he kept calling it an anatomic one) or a reverse, and the whole thing seemed to hang on an ultrasound of my rotator cuff that I'm having next week. He said, and I actually wrote it down, that my age barely came into it and it was the cuff that would make the call. Which threw me, because everyone I know assumes the older you are the more likely you are to get the more complicated operation.

So can somebody explain in plain English why a tear in the cuff would flip me from one operation to a completely different one? And is a reverse a downgrade or just different? I keep reading that the deltoid does the lifting in a reverse and I have no real idea what that means for what my arm will actually do afterwards.

Reverse here, done at 68, so I can at least tell you what the deltoid thing means in practice. In a normal shoulder your rotator cuff is the set of small muscles that holds the ball in the socket and gets the arm moving before the big muscles take over. Mine was torn beyond fixing on top of the arthritis, so a standard total would have had nothing to hold it together and it would have failed early.

The reverse swaps the ball and socket around so the geometry changes and your deltoid, the big shoulder muscle you can actually feel, does the lifting instead of the cuff. It sounds drastic and it is a different shoulder afterwards, but calling it a downgrade is wrong. For a cuff that is gone it is the operation that works. I can lift a full kettle, reach a shelf, hang washing. What I cannot do as well is reach round behind my back to tuck a shirt in, that inward rotation stayed a bit limited. Knew that going in, so it did not upset me.

Derek I made the exact mistake you might be making, I assumed reverse was the "worse" or emergency version and total was the gold standard everyone wants. It isn't a ladder. My cuff was intact so I had an anatomic total and it's brilliant for me, but the surgeon was clear that if my cuff had been shot the total would have been the wrong choice FOR ME, not a promotion I'd missed out on. Different joints, different answers.

Derek, you have landed on the one thing this whole site grew out of, because it is exactly what nobody explained to me. I had a reverse myself after a surgeon put my scan up and showed me a cuff that was long past repairing, so I have stood where you are.

The plain version: the rotator cuff is what an anatomic total replacement relies on to move and steady the arm. Cap the worn ball, resurface the socket, keep the natural setup, and it works beautifully as long as the cuff still works. Take away a functioning cuff and that same operation has nothing to drive or stabilise it, so it loosens and fails early. The reverse exists precisely for that situation. It changes the mechanics so the deltoid powers the arm and the cuff is no longer the boss. That is why your surgeon keeps coming back to the ultrasound and not your birth certificate. Age barely moves the decision. The cuff moves it. Our walk-through of an anatomic versus a reverse replacement lays that fork out properly, and if the scan does show cuff damage then why an irreparable cuff points to a reverse is the one to read next.

On lasting, both hold up well. Registry and long-term figures put shoulder replacements around 90 percent still in place at 10 years, anatomic totals a touch higher, primary reverses over 90 percent too, so you are not trading away durability by ending up with a reverse. What reverse-at-68 said about reaching behind your back is the honest trade to expect, not a failure. I am a patient and not your surgeon though, so let the ultrasound and the person examining you make the actual call.

Coming back to close the loop. Had the ultrasound, cuff is torn and not worth repairing, so it's a reverse. Six weeks ago I'd have read that as bad news. After this thread I read it as "right, so that's the operation that suits the shoulder I've actually got." Massive difference in how I feel walking in. Cheers all, especially for the behind-the-back warning, I'd rather know now than find out in month three.