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Rotator cuff arthropathy: shoulder arthritis following a long-standing, massive rotator cuff tear and its impact on function.

Updated Aug 2026
A hand-drawn illustration of an older faceless person struggling to lift their arm out to the side with shoulder pain.
Rotator cuff arthropathy: arthritis following a long-standing rotator cuff tear. Kieran Hirpara 4.0

What you're feeling

You likely have deep pain in your shoulder that does not go away. This pain comes from wear-and-tear arthritis combined with a torn rotator cuff. You may feel it at the base of your neck or down your upper arm. The pain is often worse at night. It can wake you up if you roll onto that side. You might also notice stiffness when you first wake up in the morning.

Simple daily tasks become difficult because you cannot lift your arm properly. You may struggle to reach items on a high shelf. Putting on a jacket can feel impossible without help. Reaching into the back pocket of your trousers may cause sharp pain. Even washing your hair or brushing your teeth can be challenging. You might find yourself using your other hand for almost everything.

The pain often flares after activity. Lifting even light objects can trigger a flare-up that lasts for hours. You may feel a sense of weakness when trying to raise your arm. This is because the muscles that usually lift your shoulder are damaged. Instead, you rely on your deltoid muscle, which can tire quickly. You might feel a grinding sensation or hear clicking sounds when you move.

Some days are better than others. Rest often helps reduce the ache. However, the pain rarely disappears completely without treatment. You might notice that certain positions feel more comfortable than others. Keeping your arm close to your body may provide some relief. Moving your arm away from your side usually increases the discomfort.

If you have had previous shoulder surgery, the pain might feel different. Revision surgery often leads to more complex symptoms. You may experience new pain or a sudden loss of function. This can happen even if your previous recovery was smooth. Sudden changes in pain levels should always be checked by your surgeon. They can determine if there is a new issue like a fracture or infection.

Your surgeon will assess these symptoms to confirm the diagnosis. They will look for signs of instability or weakness. You might be asked to perform specific movements to test your strength. These tests help us understand the extent of the damage. Understanding what you are feeling is the first step toward relief. We can discuss options that match your specific symptoms and goals.

What's actually happening

Your shoulder is a ball-and-socket joint. The ball sits on your upper arm bone, and the socket is on your shoulder blade. In cuff arthropathy, the tendons that usually stabilize this joint are torn and worn out. Without these tendons, the ball slips upward instead of rotating smoothly.

Think of your shoulder like a door hinge. The tendons are the springs that keep the door aligned. When the springs break, the door hangs loose and rubs against the frame. In your shoulder, the ball bone grinds against the socket bone. This wear-and-tear damages the cartilage, which acts as a shock absorber. You lose your smooth range of motion and feel pain with every movement.

To fix this, your surgeon replaces the joint surfaces with a reverse prosthesis. This device flips the ball and socket positions. The metal ball goes on your shoulder blade, and the plastic cup goes on your arm bone. This design relies on your deltoid muscle to lift your arm, rather than the torn rotator cuff tendons.

The new joint changes how your shoulder moves. You will use more of your shoulder blade to lift your arm. This compensates for the missing tendons. It restores function, but it does not feel exactly like a natural shoulder. Your movement pattern changes permanently.

This surgery is complex. It requires careful planning to match the new joint to your anatomy. Your surgeon considers your bone quality and muscle strength. Older patients and those with weaker bones face higher risks of complications, such as fractures around the implant. However, for many, this procedure offers significant pain relief and improved ability to perform daily tasks.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this condition in our clinic by matching the treatment to your specific shoulder anatomy and symptoms. We guide you through a clear pathway of care, starting with the least invasive options and moving to surgery only when necessary. Your journey begins with a thorough assessment to understand exactly what is causing your pain and stiffness.

For many patients, we start with self-management and physiotherapy. This approach focuses on protecting the shoulder while maintaining as much movement as possible. Our physiotherapists work with you to strengthen the muscles around the joint, particularly the deltoid, which helps lift the arm when the rotator cuff is damaged. We also advise on activity changes to avoid movements that cause pain. You should give this non-operative care a fair trial, typically over several weeks or months, to see if it provides enough relief. In some cases, conservative treatment is all you need to manage your symptoms effectively.

If physiotherapy alone does not provide sufficient relief, we consider medical management to help control pain and inflammation. This may include over-the-counter pain relievers or anti-inflammatory medications. We also discuss injection therapies, such as cortisone injections, which can reduce swelling and pain in the joint for a limited time. These injections are not a cure, but they can offer a window of comfort that allows you to participate more fully in your rehabilitation. We review the benefits and duration of each option with you to ensure it fits your lifestyle and health needs.

