Shoulder and elbow surgery · UK
Reverse shoulder replacement, by a BESS shoulder surgeon.
A deltoid-driven joint replacement for a cuff-deficient shoulder - planned from a CT scan with patient-specific instruments, performed by a high-volume consultant in a London shoulder unit, with revision expertise on the same panel.
Why patients choose us
- 01
A high-volume BESS shoulder surgeon
Not a general orthopaedic list. A named consultant with a high annual rTSA case volume, published outcomes, and BESS membership.
- 02
The right implant for your glenoid
Grammont, lateralised, bony increased-offset, or PSI-planned. We match the platform (Zimmer, Stryker, Exactech, Enovis, Arthrex) to your CT.
- 03
Independent, and free
We are paid by no hospital, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private reverse shoulder replacement costs in the UK.
Indicative ranges across our London and South East panel. Send the imaging and we quote firm figures across two or three surgeons.
In short
A primary reverse shoulder replacement in London: £16,500 to £24,000, home in 1 to 2 nights.
| Procedure | Indicative range | Typical duration | Hospital stay |
|---|---|---|---|
| Consultation, X-rays and planning CT | £450 to £950 | 45 to 60 min | Same visit |
| Primary reverse shoulder replacement (unilateral) | £16,500 to £24,000 | 1 to 2 hours | 1 to 2 nights |
| Revision reverse shoulder replacement | £22,000 to £35,000 | 2 to 4 hours | 2 to 4 nights |
| Bilateral staged rTSA (both shoulders, months apart) | £28,000 to £42,000 | Two sittings | Two admissions |
| rTSA for proximal humerus fracture (elderly) | £18,000 to £26,000 | 2 to 3 hours | 2 to 4 nights |
| Second-opinion review of imaging and prior notes | £300 to £500 | 30 min | 48 hours |
Prices vary by hospital (Fortius, HCA Wellington, Cromwell BUPA, RNOH Private), by surgeon, by implant platform (Zimmer, Stryker, Exactech, Enovis, Arthrex) and by whether PSI is used. We come back with a firm quote within one working day.
The journey
From referral to rehab - what happens, in order.
One team from first message through surgery to your 12-week strengthening milestone.
- 01
Before
You send us the imaging and referral
A short, confidential form. Grashey X-ray, CT of the glenoid if you have it, and any MRI of the cuff. Symptoms and pseudoparalysis grade.
- 02
Before
We come back with a recommendation
Within one working day: whether rTSA fits, or whether cuff repair, anatomic TSA or hemiarthroplasty is the better call. Indicative price.
- 03
Before
CT planning and PSI
A planning CT drives patient-specific instruments (Blueprint, VIP, ExactechGPS) so glenoid version and inclination are set before you arrive.
- 04
On the day
Admission and interscalene block
Day-of-surgery admission. General anaesthetic with an ultrasound-guided interscalene block for 18 to 24 hours of pain cover.
- 05
On the day
The reverse shoulder replacement
1 to 2 hours. Deltopectoral approach, baseplate and glenosphere on the glenoid, stemmed or stemless humeral socket, cemented only if bone quality demands it.
- 06
On the day
One or two nights in hospital
Sling on. Pendulum exercises the same day. Home the next morning or the morning after, with written aftercare and a physiotherapy plan.
- 07
After
Rehab and 130 to 150 degrees of elevation
Passive range in sling for 4 to 6 weeks, active-assisted from 6 weeks, strength from 12 weeks. Most regain 130 to 150 degrees of active elevation by 6 months.
Typical end-to-end: 2 to 4 weeks to surgery. Sling: 4 to 6 weeks. Full elevation: 6 months.
When it helps
When a reverse is the right step - and when it is not.
The indications we see most, plus the situations where an anatomic TSA, cuff repair or watchful waiting is the better answer.
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Rotator cuff arthropathy
Long-standing cuff-deficient arthritis with proximal humeral migration. The classic indication for a Grammont-style reverse.
