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Reverse shoulder arthroplasty

Surgeon-side topic for reverse shoulder arthroplasty. Backed by 399 articles from the corpus, retrieved via combined MeSH + title-text matching.

70 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Reverse total shoulder arthroplasty (rTSA) is a versatile revision option following failure of primary procedures, including failed shoulder arthroplasty, rotator cuff repair, or proximal humerus open reduction and internal fixation [14]. It provides superior functional outcomes compared with conservative treatment for patients presenting with an acute proximal humeral fracture [7]. However, rTSA does not appear to offer functional benefits over anatomic total shoulder arthroplasty in patients with primary osteoarthritis, an intact rotator cuff, and no glenoid deformity [1].

Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a nine-point improvement in their ASES score experience a clinically important change [18]. Those with at least a 23-point improvement experience a substantial clinical benefit [18]. The outcome of revision shoulder arthroplasty can be predicted on the basis of the indication for the procedure [24].

Reverse shoulder arthroplasty use has increased among patients younger than 60 years of age [3]. Patients younger than 60 years of age experience significantly higher rates of 90-day surgical complications from reverse total shoulder arthroplasty compared to older patients [3]. In patients under 55 years of age with primary glenohumeral osteoarthritis, reverse shoulder arthroplasty and stemless anatomic total shoulder arthroplasty have a lower short-term revision risk than stemmed anatomic total shoulder arthroplasty [4].

Patients undergoing revision of a failed anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty have worse clinical outcomes compared with those undergoing primary rTSA, including all PROMs, abduction, elevation, pain relief, and patient satisfaction [6]. These patients also have higher complication and revision rates compared with those undergoing primary rTSA [6]. Conversely, revision reverse shoulder arthroplasty demonstrates significant long-term clinical improvements and an implant survival rate of 85% at ten years [2]. Patients with good outcomes after first reverse total shoulder arthroplasty can be counseled on contralateral TSA as early as 3 months postoperatively with confidence of a similar result on the contralateral side [5].

Reverse shoulder arthroplasty for fractures versus arthropathy have substantial differences in patient characteristics, surgical complexity, and hospital resource utilization [15].

Anatomy & Pathophysiology

Osseous

The glenoid is suspended from the scapular body by the neck and fixed to the clavicle via the acromioclavicular and coracoclavicular ligaments [25]. The glenoid vault narrows as the face transitions into the neck [25]. Posteriorly, the scapular spine is subcutaneous and widens gradually as it transitions into the base of the acromion laterally [25]. The acromion curves anteriorly to meet the clavicle at the acromioclavicular joint and meets the coracoid via the coracoacromial ligament, which originates under the anterior margin of the acromion [25].

Vascular & Neural

The suprascapular nerve arises from the C4–C5 nerve roots off the supraclavicular brachial plexus at “Erb’s point” [25]. It runs just medial to the base of the coracoid, under the transverse scapular ligament within the suprascapular notch [25]. Branches to the supraspinatus are given off within 1 cm of the suprascapular notch [25]. The nerve continues through the supraspinatus fossa on the under surface of the supraspinatus, running under the ill-defined spinoglenoid ligament around the lateral base of the scapula within the spinoglenoid notch [25]. It terminates in posterior capsular sensory branches heading laterally and an infraspinatus motor branch heading medially within 1 cm of the lateral margin of the scapular spine [25]. The nerve is present 29 mm (23 to 35 mm) from the superior rim of the glenoid at the suprascapular notch and 18 mm (14 to 24 mm) from the posterior rim at the spinoglenoid notch [25]. Injury to this nerve causes pain and denervation of the supraspinatus and infraspinatus [25].

Kinematics

The traditional Grammont-style reverse shoulder arthroplasty prosthesis features a glenoid component shaped as a third of a sphere [28]. Its center of rotation is medial to the glenoid component–bone interface [28]. The humeral component is inset, resting almost completely inside the proximal humerus metaphysis [28]. The polyethylene opening angle is relatively horizontal (155 degrees) compared with conventional arthroplasty [28]. Articulation places the humerus more medial and more distal than preoperatively [28]. Medialization of the center of rotation decreases shear stress and provides compressive stress to decrease the chances of glenoid loosening [28]. Distalization of the center of rotation doubles the lever arm of the deltoid and optimizes the length–tension curve of its sarcomeres, increasing efficiency by 30% at the cost of rotational strength [46]. The semiconstrained nature of the prosthesis provides a stable fulcrum that allows the deltoid to elevate the shoulder even in the absence of a functional rotator cuff [28]. Without rotator cuff centering, the deltoid pulls the humerus proximally, shearing along the glenoid and resulting in eccentric glenoid wear, acetabularization of the acromion, and pseudoparalysis [46]. Reverse shoulder arthroplasty does not require the rotator cuff for function but is dependent on an intact deltoid neuromuscular unit [46].