Surgery is considered when conservative care has reached its limit and your quality of life remains significantly impacted. For cuff arthropathy, where the rotator cuff is damaged and arthritis is present, we often recommend a reverse total shoulder replacement. This procedure changes the mechanics of the joint to allow the deltoid muscle to lift your arm, bypassing the need for a functional rotator cuff. The outcome of this surgery depends on several factors, but revision reverse shoulder arthroplasty demonstrates an implant survival rate of 85% at ten years. We discuss these figures with you as part of a shared decision, ensuring you understand the potential benefits and risks before proceeding.

What to expect

Your shoulder function typically improves significantly after surgery. Most patients reach their maximum medical improvement one year after the procedure. You can expect a steady recovery rather than an immediate fix. Early on, you may notice very low pain scores within just two weeks. This rapid initial relief is common for the majority of patients.

Long-term results are strong. The implant survives in 85% of cases at ten years. You will likely regain the ability to lift your arm above your head. This improvement happens regardless of specific muscle transfers during surgery. However, active external rotation remains complex and may not fully return to normal.

If you have a previous failed shoulder replacement, your outlook is different. Revision surgery carries higher complication and revision rates than primary surgery. Clinical outcomes, including pain relief and satisfaction, are generally worse for revision patients compared to those having their first reverse shoulder replacement. You should be aware that these procedures are more complex and carry greater risks.

Without treatment, rotator cuff tear arthropathy often leads to persistent pain and weakness. Conservative management rarely restores significant function. Surgery offers a clear path to better mobility and pain control. If you have good outcomes on one side, you may consider surgery on the other shoulder as early as three months later.

Return to daily activities is highly achievable. Many patients return to sports, with walking and swimming being the most common choices. Driving is typically possible between six and twelve weeks after surgery. Your surgeon will guide you on when it is safe to resume specific activities based on your individual progress.

When to see someone

See your GP if you have persistent shoulder pain that does not improve with rest, or if you notice new weakness, instability, or a feeling of locking. Sudden worsening of symptoms, loss of function, or pain that interferes with sleep or work are also signs to seek review. Be alert for new pain at the base of the shoulder blade (acromion), as this can signal a stress reaction or fracture. These issues may arise even years after surgery. Do not ignore a sudden loss of movement or increased pain, as these can indicate serious complications like infection or implant failure. Early assessment helps protect your joint and function.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

  • Reverse total shoulder arthroplasty (RTSA) utilization has increased due to more RTSAs performed for rotator cuff tear arthropathy and expanding surgical indications for RTSA [1].
  • Primary anatomic total shoulder arthroplasty (aTSA) and rTSA patients with osteoarthritis and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes at a mean of 41 months follow-up [2].
  • Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty experience a clinically important change with at least a nine-point improvement in their American Shoulder and Elbow Surgeons (ASES) score [3].
  • Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty experience a substantial clinical benefit with at least a 23-point improvement in their ASES score [3].
  • There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff [4].
  • In patients with primary glenohumeral osteoarthritis with an intact rotator cuff, total shoulder arthroplasty (TSA) is favored to hemiarthroplasty (HA) in terms of clinical outcome, risk of revision surgery, and postoperative complications [6].
  • Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [7].
  • In patients with rotator cuff-intact glenohumeral osteoarthritis with no bone loss, treatment with reverse total shoulder arthroplasty demonstrated similar improvements compared to anatomic total shoulder arthroplasty except for less improvement in abduction [9].
  • Anatomic total shoulder arthroplasty remains the preferred and less costly approach for the majority of patients with cuff-intact arthritis [10].
  • More studies critically analyzing the value of health-care expenditures are needed in shoulder arthroplasty [10].
  • Over 90% of patients who underwent reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff experienced substantial clinical benefit [15].
  • Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes [17].
  • Reverse total shoulder arthroplasty is popular for indications beyond rotator cuff-tear arthropathy despite concerns regarding high complication rates and limited implant longevity [28].
  • The Western Ontario Osteoarthritis of the Shoulder Index (WOOS) is recommended for continued use in shoulder arthroplasty registries and observational studies [30].

