Rotator Cuff Surgery Options: A Guide for Patients Over 70
Understanding Your Supraspinatus Tear and Treatment Choices
You've been dealing with shoulder pain for months now. Physical therapy didn't give you the relief you hoped for, and those cortisone shots only helped temporarily. Now you're facing a decision that many of my patients in their 70s wrestle with: should you have your rotator cuff repaired, or is it time to consider a reverse total shoulder replacement?
I've been performing both rotator cuff surgery and reverse total shoulder replacement surgery here in Durango since 2013, and I've helped hundreds of patients just like you make this choice. Let me walk you through what each option means for someone in your situation.
Your supraspinatus tear is like a rip in the fabric of your shoulder. This muscle and tendon help lift your arm overhead and provide stability. When it tears, simple tasks like reaching for a coffee mug or brushing your hair become painful reminders of what you've lost.
Option 1: Arthroscopic Rotator Cuff Repair Surgery
Think of rotator cuff repair as mending that torn fabric. During this procedure, I use small incisions and a tiny camera to reattach your torn supraspinatus tendon back to the bone where it belongs.
What makes you a good candidate for rotator cuff repair:
Your tear is still repairable (not too large or retracted)
The muscle hasn't shrunk (atrophied) significantly
You have good bone quality
You're motivated to follow the lengthy rehabilitation process
The recovery process: Recovery from rotator cuff surgery takes patience. You'll wear a sling for about six weeks followed by a 2 week weaning process, and it typically takes four to six months before you feel like your shoulder is truly back to normal.
One of my patients, a 72-year-old rancher from Pagosa Springs, had his rotator cuff repaired two years ago. He was back to handling his cattle and fixing fence posts within eight months. But he'll tell you those first few months required discipline with his physical therapy.
The advantages:
Preserves your natural shoulder joint
Generally less invasive than joint replacement
Good long-term results when the repair heals properly
You keep your own bone and cartilage
The challenges:
Healing depends on your tendon growing back to bone
Re-tear rates are higher in patients over 70
Recovery can be slower and more demanding
May not restore full strength if the tear is large
Very small risk of a major complication (like infection)
Option 2: Reverse Total Shoulder Replacement Surgery
A reverse total shoulder replacement is different from traditional shoulder replacement. Instead of trying to fix what's broken, we essentially redesign how your shoulder works. The ball and socket are reversed, allowing your deltoid muscle to do the heavy lifting that your rotator cuff can no longer handle.
What makes you a good candidate for reverse shoulder replacement:
Large, irreparable rotator cuff tears
Failed previous rotator cuff repairs
Significant weakness when lifting your arm
Arthritis along with your rotator cuff tear
You want more predictable pain relief
The recovery process: Recovery from reverse total shoulder replacement surgery is often more straightforward than rotator cuff repair. Most patients start moving their arm within days of surgery. You are in a sling for 2 weeks, and then starting to use the shoulder for light activity. Many of my patients are driving within two weeks.
A 74-year-old teacher from Cortez had her reverse shoulder replacement last year. She was back to playing with her grandchildren and tending her garden within three months. She tells everyone that her only regret was waiting so long to have the surgery.
The advantages:
More predictable pain relief
Faster return to daily activities
Doesn't rely on tendon healing
Works well even with massive rotator cuff tears
Lower risk of needing repeat surgery
The challenges:
It's a bigger surgery with implants
Some activities may always be limited
Small risk of implant problems over time
Not easily reversible
Very small risk of a major complication (like infection)
Making the Right Choice for Your Lifestyle
The decision between these surgeries isn't just medical—it's personal. I always ask my patients to think about what they want to get back to doing.
Consider rotator cuff repair if:
You're in good health and motivated for a longer recovery
Your tear is repairable
You want to preserve your natural joint
You're willing to accept some uncertainty about the outcome
Consider reverse shoulder replacement if:
You want more predictable pain relief – more certainty of success
Your tear is large or you have significant weakness
You have arthritis in addition to your rotator cuff tear
You prefer a faster return to daily activities
Questions to Discuss During Your Next Visit
Before we make this decision together, think about these questions:
What activities do you miss most because of your shoulder pain?
How important is it to you to preserve your natural joint?
Are you prepared for a longer, more uncertain recovery with rotator cuff repair?
Would you prefer a more predictable outcome even if it means joint replacement?
Do you have other health conditions that might affect your healing?
Success Rates and Realistic Expectations
Let me be honest about what the research shows for patients in your age group. Success rates help guide this decision, but they're not the whole story.
Rotator cuff repair success rates for patients over 70:
Pain relief occurs in about 85-90% of patients
However, re-tear rates are higher - around 30-40% for patients your age
Even when tears happen again, many patients still feel better than before surgery
Full strength recovery is less predictable, especially with larger tears
Reverse shoulder replacement success rates:
Pain relief occurs in 90-95% of patients
Satisfaction rates are consistently high - around 95%
The surgery works reliably even when rotator cuff muscles are severely damaged
Most patients regain good function for daily activities
The numbers favor reverse shoulder replacement for predictable outcomes, but that doesn't make it automatically right for everyone. Your goals matter more than statistics.
Take Your Time With This Decision
Both rotator cuff surgery and reverse total shoulder replacement surgery have helped countless patients in Durango, Farmington, Cortez, and Pagosa Springs get back to their active lifestyles. Based on your MRI and examination, either option could work for you - that's why this choice is yours to make.
Take this information home. Talk it over with your family. Think about what matters most to you in your recovery. There's no rush, and there's no wrong choice here.
When you're ready to move forward, just call the office and let us know which direction feels right for you. I've been helping patients navigate these choices for over a decade, and I'm confident that whichever option you choose, we can get you back to a more comfortable, active life.
Your shoulder pain has already taken enough from you. Let's work together to get you back to living the life you want in our beautiful corner of Colorado and New Mexico.
Please email me at doctorbutzen@gmail.com if you have any questions about this topic.