Reverse shoulder arthroplasty restores forward elevation primarily via compensatory scapulothoracic motion and deltoid-driven neuromuscular strategies rather than normalization of glenohumeral mechanics [36]. The scapulothoracic contribution to overall shoulder movement is significantly increased in patients with an rTSA compared with a healthy shoulder [40]. There is an increased contribution of scapulothoracic rotation relative to glenohumeral motion throughout arm elevation following TSA compared to asymptomatic shoulders [48]. Postoperative changes in scapular kinematics following rTSA positively impact shoulder function and patient-reported outcome measures [39]. Scapular kinematics during rehabilitation exercises after rTSA differ depending on the plane and modality of the exercise [42]. Isolated humeral distalization in rTSA causes dramatic increases in the muscle forces required to perform scapular-plane abduction, with joint reaction forces increasing correspondingly [44].

Complications & Biomechanics

A 135° neck-shaft angle with a 42mm glenosphere maximized ROM for most motions, while a 155° neck-shaft angle with a 36mm glenosphere optimized abduction and forward elevation [54]. Joint stability and abduction capability were compromised by more extensive rotator cuff tears, and subscapularis repair might be essential to enhancing biomechanical effectiveness in lateralized rTSA [57]. The isolated effect of increasing glenosphere eccentricity on shoulder stability following rTSA appears negligible in the position of instability [63]. Internal rotation post-reverse shoulder arthroplasty is associated with a limited range compared with other shoulder motions, resulting in lower recovery rates for ADLs associated with internal rotation [65]. Subscapularis repair was associated with clinically significant improvements in pain while sleeping on the affected shoulder after primary reverse shoulder arthroplasty [62].

Periprosthetic scapular fractures are universally associated with stable glenoid implants [19]. These fractures can result in new glenohumeral instability due to the change of the orientation of the glenosphere and loss of deltoid tension [19]. Postoperative periprosthetic scapular fractures occur at rates of 0.9% to 11.2% [46]. They are an effect of nonphysiologic forces transferred from the implant to the scapula, often in a suboptimal host [46]. Female gender has been implicated as a risk factor for postoperative periprosthetic scapular fracture, accounting for up to 100% of some series [46]. Postoperative periprosthetic scapular fractures typically occur in patients 70 to 80 years old [46]. Osteoporosis is a significant risk factor for postoperative periprosthetic scapular fracture [46]. Fatigue fractures of the scapula occur through already weakened acromia or those with preexisting lesions [46].

Classification

Indications: Reverse total shoulder arthroplasty (RTSA) is indicated for primary osteoarthritis with an intact rotator cuff and no glenoid deformity [1], primary glenohumeral osteoarthritis in patients under 55 years of age [4], and inflammatory arthritis [16, 26]. It is indicated for avascular necrosis [26], glenohumeral arthritis following shoulder dislocation [26], tumor resection [26], and septic arthritis [26]. RTSA is indicated for cuff tear arthropathy, defined by radiographic features of acetabularization of the acromion, femoralization of the humeral head, and superior or anterosuperior migration of the humeral head [72], as well as for displaced proximal humeral fractures [7]. It serves as a revision option following failure of primary shoulder arthroplasty [14], rotator cuff repair [14], or proximal humerus open reduction and internal fixation [14].

Glenoid Classification: Glenoid wear in primary RTSA is classified into four groups based on location and severity: Group 1 (severe central glenoid erosion with medialization of the joint line), Group 2 (anterior glenoid bone loss, D glenoid), Group 3 (posterior glenoid bone loss with posterior subluxation, B3 glenoid), and Group 4 (small glenoids with osteoporotic bone and glenoid vault ≤ 20 mm depth) [71]. Glenoid erosion in the sagittal plane is evaluated using the Favard classification (E0, E1, E2, E3) [71]. Glenoid bone loss in revision RTSA is quantified using the Sauzieres classification: Type A (central defect respecting cortical bone) and Type B (peripheral defect of the anterior wall of less than a third of the depth) [71]. The Walch classification is used to describe glenoid wear patterns [33]. The Sirveaux classification is used for radiographic evaluation in primary RTSA cases performed for massive cuff tear or cuff tear arthropathy [74].