Anatomy & Pathophysiology

  • Scapulothoracic motion is more complex in patients with rotator cuff arthropathy than previously reported, featuring a dynamically changing scapulohumeral rhythm [5].
  • Patients with rotator cuff arthropathy exhibit counter-directed scapular rotation before clinically visible arm elevation [5].
  • The scapulothoracic contribution to overall shoulder movement is significantly increased in patients with reverse total shoulder arthroplasty compared with a healthy shoulder [34].
  • Scapular kinematics in patients with shoulder arthroplasty are influenced by the implementation of external loads, but not by the type of load [33].
  • MR imaging-derived rotator cuff muscle proton density fat-fraction is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes [31].
  • Imbalance in axial-plane rotator cuff fatty infiltration occurs in posteriorly worn glenoids in primary glenohumeral osteoarthritis [44].
  • These imbalances in fatty infiltration may contribute to higher rates of failure after anatomic total shoulder arthroplasty in patients with posterior wear compared with those with concentric wear [44].
  • Performing shoulder arthroplasty did not positively affect the component of proprioception evaluated by the active angle-reproduction test [47].
  • The axillary view provides a practical method of characterizing glenohumeral anatomy before and after surgery that is less costly and exposes the patient to less radiation than a CT scan [45].
  • The medial margin of the scapula demonstrated the best intraobserver and interobserver reliability for assessing glenoid component inclination compared with other landmarks when the scapula is tilted [48].

Classification

  • Rotator cuff tear arthropathy is characterized by rotator cuff insufficiency [22].
  • Rotator cuff tear arthropathy involves degenerative changes of the glenohumeral joint [22].
  • Rotator cuff tear arthropathy is associated with superior migration of the humeral head [22].
  • Rotator cuff tear arthropathy represents a spectrum of shoulder pathology [22].
  • Scapulothoracic motion in patients with rotator cuff arthropathy is more complex than previously reported [5].
  • Patients with rotator cuff arthropathy exhibit a dynamically changing scapulohumeral rhythm [5].
  • Patients with rotator cuff arthropathy demonstrate counter-directed scapular rotation before clinically visible arm elevation [5].

Clinical Presentation

  • Rotator cuff tear arthropathy is characterized by rotator cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head [22].
  • Scapulothoracic motion in patients with rotator cuff arthropathy involves a dynamically changing scapulohumeral rhythm and counter-directed scapular rotation before clinically visible arm elevation [5].
  • Rotator cuff repairs fail at an alarmingly high rate during long-term follow-up, particularly in cases with advanced fatty infiltration, atrophy, and large-to-massive tear size [26].
  • Rotator cuff repair failure leads to functional deterioration and progression of glenohumeral arthritis [26].
  • Osteoarthritis patients undergo contralateral shoulder arthroplasty sooner than cuff tear arthropathy patients [11].
  • Osteoarthritis patients with radiographic changes on the contralateral shoulder prior to the first surgery undergo contralateral arthroplasty sooner than those without such changes [11].
  • Nonoperative modalities should be utilized before surgical options for shoulder osteoarthritis, particularly for patients with moderate-to-mild disease [27].
  • Surgical treatments like arthroplasty are considered effective for severe cases of shoulder osteoarthritis [27].
  • The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, with many treatment options to consider based on clinical presentations and anatomic pathologies [14].
  • There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff [4].
  • Anatomic total shoulder arthroplasty remains the preferred and less costly approach for the majority of patients with cuff-intact arthritis [10].
  • There is a need for standardization of outcome assessment following treatment of shoulder arthritis [16].

Investigations

  • Primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis and an intact rotator cuff had similar clinical and radiographic outcomes at a mean of 41 months follow-up [2].
  • There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff [4].
  • Scapulothoracic motion is more complex in patients with rotator cuff arthropathy, featuring a dynamically changing scapulohumeral rhythm and counter-directed scapular rotation before clinically visible arm elevation [5].
  • Arthroscopy is a powerful tool in the management of painful total shoulder arthroplasty and should be considered when evaluating cases with no clear cause of pain [8].
  • In patients with rotator cuff-intact glenohumeral osteoarthritis and no bone loss, reverse total shoulder arthroplasty demonstrated similar improvements compared to anatomic total shoulder arthroplasty except for less improvement in abduction [9].
  • Osteoarthritis patients had their contralateral shoulder arthroplasty sooner than cuff tear arthropathy patients [11].
  • Osteoarthritis patients with radiographic changes on the contralateral shoulder prior to the first surgery had their contralateral arthroplasty sooner than those without [11].
  • The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, with many treatment options to consider based on clinical presentations and anatomic pathologies [14].
  • Over 90% of patients who underwent reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff experienced substantial clinical benefit [15].
  • There is a need for standardization of outcome assessment following treatment of shoulder arthritis [16].
  • Reverse total shoulder arthroplasty should be considered for glenohumeral osteoarthritis when rotator cuff dysfunction, glenoid bone deformity, or preoperative stiffness are present [18].
  • Preventive arthroscopic distal clavicle resection in patients with rotator cuff tears and concomitant asymptomatic radiological acromioclavicular joint arthritis did not result in better clinical or structural outcomes and led to symptomatic acromioclavicular joint instability in some patients [20].
  • MR imaging-derived rotator cuff muscle proton density fat-fraction is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes [31].
  • Biologic resurfacing of the arthritic glenohumeral joint is reviewed for historical basis and current applications in young, active individuals with glenohumeral arthritis [32].
  • Computed tomography underestimates the infraspinatus area compared with MRI, but the difference is less than 1 cm² and likely clinically insignificant [41].
  • Reverse total shoulder arthroplasty performed in patients with glenohumeral osteoarthritis and an intact rotator cuff is associated with improved functional and clinical outcomes compared with patients treated for cuff tear arthropathy [49].
  • A semi-automated quantitative CT method allows for quantitatively and reproducibly measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis [53].
  • Performing selective MRI to assess rotator cuff integrity to indicate reverse or anatomic total shoulder arthroplasty is cost-effective if surgical preparedness, patient expectations, and implant availability preclude the ability to switch implants intraoperatively [54].
  • Early results for glenoid bone grafting with a reverse design prosthesis are encouraging, but further clinical and radiologic assessment is necessary [57].