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Massive irreparable cuff tear with pseudoparalysis
You cannot raise the arm above shoulder height despite an intact deltoid. rTSA converts the deltoid into the elevator.
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Glenohumeral OA with a deficient cuff
Arthritis where the cuff is too thin or torn for an anatomic TSA. The reverse gives a stable, functional replacement.
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Proximal humerus fracture in the elderly
Three or four-part fractures in patients over 70 where fixation and tuberosity healing are unreliable. rTSA gives predictable elevation.
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Failed hemiarthroplasty or anatomic TSA
Painful, unstable or cuff-failed prior replacement. Revision to a reverse construct restores function in the majority.
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Inflammatory arthropathy of the shoulder
Rheumatoid or seronegative arthritis with cuff attrition. Careful bone stock assessment on CT before committing to rTSA.
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Tumour or post-oncology reconstruction
Selected proximal humerus resections reconstructed with a reverse platform, sometimes combined with allograft or a megaprosthesis.
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When rTSA is not the answer
A young active patient with a repairable cuff, active infection, deltoid palsy, or severe glenoid bone loss without augmentation planning.
Implant options
A family of reverse designs - matched to your glenoid on CT.
What each design and platform actually involves, and which fits which shoulder. Complex glenoid bone loss goes to a specialist revision surgeon.
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Grammont inverse-anatomy design
The classic reverse. A glenosphere on the glenoid, a concave socket on the humerus. The centre of rotation is medialised and lowered so the deltoid can elevate the arm.
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Lateralised glenosphere
Modern designs push the centre of rotation laterally to reduce scapular notching, improve rotation and restore a more natural shoulder contour.
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Bony increased-offset (BIO-RSA)
A humeral head autograft is placed behind the baseplate to lateralise the construct with the patient's own bone. Popular in younger, more active patients.
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Stemmed vs stemless humeral component
A short or standard stem for most primaries; stemless designs preserve bone in good-quality metaphysis; long revision stems for bone loss or fracture cases.
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Cemented vs press-fit fixation
Press-fit humeral stems in good bone; cemented stems in osteoporotic bone, revision, or fracture cases where immediate stability matters more than future revision.
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Patient-specific instruments (PSI)
A planning CT drives 3D software (Blueprint, VIP, ExactechGPS, Materialise) that prints guides for glenoid version, inclination and screw trajectory.
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Zimmer, Stryker, Exactech, Enovis, Arthrex
Every major platform (Comprehensive, Ascend Flex, Equinoxe, Reverse Shoulder System, Univers Revers, Aequalis Ascend) is available across our network.
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Second-opinion review
A specialist review of your X-rays, CT and MRI - sometimes the answer is a cuff repair, an anatomic TSA, or watchful waiting rather than a reverse.
Our vetted London network
A small panel of BESS shoulder surgeons, we picked them.
Consultant shoulder and elbow surgeons with high annual rTSA volumes at Fortius, London Shoulder Partnership, HCA Wellington, Cromwell BUPA and RNOH Private. Introductions are made privately once we understand your case.
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BESS-member consultant shoulder and elbow surgeons with high annual rTSA volumes
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Fortius Shoulder and Elbow, London Shoulder Partnership, HCA Wellington, Cromwell BUPA, RNOH Private
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CT-based PSI planning available on every platform (Zimmer, Stryker, Exactech, Enovis, Arthrex)
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Anaesthetist-led interscalene regional blocks and enhanced recovery for day-two discharge
Safety and recovery
What to expect afterwards - honestly.
Reverse shoulder replacement is well established with good long-term data. The things worth planning are your sling weeks, the physio milestones, and the specific reverse-related risks.
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Interscalene block and general anaesthetic
A GA combined with an ultrasound-guided interscalene block gives 18 to 24 hours of shoulder pain cover and reduces opioid use after surgery.
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Scapular notching in 20 to 40 percent
The humeral component impinges on the scapular pillar in inferior adduction. Usually painless, worth knowing about. Lateralised designs reduce the rate.