Prosthesis Classification: RTSA prostheses are classified by humeral tray design as inlay or onlay [72]. RTSA prostheses are classified by glenosphere positioning as lateralized or non-lateralized [9].

Clinical Presentation

Reverse total shoulder arthroplasty (rTSA) use has increased among patients younger than 60 years of age, a population that experiences significantly higher rates of 90-day surgical complications compared to older patients [3]. The definition of "younger patient" varies within the literature, with the cutoff being 60-70 years of age [27]. Recent reports demonstrate an 87% survival rate at 15 years for rTSA in younger patients [27]. Short-term comparative studies demonstrate equivalent patient-reported outcomes and complications between younger and older patients but greater range of motion in younger patients [27]. Patients undergoing revision of a failed anatomic total shoulder arthroplasty to rTSA have worse clinical outcomes compared with those undergoing primary rTSA, including all PROMs, abduction, elevation, pain relief, and patient satisfaction, with higher complication and revision rates [6]. Patients undergoing rTSA for inflammatory conditions, fractures, and arthroplasty revision are at higher risk for complications [26]. Patients with diagnoses portending higher preoperative outcome scores were at risk for less overall improvement [26].

Patients typically present around their 8th decade of life after a sudden increase in pain or loss of function in an otherwise smooth postoperative course [19]. Presentation is generally within 1 year but up to 2 years from surgery [19]. Patients who go on to have periprosthetic scapular fractures initially outperform those who do not [19]. Diagnosis of periprosthetic fractures is often subtle and requires a high index of suspicion [19]. New pain at the base of the acromion may be the only finding in a stress reaction, raising suspicion for fracture [19]. Stress fractures can be more painful than after they propagate into a displaced fracture [19]. Fracture can result in motion limited by pain, new weakness, or loss of function [19]. A sudden loss of function or increase in pain is consistent with both scapular fracture and infection [19].

Deformity: Deformity on physical examination is concerning for dislocation, hematoma, or displaced fracture [19]. Erythema or incisional dehiscence: These findings are concerning for infection [19]. Tenderness: Tenderness along the acromion or scapular spine raises suspicion for fracture [19]. Risk factors for periprosthetic scapular fractures include a history of steroid use, osteoporosis, subacromial decompression, or rotator cuff tear arthropathy [19].

Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or rTSA and have at least a nine-point improvement in their ASES score experience a clinically important change, whereas those who have at least a 23-point improvement in their ASES score experience a substantial clinical benefit [18]. All studies reported improved American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation or Subjective Shoulder Value scores as well as improved range of motion following rTSA [49]. Patients who underwent rTSA for acute or chronic proximal humerus fracture or failed primary arthroplasty reported lower patient-reported outcomes when compared to other indications [49]. Reverse total shoulder arthroplasty provides generally satisfactory outcomes regardless of preoperative pathology [26]. Direct comparison studies revealed overall superior outcomes of rTSA for glenohumeral arthritis with intact rotator cuff as compared to patients with rotator cuff arthropathy [26]. The outcome for rTSA can be measured with the treatment effect method, with 2 years treatment effects varying from 1 to 0.09 [23].

Return to sports after rTSA is possible and highly frequent [13]. Patients undergoing rTSA return to sporting activities at varying rates depending on age and prior surgery, with walking and swimming being the most common activities postoperatively [29]. Patients achieved maximum medical improvement at 1 postoperative year following rTSA [8]. Rehabilitation following rTSA aims to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery [21].

Near-simultaneous rTSA for bilateral displaced proximal humerus fractures in a geriatric patient demonstrates clinical and radiological success with early range of motion [20]. Superior functional outcome follows rTSA compared to hemiarthroplasty for displaced three- and four-part fractures in patients 65 and older [30]. Reverse arthroplasty may be a reliable treatment option in patients at risk for developing rotator cuff failure, demonstrating similar outcomes but faster range of motion recovery compared to anatomic total shoulder arthroplasty in patients with restricted preoperative forward elevation [22]. Concomitant subscapularis repair in lateralized rTSA decreased glenohumeral abduction and increased internal rotation [9]. Radiographic measurements are generally valid for evaluating postoperative parameters in rTSA [34]. Lateralization and distalization shoulder angles may not predict clinical outcomes in rTSA [45]. There is a weak, nonsignificant association between preoperative deltoid cross-sectional area and postoperative Constant-Murley scores following rTSA [47]. The "tipping point" for revision rTSA is the clinical status that patients deem dysfunctional enough to warrant surgery, requiring balancing of potential functional and pain improvements with surgical risks [43].