Treatment

Non-Operative Management

  • Nonoperative modalities should be utilized before surgical options for shoulder osteoarthritis, particularly in patients with moderate-to-mild disease [27].
  • Nonoperative treatment is helpful for most patients with painful conditions of the acromioclavicular joint, although those with osteolysis may need to modify their activities [52].
  • Percutaneous insertion of a subacromial balloon spacer results in a significant reduction of pain in patients aged 60 years and older with rotator cuff arthropathy [38].
  • Percutaneous insertion of a subacromial balloon spacer does not improve function in patients aged 60 years and older with rotator cuff arthropathy at a minimum 1-year follow-up [38].
  • The subacromial spacer is likely to provide a safe, effective, and cost-effective option for patients with massive irreparable rotator cuff tears based on available evidence and conservative assumptions [39].

Surgical Management: Arthroplasty Indications and Selection

  • Anatomic total shoulder arthroplasty remains the preferred and less costly approach for the majority of patients with cuff-intact arthritis [10].
  • More studies critically analyzing the value of health-care expenditures in shoulder arthroplasty are needed [10].
  • Knowledge of the array of shoulder prostheses currently available, their indications, and the use of treatment algorithms can lead to optimized patient outcomes [17].
  • The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, with many treatment options to consider based on clinical presentations and anatomic pathologies [14].
  • There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff [4].
  • The increase in reverse total shoulder arthroplasty (RTSA) utilization is due to both an increase in RTSAs performed for rotator cuff tear arthropathy and expanding surgical indications for RTSA [1].
  • Reverse total shoulder arthroplasty is popular for indications beyond rotator cuff-tear arthropathy despite concerns regarding high complication rates and limited implant longevity [28].
  • The use of a reverse total shoulder arthroplasty in the setting of a massive rotator cuff tear with an associated lateral deltoid rupture must remain cautious, although patients may perform well at 2 years' follow-up [19].

Surgical Management: Anatomic vs. Reverse Arthroplasty Outcomes

  • Primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes at a mean of 41 months follow-up [2].
  • In patients with rotator cuff-intact glenohumeral osteoarthritis with no bone loss, treatment with reverse total shoulder arthroplasty demonstrated similar improvements compared to anatomic total shoulder arthroplasty except for less improvement in abduction [9].
  • Reverse total shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff [7].
  • At short-term follow-up, preservation of the rotator cuff in reverse shoulder arthroplasty demonstrated similarly excellent outcomes and low complication rates compared with reverse shoulder arthroplasty with a deficient rotator cuff and anatomic total shoulder arthroplasty, except for slightly lower internal and external rotation compared with anatomic total shoulder arthroplasty [12].
  • Over 90% of patients who underwent reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff experienced substantial clinical benefit [15].
  • In patients with primary glenohumeral osteoarthritis with an intact rotator cuff, total shoulder arthroplasty is favored to hemiarthroplasty in terms of clinical outcome, risk of revision surgery, and postoperative complications [6].

Surgical Management: Painful Arthroplasty and Adjunct Procedures

  • Arthroscopy is a powerful tool in the management of the painful total shoulder arthroplasty and should be considered when evaluating cases in which a clear cause of pain is not present [8].
  • Preventive arthroscopic distal clavicle resection in patients with rotator cuff tears and concomitant asymptomatic radiological acromioclavicular joint arthritis did not result in better clinical or structural outcomes and led to symptomatic acromioclavicular joint instability in some patients [20].