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Dislocation in 2 to 5 percent
Most instability is early and posterior. Sling compliance for 4 to 6 weeks matters. Recurrent instability may need a spacer swap or component revision.
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Acromial or scapular spine stress fracture
Around 1 to 4 percent. Presents as new deltoid pain after weeks or months. Managed with rest, sling and occasionally fixation.
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Infection is uncommon but serious
Around 1 percent. Cutibacterium acnes is the shoulder-specific concern. Managed with washout and antibiotics; two-stage revision if it becomes chronic.
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Sling for 4 to 6 weeks
Passive range of motion in a sling initially. No active elevation until the physio clears you. Sleeping in a recliner or with pillow support for the first weeks helps.
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Active-assisted from 6 weeks
Guided physio starts wall-slides, pulleys and table-top exercises. Strengthening from 12 weeks. Driving usually possible by 8 to 10 weeks.
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10 to 15 year implant survival 85 to 90 percent
Modern reverse designs have good long-term survival. Revision, when needed, is technically demanding and warrants a specialist revision surgeon.
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Red flags after discharge
Fever, wound discharge, sudden new pain, an audible clunk with loss of elevation, or arm numbness - call the unit or attend A&E the same day.
Recognised by major UK insurers
Cover for reverse shoulder replacement varies by insurer and by indication - usually funded when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about reverse shoulder replacement.
Quick answers on eligibility, cost, recovery, and long-term implant survival.
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What is a reverse shoulder replacement?
A reverse total shoulder replacement (rTSA) is a joint replacement where the anatomy of the shoulder is inverted. A ball (glenosphere) is fixed to the glenoid on the shoulder blade, and a concave socket is fixed to the top of the upper arm bone. This changes the biomechanics so the deltoid muscle can elevate the arm, even when the rotator cuff is torn or deficient. It was designed by Paul Grammont in the 1980s and is now the standard operation for cuff-deficient shoulder arthritis.
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Am I a candidate for a reverse rather than an anatomic replacement?
A reverse replacement is preferred when the rotator cuff is torn, deficient or unlikely to heal - typically in rotator cuff arthropathy, massive irreparable cuff tears with pseudoparalysis, glenohumeral arthritis with a poor cuff, complex proximal humerus fractures in older patients, and revision of failed hemiarthroplasty or anatomic TSA. An anatomic replacement is better when the cuff is intact. The final decision is made after X-rays, a planning CT and often an MRI of the cuff.
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How much does a private reverse shoulder replacement cost in the UK?
A primary unilateral rTSA costs £16,500 to £24,000 self-pay in London and the South East, including consultation, implant, hospital stay and standard follow-up. Revision surgery is £22,000 to £35,000. Bilateral staged replacements over two admissions run £28,000 to £42,000. We confirm a firm figure within one working day once we have your imaging.
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How long does the operation take and how long will I be in hospital?
The operation itself takes 1 to 2 hours for a primary case, longer for revision or fracture reconstruction. It is done under general anaesthesia with an interscalene regional block for pain relief. Most patients spend one or two nights in hospital and go home the morning after with a sling and a written physiotherapy plan.
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What range of motion and function can I expect afterwards?
Most patients regain 130 to 150 degrees of active forward elevation and can dress, wash, eat and reach an overhead shelf comfortably. External rotation gains are more modest and depend on the residual teres minor and the implant design chosen. Heavy lifting above shoulder height and impact sports are usually not recommended long-term to protect the construct.
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What are the main risks and how long do the implants last?
The main specific risks are scapular notching in 20 to 40 percent (usually painless), dislocation in 2 to 5 percent (mostly early), acromial stress fracture in 1 to 4 percent, and infection in about 1 percent. Modern reverse implants have a 10 to 15 year survival of 85 to 90 percent. When revision is needed it is technically demanding and should be done by a specialist revision shoulder surgeon.
Ready to talk it through?
Send us your X-rays and we come back within one working day.
An honest read on whether a reverse shoulder replacement is right for you, a firm price across two or three London surgeons, and an introduction only when you are ready.
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