Investigations

Plain radiography: Anteroposterior, scapular Y, and axillary views are routine for identifying periprosthetic scapular fractures, although they can miss subtle fractures [61]. Plain radiographs are unreliable for detecting fracture or fracture union, with a kappa value of 0.05 [61]. Radiographs of both humeri with magnifier markers may be used to understand where the stem should be positioned in reference to the fracture line on the humeral shaft [31].

CT: New pain along the scapula in the setting of normal radiographs should trigger a CT scan to diagnose nondisplaced fractures [61]. Careful assessment of preoperative radiographs and CT with three-dimensional reconstruction is useful for understanding fracture patterns and anticipating the ideal height of stem implantation [31]. Preoperative CT is used to assess glenoid morphology for glenoid component implantation, including version, inclination, and rotation [31].

Bone scan: A negative CT scan may occur in the setting of a stress reaction, which may be better elicited on a bone scan [61].

Other Considerations: Patients achieve maximum medical improvement at 1 postoperative year following reverse total shoulder arthroplasty [8]. Early outcomes after first reverse total shoulder arthroplasty better prognosticate contralateral success compared with early outcomes after anatomic total shoulder arthroplasty [5]. The outcome for reverse shoulder arthroplasty can be measured with the treatment effect method, with 2-year treatment effects varying from 1 to 0.09 [23].

Treatment

Non-Operative

Patients with severe shoulder pain who are possible candidates for shoulder arthroplasty should exhaust other pain-reducing options before using opioid pain medications [80].

Operative

Indications: Reverse total shoulder arthroplasty (RTSA) is the replacement procedure of choice when arthroplasty is considered for proximal humeral fractures [28]. It provides superior functional outcomes compared with conservative treatment for acute proximal humeral fractures [7] and compared with hemiarthroplasty for displaced three- and four-part proximal humeral fractures in patients 65 and older [30]. RTSA is advocated for complex proximal humerus fractures in elderly patients because it provides more consistent and predictable results compared with hemiarthroplasty or plate osteosynthesis [68]. For primary osteoarthritis with an intact rotator cuff and no glenoid deformity, RTSA does not offer functional benefits over anatomic total shoulder arthroplasty (TSA) [1]. The Reverse or Anatomical replacement for Painful Shoulder Osteoarthritis, Differences between Interventions trial aims to definitively compare reverse and anatomic replacement for painful shoulder osteoarthritis [16]. RTSA may be a reliable treatment option in patients with primary osteoarthritis with restricted preoperative forward elevation who are at risk for developing rotator cuff failure [22]. In the predominantly male patient population below the age of 55, RTSA and stemless anatomic TSA have a lower short-term revision risk than stemmed anatomic TSA [4]. There is no consensus regarding the use of RTSA in younger patients, with the definition of "younger patient" varying within the literature with a cutoff of 60-70 years of age [27].

Surgical Approach / Technique: Rehabilitation guidelines for reverse total shoulder replacement aim to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery [21]. Patients achieved maximum medical improvement at 1 postoperative year following RTSA for rotator cuff deficiency [8]. Distal acromial tip fusion is a novel procedure proposed to mitigate acromial stress fractures in high-risk patients undergoing RTSA [82].

Implant Selection: Structural bone grafting with a long post can be used for RTSA in osteoarthritis with severe glenoid bone loss [85]. Patient-specific implants are an innovative approach to addressing complex glenoid bone loss cases in RTSA by restoring the native joint line, minimizing bone removal, and providing customized fixation [70].

Alignment / Balancing Strategy: RTSA is effective in restoring forward elevation irrespective of latissimus dorsi and teres major transfer or lateralization for combined loss of elevation and external rotation [10]. Active external rotation after RTSA is complex and not governed by a single muscle-tendon unit [12].

Pain Management: Not specified in the provided evidence.

Adjuncts: Not specified in the provided evidence.

Setting of Care: Patients with good outcomes after first RTSA can be counseled on contralateral anatomic TSA as early as 3 months postoperatively with confidence of a similar result on the contralateral side [5].