Outcome Assessment

  • 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 American Shoulder and Elbow Surgeons (ASES) score experience a clinically important change [3].
  • Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a 23-point improvement in their ASES score experience a substantial clinical benefit [3].
  • The present review highlights the need for standardization of outcome assessment following treatment of shoulder arthritis [16].
  • The authors recommend the continued use of the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) in shoulder arthroplasty registries and observational studies [30].

Complications

  • Reverse total shoulder arthroplasty (RTSA) in the setting of a massive rotator cuff tear with an associated lateral deltoid rupture requires cautious use [19].
  • A history of previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty [56].
  • Patients with a previous rotator cuff repair should be regarded as high-risk patients when considering reverse shoulder arthroplasty [56].

Recovery

  • Primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis and an intact rotator cuff have similar clinical and radiographic outcomes at a mean of 41 months follow-up [2].
  • Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short-term follow-up for glenohumeral osteoarthritis with an intact rotator cuff [7].
  • At short-term follow-up, reverse shoulder arthroplasty with preservation of the rotator cuff demonstrates similarly excellent outcomes and low complication rates compared with reverse shoulder arthroplasty for cuff arthropathy and anatomic total shoulder arthroplasty, except for slightly lower internal and external rotation compared with anatomic total shoulder arthroplasty [12].
  • 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 American Shoulder and Elbow Surgeons (ASES) score experience a clinically important change [3].
  • Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a 23-point improvement in their ASES score experience a substantial clinical benefit [3].
  • Reverse shoulder arthroplasty for the shoulder damaged by inflammatory arthritis and with a deficient rotator cuff can provide noteworthy improvement for most patients at early follow-up [13].
  • Outcomes of reverse total shoulder arthroplasty are impacted by both the etiology of shoulder dysfunction and the time since implantation [21].
  • Bridging reconstruction for large-to-massive rotator cuff tears has a 98% survivorship rate with a low rate of conversion to reverse total shoulder arthroplasty and a low progression of cuff arthropathy at a minimum five-year follow-up with a mean of 7.3 years [24].
  • Bridging reconstruction for large-to-massive rotator cuff tears has a 98% survivorship rate with a low rate of conversion to reverse total shoulder arthroplasty and a low progression of cuff arthropathy at a minimum five-year follow-up with a mean of 7.3 years [25].
  • The use of reverse total shoulder arthroplasty in the setting of a massive rotator cuff tear with an associated lateral deltoid rupture must remain cautious, although the patient performed well at 2 years' follow-up [19].
  • Copeland surface replacement shoulder arthroplasty survival analysis shows no variance from acceptable standards for shoulder replacement for the period of study [59].
  • Lower surgical volume is associated with higher all-cause revision rates in the early postoperative period in total shoulder arthroplasty and reverse total shoulder arthroplasty for osteoarthritis and throughout the follow-up period in reverse total shoulder arthroplasty for cuff arthropathy [60].

