Reverse Shoulder Replacement in Nashville, TN
When the rotator cuff is worn out and the shoulder is also arthritic, a conventional shoulder replacement usually cannot solve the problem. A standard total shoulder depends on a working rotator cuff to lift and rotate the arm. Take the cuff out of the equation and a regular implant rides up, loosens, and leaves the arm just as weak as it was before surgery. Reverse shoulder replacement was designed for this exact situation, with the ball and socket positions flipped so the deltoid muscle does the work the cuff used to do.
Dr. Damon H. Petty has performed reverse shoulder replacement for more than 15 years in Nashville. Across that span he has had zero dislocations and zero component failures to date using the DJO Reverse Shoulder System. He is board-certified in Orthopedic Surgery and Sports Medicine, practices through Tennessee Orthopaedic Alliance (TOA), and sees patients at TOA offices in Brentwood, Franklin, and Nashville’s One City campus.
What Is a Reverse Shoulder Replacement?
A reverse shoulder replacement is a prosthetic shoulder built for patients whose rotator cuff no longer works. In a healthy shoulder, a ball sits at the top of the upper arm bone, the humerus, and rotates inside a shallow socket on the shoulder blade, or scapula. The socket itself is called the glenoid. Four rotator cuff tendons wrap around the humerus and power most of the lifting motion you use every day.
When the rotator cuff tears completely and the tissue cannot be repaired, the mechanics fall apart. Patients often lose the ability to lift the arm at all, even though the joint itself can still move passively. Put a conventional implant into a shoulder with no working cuff and the ball rides up against the underside of the acromion, the implant loosens, and the arm still will not elevate. A reverse procedure is the one that resets those mechanics.
A reverse shoulder replacement flips that geometry. The ball goes on the glenoid side, where the socket used to be. A new socket sits on top of the humerus. Once the fulcrum of the joint shifts, the deltoid muscle across the top of the shoulder takes over the lifting job the rotator cuff used to do. Patients who could not raise a cup of coffee before surgery can often reach an overhead shelf within a few months of recovery.
The modern reverse prosthesis received FDA approval in the United States in 2004, after roughly twenty years of use in Europe. Long-term data now show excellent durability, with most implants lasting fifteen to twenty years or longer in properly selected patients. For patients with rotator cuff tear arthropathy (advanced arthritis combined with an irreparable cuff), failed prior replacements, or complex fractures of the humerus with a compromised cuff, a reverse is often the only procedure that will meaningfully restore arm function and relieve pain.
How Reverse Differs From a Conventional Total Shoulder
Both procedures replace the worn surfaces of the shoulder with metal and plastic components, but the mechanics are different and the patients are different.
Conventional Total Shoulder Replacement
Patients with shoulder arthritis and a healthy rotator cuff
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Preserves your natural shoulder anatomy
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Metal ball replaces the humeral head
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Plastic socket is placed in the glenoid
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Rotator cuff continues to power movement and stability
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Glenohumeral arthritis
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Intact rotator cuff
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Good soft tissue quality
Reverse Shoulder Replacement
Patients with significant rotator cuff damage
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Ball is attached to the glenoid
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Socket is placed on the arm bone
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Deltoid muscle becomes the primary source of motion
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Allows arm elevation even without a functioning rotator cuff
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Rotator cuff tear arthropathy
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Massive irreparable rotator cuff tears
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Failed prior shoulder replacement
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Complex revision cases
Best For
How It Works
Ideal Candidates
For complex primary reverse cases and every revision, Dr. Petty uses CT-based 3D modeling with the Arthrex VIP System to plan the implant size, glenoid component position, and soft tissue tension before surgery begins. A few millimeters of glenosphere offset can change the risk of dislocation and scapular notching substantially, so the planning work matters.
Who Is a Candidate for Reverse Shoulder Replacement?
Not every patient with shoulder pain needs a reverse shoulder replacement, and not every patient who has exhausted conservative care is a reverse candidate. A careful evaluation, including X-rays, MRI, and sometimes a CT, is what separates the two groups.
Dr. Petty considers the following indications:
When reverse is not the right call
Patients without a functioning deltoid, those with an active joint infection, and those with severely deficient glenoid bone are not safe reverse candidates in their current state. Dr. Petty walks you through your imaging and explains honestly whether your anatomy will support a reverse, whether a preparatory step like bone grafting or infection clearance is needed first, or whether a different plan altogether is wiser.
The Reverse Shoulder Replacement Procedure, Step by Step
Every reverse shoulder replacement Dr. Petty performs follows the four principles that guide every joint replacement in his practice: high-quality implants, a precise and reproducible surgical technique, a low complication profile, and maximum durability of the result.
Most patients spend one to two nights in the hospital. You go home with your arm in a sling, and the recovery plan is set before you leave.
Recovery After Reverse Shoulder Replacement
Recovery from a reverse shoulder replacement is more gradual than a knee or hip. Shoulder soft tissue has to heal around the new biomechanics before aggressive motion is safe. Most patients work through four phases across roughly twelve months, though many are back to normal daily life well before that.
Dr. Petty coordinates rehabilitation with physical therapists in Nashville, Brentwood, and Franklin who are familiar with reverse shoulder biomechanics. A home exercise program, regular recovery check-ins at six weeks, three months, six months, and one year, and annual follow-ups after that let him monitor implant position and function over the long haul. The point of the recovery plan is to get you back to daily life with confidence and to protect the longevity of the implant.