Revision: RTSA is a versatile revision option following failure of primary procedures including failed shoulder arthroplasty, rotator cuff repair, or proximal humerus open reduction and internal fixation [14]. Revision RTSA demonstrates significant long-term clinical improvements and an implant survival rate of 85% at ten years [2]. Patients undergoing revision of a failed anatomic TSA to RTSA have worse clinical outcomes compared with those undergoing primary RTSA, including all PROMs, abduction, elevation, pain relief, and patient satisfaction, with higher complication and revision rates [6]. Functional improvement was obtained after reimplantation of a reverse total shoulder prosthesis in staged revision with antibiotic spacers for shoulder prosthetic joint infections, but was not seen after hemiarthroplasty and cement spacer [17].

Other Considerations: RTSA use increased 191% from 2011 to 2017, with an expected increase of 122% through 2025 [27]. In 2020, RTSA constituted 70% of all shoulder arthroplasties and is commonly performed more than hemiarthroplasty or anatomic TSA in many regions [27]. Recent reports demonstrate an 87% survival rate at 15 years for RTSA in younger patients, with trends comparable to total hip and knee arthroplasty [27].

Complications

Infection (PJI): The provided evidence does not specify incidence rates or risk factors for periprosthetic joint infection in this dataset.

Aseptic loosening: The cement-within-cement technique in revision reverse total shoulder arthroplasty is associated with higher rates of complications and re-revision surgery over time, primarily due to aseptic glenoid component loosening and instability [73].

Instability: Instability is the main cause for stemmed anatomic and reverse total shoulder arthroplasty in patients under 55 years of age [84]. Revision reverse shoulder arthroplasty for baseplate failure has higher complication and reoperation rates than primary reverse total shoulder arthroplasty [78].

Periprosthetic fracture: The incidence of intraoperative greater tuberosity fractures is more than double when revising an arthroplasty to reverse total shoulder arthroplasty compared with primary reverse total shoulder arthroplasty [92].

Thromboembolism: The use of therapeutic postoperative anticoagulation is a risk factor for significantly elevated wound complications and revision rates in patients undergoing shoulder arthroplasty compared with controls [88].

Wound complications: The use of therapeutic postoperative anticoagulation is a risk factor for significantly elevated wound complications and revision rates in patients undergoing shoulder arthroplasty compared with controls [88].

Other Considerations: Reverse total shoulder arthroplasty does not offer functional benefits over anatomic total shoulder arthroplasty in patients with primary osteoarthritis, an intact rotator cuff, and no glenoid deformity [1]. Patients younger than 60 years of age undergoing reverse total shoulder arthroplasty experience significantly higher rates of 90-day surgical complications compared to older patients [3]. Patients undergoing revision of a failed anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty have worse clinical outcomes, including all patient-reported outcome measures, abduction, elevation, pain relief, and patient satisfaction, as well as higher complication and revision rates compared with those undergoing primary reverse total shoulder arthroplasty [6]. Glenoid erosion is the predominant cause of revision for humeral resurfacing and hemiarthroplasty [84].

Recovery

Light activity (weeks): Recommendations for return to driving after shoulder arthroplasty range from 6 to 12 weeks [60]. Desk work and light activities of daily living (ADLs) typically resume within this window, supported by rehabilitation guidelines that aim to achieve optimal pain relief and maximize functional outcomes while mitigating surgical risks [21].

Full activity (months): A high return to sport can be expected after total shoulder arthroplasty [67]. Reverse total shoulder arthroplasty is effective in restoring forward elevation irrespective of latissimus dorsi and teres major transfer or lateralization [10]. Near-simultaneous reverse shoulder arthroplasty for bilateral displaced proximal humerus fractures in a geriatric patient can result in clinical and radiological success with early range of motion [20].

Complete recovery / outcome plateau (months): Revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years [2]. Chronic recovery after total shoulder arthroplasty can be assessed via time spent above 90 degrees of elevation [90].

Rehabilitation protocol: Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme [37]. Self-directed home therapy following reverse shoulder arthroplasty may be a viable alternative to formal supervised physical therapy, showing no significant differences in outcomes across multiple measures [41].

Functional milestones: Six distinct early recovery trajectories were identified after total shoulder arthroplasty, with 83.7% of patients (the 'Faster group') experiencing very low pain scores after only 2 weeks [86]. Acute recovery after total shoulder arthroplasty can be assessed via maximum elevation [90].

Other Considerations: There remains little knowledge regarding the optimal glenoid version in reverse shoulder arthroplasty [35]. Timely interventions, such as pectoralis major tendon transfer, may provide meaningful functional recovery in cases of subscapularis retear after reverse total shoulder arthroplasty [53].