Key Evidence

  • [L4] This increase is due to both an increase in the number of RTSAs performed for rotator cuff tear arthropathy as well as expanding surgical indications for RTSA. [1] (10.5435/jaaos-d-17-00075)
  • [L3] At a mean of 41 month follow-up, primary aTSA and rTSA patients with OA and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes. [2] (10.5435/jaaos-d-22-00014)
  • [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. [3] (10.1007/s11999-016-4968-z)
  • [L4] There is no clear consensus for the optimal arthroplasty option in patients with glenohumeral osteoarthritis with an intact rotator cuff. [4] (10.1177/17585732251319977)
  • [L3] Scapulothoracic motion is more complex than previously reported, especially in patients with rotator cuff arthropathy, with a dynamically changing scapulohumeral rhythm and counter-directed scapular rotation before clinically visible arm elevation. [5] (10.1097/corr.0000000000001406)
  • [L1] In patients with primary glenohumeral osteoarthritis with an intact rotator cuff, TSA is favored to HA in terms of clinical outcome, risk of revision surgery, and postoperative complications. [6] (10.1016/j.jse.2022.07.012)
  • [L4] Reverse shoulder arthroplasty provides optimal outcomes with low complication rates across a short term of follow-up for glenohumeral osteoarthritis with an intact rotator cuff. [7] (10.1016/j.jse.2021.06.010)
  • [Commentary] Arthroscopy is a powerful tool in the management of the painful total shoulder arthroplasty and should be considered when evaluating cases in which a clear cause of pain is not present. [8] (10.1016/j.arthro.2020.02.031)
  • [L3] In patients with rotator cuff-intact glenohumeral osteoarthritis with no bone loss, treatment with reverse total shoulder arthroplasty demonstrated similar improvements compared to anatomic total shoulder arthroplasty except for less improvement in abduction. [9] (10.1016/j.jse.2025.01.038)
  • [L5] Anatomic total shoulder arthroplasty remains the preferred and less costly approach for the majority of patients with cuff-intact arthritis, and more studies critically analyzing the value of health-care expenditures are needed. [10] (10.2106/jbjs.21.00034)
  • [L3] Osteoarthritis patients had their contralateral shoulder arthroplasty sooner than cuff tear arthropathy patients, and OA patients with radiographic changes on the contralateral shoulder prior to the first surgery had their contralateral arthroplasty sooner than those without. [11] (10.1016/j.jse.2020.12.023)
  • [L3] At short-term follow-up, preservation of the rotator cuff in RSA demonstrated similarly excellent outcomes and low complication rates compared with RSA with a deficient rotator cuff and TSA, except for slightly lower internal and external rotation compared with TSA. [12] (10.1016/j.jse.2023.02.005)
  • [L4] At early follow-up, reverse shoulder arthroplasty for the shoulder damaged by inflammatory arthritis and with a deficient rotator cuff can provide noteworthy improvement for most patients. [13] (10.1016/j.jhsa.2012.05.015)
  • [L5] The optimal treatment of glenohumeral arthritis in patients ≤ 50 years of age remains controversial, and there are many treatment options to consider when responding to the variety of clinical presentations and anatomic pathologies. [14] (10.1016/j.jse.2023.01.009)
  • [L3] Over 90% of patients who underwent RSA for GHOA with an intact rotator cuff experienced substantial clinical benefit. [15] (10.1016/j.jse.2024.01.027)
  • [L1] The present review highlights the need for standardization of outcome assessment following treatment of shoulder arthritis. [16] (10.1177/1758573215622385)
  • [L5] Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes. [17] (10.5435/00124635-200907000-00002)
  • [L4] The article describes conditions under which RSA should be considered for glenohumeral osteoarthritis, specifically when rotator cuff dysfunction, glenoid bone deformity, or preoperative stiffness are present, noting that RSA has shown good results comparable with anatomical TSA in these scenarios. [18] (10.5397/cise.2021.00633)
  • [L4] Although the patient performed well at 2 years' follow-up, the use of a reverse total shoulder arthroplasty in the setting of a massive rotator cuff tear with an associated lateral deltoid rupture must still remain cautious. [19] (10.1016/j.jse.2011.03.013)
  • [L1] Preventive arthroscopic DCR in patients with rotator cuff tears and concomitant asymptomatic radiological ACJ arthritis did not result in better clinical or structural outcomes, and it did lead to symptomatic ACJ instability in some patients. [20] (10.1177/0363546514547254)
  • [L3] The study acknowledges that outcomes are impacted by both the etiology of shoulder dysfunction and the time since implantation. [21] (10.2106/jbjs.16.00223)
  • [L5] Rotator cuff tear arthropathy is a spectrum of shoulder pathology characterized by rotator cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head. [22] (10.5435/00124635-200706000-00003)