Why Patients Choose Dr. Petty for Reverse Shoulder Replacement in Nashville
Reverse shoulder replacement is not a procedure a surgeon should be learning on you. It rewards experience, careful candidate selection, and a consistent technique repeated across a high case volume. Dr. Petty brings a combination of training, track record, and technology that is hard to match in Middle Tennessee.
Fifteen years, zero dislocations, zero component failures
Dr. Petty has performed reverse shoulder replacement for more than fifteen years and, to date, has had zero dislocations and zero component failures using the DJO Reverse Shoulder System. Dislocation is the single most common complication of reverse shoulder, and component failure is among the most costly. Avoiding both across a volume practice comes from surgical discipline, careful intraoperative tension checking, and the willingness to tell a patient up front when they are not the right candidate.
Dual board certification
Dr. Petty is board-certified in Orthopedic Surgery and in Sports Medicine. Most orthopedic surgeons hold one of those boards. Very few hold both. The combination matters for reverse patients because the shoulder often has a long injury history, often including failed repairs, prior arthroscopy, and residual soft tissue problems that benefit from a sports medicine lens as much as a replacement lens.
Training under Drs. James Andrews and William Clancy
Dr. Petty completed his sports medicine fellowship under Drs. James Andrews and William Clancy in Birmingham, Alabama. Dr. Andrews is widely regarded as the most prominent sports medicine surgeon in the world, and Dr. Clancy is among the most respected. That training shapes how Dr. Petty handles soft tissue repair and restoration in every shoulder case, athletic or not.
Advanced preoperative planning
For complex primary cases and every revision, Dr. Petty uses the Arthrex VIP System for CT-based three-dimensional modeling and patient-specific preoperative planning. The result is a more predictable implant position, a better range-of-motion target, and a lower risk of impingement or scapular notching after surgery.
An integrated Nashville shoulder practice
A reverse is one piece of a broader shoulder program. Dr. Petty also performs rotator cuff repair, shoulder arthroscopy, conventional total shoulder replacement, shoulder resurfacing with the Arthrosurface OVO, and image-guided PRP and BMAC injections he administers personally. If your shoulder needs something other than a reverse, he can offer it. If a reverse is the right answer, he can offer that too.
Published and recognized
Dr. Petty has authored peer-reviewed research in the American Journal of Sports Medicine on elbow and shoulder injuries in throwing athletes. He served as Head Orthopedic Team Physician for the Tennessee Titans from 2018 to 2026, with Vanderbilt University assuming the role for the 2026-27 season. He has been team physician for Tennessee State University for the last 15 years and served as head orthopedic doctor for the Nashville Sounds during their Pittsburgh Pirates affiliation. At TOA, his aggregate patient rating is 4.7 out of 5.0 across more than 1,033 reviews.
Reverse Shoulder Replacement vs. Other Shoulder Options
Choosing the right procedure is as important as performing it well. Your evaluation with Dr. Petty will sort through these paths honestly, based on your imaging and your goals.
Rotator cuff repair or shoulder arthroscopy
Patients with a repairable rotator cuff tear
No significant arthritis
If your MRI shows repairable tissue and your X-rays are clean, arthroscopic surgery is the first step and often the only one you need.
Conventional total shoulder replacement
Patient with shoulder arthritis
Functioning rotator cuff
Natural anatomy is preserved and long-term outcomes are excellent for the right surgeon and the right candidate.
Shoulder resurfacing (Arthrosurface OVO)
Patients with focal cartilage damage
Mostly intact joint
Dr. Petty has performed hemiarthroplasty and shoulder resurfacing for 25+ years with zero loosening or implant failures.
Reverse shoulder replacement
Rotator cuff tear arthropathy
Massive irreparable cuff tears with functional loss, failed prior replacements, or complex humerus fractures with cuff deficiency.
Can delay or avoid surgery in early arthritis or borderline cuff cases. Not a substitute for a reverse once arthropathy is advanced.
Patient Stories
“Dr. Petty did a partial shoulder replacement for me several years back. He was the first and only orthopedic I thought of when I began having an elbow issue. I would give 10 stars instead of 5 if it were allowable.”
- Mike Beckman
“I have had a very positive experience with Dr. Petty and his staff at TOA. My shoulder surgery went well and I am confident I chose the right surgeon. Dr. Petty explained the procedure in detail and set expectations for physical therapy and recovery. I expect to be able to regain full use of my shoulder and biceps muscle.”
- Loretta Baker
Best doc for me. First time pain free (shoulder/bicep) since I can remember.”
- Tracy Millette
Great expertise and knowledge on where the medicine should be applied and why.
- Healthgrades
Frequently Asked Questions
Book a Consultation With Dr. Petty in Nashville
If you have lost the ability to lift your arm, if previous rotator cuff surgeries have not held, or if a conventional shoulder replacement has failed, a reverse shoulder replacement may be the answer. Dr. Petty sees patients at his Nashville office through Tennessee Orthopaedic Alliance (TOA) at 8 City Blvd, Nashville, TN 37209. Phone: (615) 329-6600. Hours: Monday through Friday, 8:00 AM to 5:00 PM.
We serve patients from Nashville, Brentwood, Franklin, Murfreesboro, Hendersonville, Gallatin, Lebanon, and the greater Middle Tennessee area. Dr. Petty also sees patients who travel for world-class care, some from over 500 miles away, including recent patients from Kansas City, drawn by his specific expertise and reputation.