Key Evidence

  • [L3] Reverse total shoulder arthroplasty does not appear to offer functional benefits over anatomic total shoulder arthroplasty in this population. [1] (10.1016/j.jse.2025.01.038)
  • [L3] Revision reverse shoulder arthroplasty demonstrates significant long-term clinical improvements and an implant survival rate of 85% at ten years. [2] (10.1302/0301-620x.107b11.bjj-2025-0436.r1)
  • [L3] Reverse total shoulder arthroplasty use has increased among patients younger than 60 years of age, but this population experiences significantly higher rates of 90-day surgical complications compared to older patients. [3] (10.1016/j.jseint.2025.05.020)
  • [L3] In the predominantly male patient population below the age of 55, reverse shoulder arthroplasty and stemless anatomic total shoulder arthroplasty have a lower short-term revision risk than stemmed anatomic total shoulder arthroplasty. [4] (10.1016/j.jse.2024.07.032)
  • [L4] Patients with good outcomes after first reverse total shoulder arthroplasty can be counseled on contralateral TSA as early as 3 months postoperatively with confidence of a similar result on the contralateral side. [5] (10.1016/j.jse.2023.10.007)
  • [L3] Patients undergoing revision of a failed anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty have worse clinical outcomes compared with those undergoing primary rTSA, including all PROMs, abduction, elevation, pain relief, and patient satisfaction, with higher complication and revision rates. [6] (10.1016/j.jse.2024.09.019)
  • [L1] Treatment with reverse shoulder arthroplasty provides superior functional outcomes compared with conservative treatment for patients presenting with an acute proximal humeral fracture. [7] (10.1016/j.jse.2024.02.023)
  • [L2] Patients achieved maximum medical improvement at 1 postoperative year following reverse total shoulder arthroplasty. [8] (10.1016/j.jse.2018.05.029)
  • [L5] Concomitant subscapularis repair in lateralized reverse total shoulder arthroplasty decreased glenohumeral abduction and increased internal rotation. [9] (10.5397/cise.2025.00675)
  • [L3] Reverse total shoulder arthroplasty was effective in restoring forward elevation irrespective of latissimus dorsi and teres major transfer or lateralization. [10] (10.1016/j.jseint.2026.101636)
  • [L4] Active external rotation after reverse total shoulder arthroplasty is complex and not governed by a single muscle-tendon unit. [12] (10.1016/j.jse.2023.08.031)
  • [L4] Return to sports after reverse shoulder arthroplasty is possible and highly frequent. [13] (10.1136/jisakos-2020-000581)
  • [L5] Reverse shoulder arthroplasty is a versatile revision option following failure of primary procedures including failed shoulder arthroplasty, rotator cuff repair, or proximal humerus open reduction and internal fixation, with a large body of literature demonstrating its success. [14] (10.1016/j.jseint.2025.02.019)
  • [L3] Reverse shoulder arthroplasty for fractures versus arthropathy have substantial differences in patient characteristics, surgical complexity, and hospital resource utilization. [15] (10.1016/j.jse.2024.08.037)
  • [L4] The Reverse or Anatomical replacement for Painful Shoulder Osteoarthritis, Differences between Interventions trial aims to definitively answer this question. [16] (10.1177/17585732251319977)
  • [L3] Functional improvement was obtained after reimplantation of a reverse total shoulder prosthesis but was not seen after hemiarthroplasty and cement spacer. [17] (10.1007/s11999.0000000000000049)
  • [L3] Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a nine-point improvement in their ASES score experience a clinically important change, whereas those who have at least a 23-point improvement in their ASES score experience a substantial clinical benefit. [18] (10.1007/s11999-016-4968-z)
  • [Case_report] The report demonstrates the clinical and radiological success of near-simultaneous reverse shoulder arthroplasty for bilateral displaced proximal humerus fractures in a geriatric patient with early range of motion. [20] (10.1016/j.xrrt.2022.09.003)
  • [L5] The review outlines rehabilitation guidelines developed to manage patients who have undergone reverse total shoulder replacement, aiming to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery. [21] (10.1111/j.1758-5740.2011.00138.x)
  • [L3] Reverse arthroplasty may be a reliable treatment option in patients at risk for developing rotator cuff failure. [22] (10.1016/j.jse.2024.03.003)
  • [L3] The outcome for reverse shoulder arthroplasty can be measured with the treatment effect method; the 2 years TE's vary from 1 to 0.09. [23] (10.1186/s12891-020-03427-7)
  • [L5] [26] (10.1016/j.jseint.2024.06.018)
  • [L5] [27] (10.1016/j.jseint.2025.02.017)
  • [L3] Patients undergoing reverse total shoulder arthroplasty return to sporting activities at varying rates depending on age and prior surgery, with walking and swimming being the most common activities postoperatively. [29] (10.1177/2325967115s00167)
  • [L1] [30] (10.1016/j.jse.2024.05.016)
  • [Case_report] [33] (10.1016/j.xrrt.2024.12.009)
  • [L3] The study confirms that radiographic measurements are generally valid for evaluating postoperative parameters in reverse total shoulder arthroplasty. [34] (10.1016/j.jse.2024.10.016)
  • [L5] There remains little knowledge regarding the optimal glenoid version. [35] (10.1016/j.xrrt.2025.06.019)
  • [L1] rTSA restores forward elevation primarily via compensatory scapulothoracic motion and deltoid-driven neuromuscular strategies rather than normalization of glenohumeral mechanics. [36] (10.1016/j.jse.2026.03.002)
  • [L1] Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme. [37] (10.1177/1758573220937394)