  • [L4] At a minimum 5-year follow-up with a mean of 7.3 years, bridging reconstruction showed a 98% survivorship rate with a low rate of conversion to rTSA and a low progression of cuff arthropathy. [24] (10.1016/j.jisako.2023.03.403)
  • [L3] At a minimum 5-year follow-up with a mean of 7.3 years, bridging reconstruction showed a 98% survivorship rate with a low rate of conversion to reverse total shoulder arthroplasty and a low progression of cuff arthropathy. [25] (10.1177/2325967123s00074)
  • [L5] Rotator cuff repairs fail at an alarmingly high rate during long-term follow-up, particularly in cases with advanced fatty infiltration, atrophy, and large-to-massive tear size, leading to functional deterioration and progression of glenohumeral arthritis. [26] (10.1016/j.arthro.2022.04.002)
  • [L5] The article provides an overview of available treatments for shoulder osteoarthritis, noting that nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases. [27] (10.1155/2013/370231)
  • [L5] The paper reviews current concepts, results, and component wear analysis of reverse total shoulder arthroplasty, noting its popularity for indications beyond rotator cuff-tear arthropathy despite concerns regarding high complication rates and limited implant longevity. [28] (10.2106/jbjs.j.00769)
  • [L4] The authors recommend the continued use of WOOS in shoulder arthroplasty registries and observational studies. [30] (10.1186/s12891-023-06578-5)
  • [L3] MR imaging–derived RC muscle PDFF is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes. [31] (10.1177/0363546517703086)
  • [L5] The article reviews the historical basis and current applications of this procedure for young, active individuals with glenohumeral arthritis. [32] (10.1016/j.jse.2007.03.006)
  • [L4] Scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. [33] (10.1016/j.clinbiomech.2012.04.009)
  • [L4] The ST contribution to overall shoulder movement is significantly increased in patients with an rTSA compared with a healthy shoulder. [34] (10.1016/j.jse.2024.12.018)
  • [L5] Percutaneous insertion of subacromial balloon spacer results in a significant reduction of pain in patients aged 60 years and older with rotator cuff arthropathy but does not improve their function at a minimum 1-year follow-up. [38] (10.1016/j.asmr.2025.101254)
  • [L2] Based on the available evidence and reasonably conservative assumptions, subacromial spacer is likely to provide a safe, effective, and cost-effective option for patients with massive irreparable rotator cuff tears. [39] (10.1007/s00264-018-4065-x)
  • [L3] While CT underestimates the infraspinatus area as compared with MRI, the difference is less than 1 cm2 and thus likely clinically insignificant. [41] (10.1016/j.jse.2018.03.015)
  • [L3] These imbalances may contribute to the higher rates of failure after anatomic total shoulder arthroplasty in patients with posterior wear compared with those with concentric wear. [44] (10.1097/corr.0000000000001798)
  • [L4] The axillary view provides a practical method of characterizing glenohumeral anatomy before and after surgery that is less costly and exposes the patient to less radiation than a CT scan. [45] (10.1007/s11999-013-3327-6)
  • [L3] Performing shoulder arthroplasty did not positively affect the component of proprioception that was evaluated by the active angle-reproduction test. [47] (10.1007/s00264-008-0666-0)
  • [L5] The medial margin of the scapula demonstrated the best intraobserver and interobserver reliability for assessing glenoid component inclination compared with other landmarks when the scapula is tilted. [48] (10.1016/j.jse.2015.09.001)
  • [L3] RTSA performed in patients with GHOA and an intact rotator cuff is associated with improved functional and clinical outcomes compared with those patients treated for CTA. [49] (10.5435/jaaos-d-21-00797)
  • [L5] Nonoperative treatment is helpful for most patients, although those with osteolysis may have to modify their activities. [52] (10.5435/00124635-199905000-00004)
  • [L4] This new semi-automated CT method allows to quantitatively and reproducibly measure rotator cuff muscle degeneration in shoulders with primary osteoarthritis. [53] (10.1016/j.otsr.2016.12.006)
  • [L3] However, performing selective MRI to assess rotator cuff integrity to indicate RSA or TSA is cost-effective if surgical preparedness, patient expectations, and implant availability preclude the ability to switch implants intraoperatively. [54] (10.1097/corr.0000000000002110)
  • [L3] Patients with previous rotator cuff repair should be regarded as high-risk patients when considering reverse shoulder arthroplasty. [56] (10.1016/j.jse.2022.07.001)
  • [L4] Early results are encouraging, but further clinical and radiologic assessment is necessary. [57] (10.1016/j.jse.2006.02.002)
  • [L4] Survival analysis shows no variance from acceptable standards for shoulder replacement for the period of study. [59] (10.1016/j.jse.2005.02.011)
  • [L3] Lower surgical volume was associated with higher all-cause revision rates in the early postoperative period in TSA and rTSA for OA and throughout the follow-up period in rTSA for cuff arthropathy. [60] (10.1016/j.jse.2019.10.026)