  • [L4] The current study's findings suggest that postoperative changes in scapular kinematics following a reverse total shoulder arthroplasty positively impact shoulder function and patient-reported outcome measures. [39] (10.1016/j.jisako.2025.100761)
  • [L4] The ST contribution to overall shoulder movement is significantly increased in patients with an rTSA compared with a healthy shoulder. [40] (10.1016/j.jse.2024.12.018)
  • [L2] This study suggests that self-directed home therapy following reverse shoulder arthroplasty may be a viable alternative to formal supervised physical therapy, showing no significant differences in outcomes across multiple measures. [41] (10.1016/j.jseint.2025.02.012)
  • [L4] Scapular kinematics during rehabilitation exercises after rTSA differ, depending on the plane and modality of the exercise. [42] (10.1016/j.jse.2024.11.027)
  • [L3] [43] (10.1177/17585732241263753)
  • [L5] Isolated humeral distalization caused dramatic increases in the muscle forces required to perform scapular-plane abduction, with joint reaction forces increasing correspondingly. [44] (10.1016/j.jse.2024.07.055)
  • [L2] [45] (10.1016/j.jseint.2025.04.004)
  • [L1] [47] (10.1016/j.jseint.2025.05.035)
  • [L1] There is an increased contribution of scapulothoracic rotation relative to glenohumeral motion throughout arm elevation following TSA compared to asymptomatic shoulders. [48] (10.1016/j.jse.2025.08.010)
  • [L4] [49] (10.1016/j.jseint.2025.06.002)
  • [Case_report] Timely interventions, such as pectoralis major tendon transfer, may provide meaningful functional recovery in cases of subscapularis retear after reverse total shoulder arthroplasty. [53] (10.1016/j.xrrt.2026.100673)
  • [L5] A 135° neck-shaft angle with a 42mm glenosphere maximized ROM for most motions, while a 155° neck-shaft angle with a 36mm glenosphere optimized abduction and forward elevation. [54] (10.1016/j.jse.2024.12.049)
  • [L5] Joint stability and abduction capability were compromised by more extensive rotator cuff tears, and subscapularis repair might be essential to enhancing biomechanical effectiveness, even in l-rTSA. [57] (10.1016/j.jse.2025.03.027)
  • [L4] The review highlights significant variability in return-to-driving timelines across different procedures and immobilization devices, with recommendations ranging from immediate return for minor hand surgery to 6-12 weeks for shoulder arthroplasty, emphasizing the need for standardized guidelines. [60] (10.1530/EOR-23-0117)
  • [L3] In contrast, subscapularis repair was associated with clinically significant improvements. [62] (10.5397/cise.2024.01067)
  • [L5] The isolated effect of increasing glenosphere eccentricity on shoulder stability following rTSA appears negligible in the position of instability. [63] (10.1016/j.jse.2025.03.007)
  • [L4] However, IRp was associated with a limited range compared with the other shoulder motions; therefore, all ADLs associated with internal rotation demonstrated lower recovery rates than expected. [65] (10.1016/j.jse.2019.05.031)
  • [L1] A high return to sport can be expected after total shoulder arthroplasty. [67] (10.1016/j.jseint.2025.05.028)
  • [L5] Reverse shoulder arthroplasty is advocated for complex proximal humerus fractures in elderly patients because it provides more consistent and predictable results compared with hemiarthroplasty or plate osteosynthesis. [68] (10.5435/jaaos-d-24-00890)
  • [L5] Patient-specific implants have emerged as an innovative approach to addressing complex glenoid bone loss cases in reverse shoulder arthroplasty by restoring the native joint line, minimizing bone removal, and providing customized fixation. [70] (10.1016/j.jseint.2024.12.007)
  • [Paper] [71] (10.1007/s00264-018-4249-4)
  • [L3] [72] (10.1016/j.jse.2024.03.052)
  • [L4] Although a low rate of humeral component loosening was observed, higher rates of complications and re-revision surgery were observed over time secondary to aseptic glenoid component loosening and instability. [73] (10.1016/j.xrrt.2024.08.006)
  • [L4] [74] (10.1016/j.jse.2024.05.008)
  • [L4] Complications and reoperation rates were higher than those for primary RSA but outcomes were comparable for revision of failed anatomic shoulder arthroplasty. [78] (10.1016/j.jse.2023.06.039)
  • [L3] Patients with severe shoulder pain who are possible candidates for shoulder arthroplasty should exhaust other pain-reducing options before using opioid pain medications. [80] (10.5435/jaaos-d-18-00112)
  • [L5] [82] (10.1016/j.jseint.2024.12.016)
  • [L3] The study analyzed cumulative percent revision rates in patients under 55, finding that glenoid erosion was the predominant cause of revision for humeral resurfacing and hemiarthroplasty, while instability was the main cause for stemmed anatomic and reverse total shoulder arthroplasty. [84] (10.1016/j.jisako.2025.100747)
  • [L4] [85] (10.1016/j.jse.2024.06.025)
  • [L2] Six distinct early recovery trajectories were identified after total shoulder arthroplasty, with 83.7% of patients (the 'Faster group') experiencing very low pain scores after only 2 weeks. [86] (10.1016/j.jse.2025.06.016)
  • [L3] Wound complications and revision rates in patients undergoing shoulder arthroplasty who require postoperative therapeutic anticoagulation are significantly elevated compared with controls. [88] (10.1016/j.jse.2019.11.029)
  • [L4] This study demonstrates that acute and chronic recovery after total shoulder arthroplasty can be assessed via maximum elevation and time above 90 degrees, respectively. [90] (10.1016/j.jse.2019.01.003)
  • [L3] IGTFs are infrequent during primary rTSA, but the incidence is more than double when revising an arthroplasty to rTSA. [92] (10.1016/j.jse.2025.06.014)

See Also

References

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[3] Increasing use of reverse total shoulder arthroplasty in younger adults despite higher complication rates. JSES International. 2025. DOI: 10.1016/j.jseint.2025.05.020

[4] Stemless anatomic and reverse shoulder arthroplasty in patients under 55 years of age with primary glenohumeral osteoarthritis: an analysis of the Australian Orthopedic Association National Joint Replacement Registry at 5 years. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.07.032

[5] Early outcomes after first reverse total shoulder arthroplasty better prognosticate contralateral success compared with early outcomes after anatomic total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.10.007

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[30] Superior functional outcome following reverse shoulder arthroplasty compared to hemiarthroplasty for displaced three- and four-part fractures in patients 65 and older: results from a prospective multicenter randomized controlled trial - The shoulder hemiarthroplasty or reverse polarity arthoplasty (SHeRPA) trial. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.05.016

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[39] Effect of Glenosphere Lateralization or Inferiorization and Humeral Offset on Range of Motion after Reverse Total Shoulder Arthroplasty: A Robotic Assessment. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100761

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[65] Difficulty in performing activities of daily living associated with internal rotation after reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.05.031

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[68] Tuberosity Management in Reverse Shoulder Arthroplasty for Proximal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-00890

[70] Current concepts in patient specific implants for reverse shoulder arthroplasty. JSES International. 2025. DOI: 10.1016/j.jseint.2024.12.007

[71] Benefits of a metallic lateralized baseplate prolonged by a long metallic post in reverse shoulder arthroplasty to address glenoid bone loss. International Orthopaedics. 2018. DOI: 10.1007/s00264-018-4249-4

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[74] Glenoid structural bone grafting in reverse total shoulder arthroplasty: clinical and radiographic outcomes. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.008

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