References

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DOI: 10.1097/corr.0000000000001406 [6] Total shoulder arthroplasty vs. hemiarthroplasty in patients with primary glenohumeral arthritis with intact rotator cuff: meta-analysis using the ratio of means. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.07.012 [7] Glenohumeral osteoarthritis with intact rotator cuff treated with reverse shoulder arthroplasty: a systematic review. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.06.010 [8] Editorial Commentary: Does the Scope Have a Role in Painful Shoulder Arthroplasty?. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.02.031 [9] Exactech Equinoxe anatomic vs. reverse total shoulder arthroplasty for primary osteoarthritis with an intact rotator cuff in patients with no glenoid deformity. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.01.038 [10] More Value Analytics Needed in Shoulder Arthroplasty. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.21.00034 [11] Influence of preoperative factors on timing for bilateral shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.12.023 [12] Reverse shoulder arthroplasty with preservation of the rotator cuff for primary glenohumeral osteoarthritis has similar outcomes to anatomic total shoulder arthroplasty and reverse shoulder arthroplasty for cuff arthropathy. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.005 [13] Reverse Shoulder Replacement for Patients With Inflammatory Arthritis. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.05.015 [14] International consensus statement on the management of glenohumeral arthritis in patients ≤ 50 years old. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.01.009 [15] Predictors of poor and excellent outcomes following reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.01.027 [16] Is there sufficient evidence to support intervention to manage shoulder arthritis?. Shoulder & Elbow. 2016. DOI: 10.1177/1758573215622385 [17] Shoulder Arthroplasty: Prosthetic Options and Indications. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200907000-00002 [18] When should reverse total shoulder arthroplasty be considered in glenohumeral joint arthritis?. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00633 [19] Irreparable spontaneous deltoid rupture in rotator cuff arthropathy: the use of a reverse total shoulder replacement. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.03.013 [20] Is Arthroscopic Distal Clavicle Resection Necessary for Patients With Radiological Acromioclavicular Joint Arthritis and Rotator Cuff Tears?. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514547254 [21] Long-Term Outcomes of Reverse Total Shoulder Arthroplasty. Journal of Bone and Joint Surgery. 2017. DOI: 10.2106/jbjs.16.00223 [22] Rotator Cuff Tear Arthropathy. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200706000-00003 [24] Bridging Reconstruction For Large-To-Massive Rotator Cuff Tears Has A Low Rate Of Cuff Arthropathy Progression At A Minimum Five-Year Follow-Up. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.403 [25] Paper 49: Bridging Reconstruction for Large-to-Massive Rotator Cuff Tears Has a Low Rate of Cuff Arthropathy Progression at A Minimum Five-Year Follow-Up. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00074 [26] Editorial Commentary: Rotator Cuff Repairs Fail at an Alarmingly High Rate During Long‐Term Follow‐Up: Graft Augmentation and Biologics May Improve Future Outcomes. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.04.002 [27] Shoulder Osteoarthritis. Arthritis. 2013. DOI: 10.1155/2013/370231 [28] Reverse Total Shoulder Arthroplasty: Current Concepts, Results, and Component Wear Analysis. Journal of Bone and Joint Surgery. 2010. DOI: 10.2106/jbjs.j.00769 [30] Western Ontario Osteoarthritis of the Shoulder Index (WOOS) - a validation for use in proximal humerus fractures treated with arthroplasty. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06578-5 [31] Proton Density Fat-Fraction of Rotator Cuff Muscles Is Associated With Isometric Strength 10 Years After Rotator Cuff Repair: A Quantitative Magnetic Resonance Imaging Study of the Shoulder. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517703086 [32] Biologic resurfacing of the arthritic glenohumeral joint: Historical review and current applications. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.03.006 [33] Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads. Clinical Biomechanics. 2012. DOI: 10.1016/j.clinbiomech.2012.04.009 [34] Involvement of the scapulothoracic articulation after well-functioning reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.018 [38] Percutaneous Subacromial Balloon Spacer Insertion Under Fluoroscopic Guidance in Patients Older Than 60 Years With Rotator Cuff Arthropathy Results in Significant Pain Relief but Does Not Improve Function. Arthroscopy, Sports Medicine, and Rehabilitation. 2025. DOI: 10.1016/j.asmr.2025.101254 [39] Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears. International Orthopaedics. 2018. DOI: 10.1007/s00264-018-4065-x [41] Do magnetic resonance imaging and computed tomography provide equivalent measures of rotator cuff muscle size in glenohumeral osteoarthritis?. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.03.015 [44] Imbalance in Axial-plane Rotator Cuff Fatty Infiltration in Posteriorly Worn Glenoids in Primary Glenohumeral Osteoarthritis: An MRI-based Study. Clinical Orthopaedics & Related Research. 2021. DOI: 10.1097/corr.0000000000001798 [45] Axillary View: Arthritic Glenohumeral Anatomy and Changes After Ream and Run. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-013-3327-6 [47] Proprioception in total, hemi- and reverse shoulder arthroplasty in 3D motion analyses: a prospective study. International Orthopaedics. 2008. DOI: 10.1007/s00264-008-0666-0 [48] Influence of scapular tilt on radiographic assessment of the glenoid component after total shoulder arthroplasty: which radiographic landmarks are reliable?. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.09.001 [49] Clinical Outcomes After Reverse Total Shoulder Arthroplasty in Patients With Primary Glenohumeral Osteoarthritis Compared With Rotator Cuff Tear Arthropathy: Does Preoperative Diagnosis Make a Difference?. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-21-00797 [52] Painful Conditions of the Acromioclavicular Joint. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199905000-00004 [53] A semi-automated quantitative CT method for measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis. Orthopaedics & Traumatology: Surgery & Research. 2017. 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Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.10.026

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