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Total shoulder arthroplasty

Surgeon-side topic for total shoulder arthroplasty. Backed by 412 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Total shoulder arthroplasty encompasses anatomic and reverse designs, with indications expanding due to improved surgical technique, implant design, and surgeon experience [18]. Reverse total shoulder arthroplasty use has increased among patients younger than 60 years of age, though this population experiences significantly higher rates of 90-day surgical complications compared to older patients [16]. For primary osteoarthritis with an intact rotator cuff and no glenoid deformity, reverse total shoulder arthroplasty does not appear to offer functional benefits over anatomic total shoulder arthroplasty [5]. Outcomes with reverse total shoulder arthroplasty are comparable to anatomic total shoulder arthroplasty with very low reoperation rates [18].

Complication and reoperation rates for shoulder arthroplasty addressing anterior instability arthropathy and prior stabilization procedures are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis, though the difference is not statistically significant [1]. Patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values at mid-term follow-up [3]. The outcome of revision shoulder arthroplasty can be predicted based on the indication for the procedure [2]. Early outcomes after first reverse total shoulder arthroplasty better prognosticate contralateral success compared with early outcomes after anatomic total shoulder arthroplasty [4]. Success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year [4].

Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty [8]. Return rates for total shoulder arthroplasty are slightly higher than those reported for reverse total shoulder arthroplasty and hemiarthroplasty [10]. Outpatient total shoulder arthroplasty is a safe and effective option for appropriately selected patients, offering reduced costs, improved access, and high patient satisfaction compared to inpatient procedures [20]. Patients undergoing inverted-bearing reverse total shoulder arthroplasty can expect good and stable long-term clinical outcomes with low complication and revision rates [56]. Inverted-bearing reverse total shoulder arthroplasty is a viable choice for different shoulder pathologies [56].

Anatomy & Pathophysiology

Shoulder arthroplasty addresses the sequelae of anterior instability arthropathy and prior stabilization procedures [1]. Reverse total shoulder arthroplasty (rTSA) restores forward elevation primarily via compensatory scapulothoracic motion and deltoid-driven neuromuscular strategies rather than normalization of glenohumeral mechanics [34]. The scapulothoracic (ST) contribution to overall shoulder movement is significantly increased in patients with an rTSA compared with a healthy shoulder [38]. There is an increased contribution of scapulothoracic rotation relative to glenohumeral motion throughout arm elevation following TSA compared to asymptomatic shoulders [42]. Postoperative changes in scapular kinematics following rTSA positively impact shoulder function and patient-reported outcome measures [37]. Significant changes from preoperative to postoperative conditions were not demonstrated for all kinematic parameters after rTSA [46]. Clavicle hook plate fixation changes scapular kinematics and scapulohumeral rhythm [48].

Preoperative planning using supine CT may inaccurately pose bones, with consequent effects on the surgical plan, resultant shoulder biomechanics, and clinical outcomes [36]. Adjusting patient-specific scapula posture significantly impacts predicted impingement-free motion amplitudes and range of motion in rTSA [45]. All movement planes showed significant differences in simulated range of motion when comparing protocols with and without adjustment for posture in rTSA preoperative planning [41]. Shoulder surgeons must understand key aspects of 3D preoperative planning software, including segmentation techniques, landmark definition, and potential limitations, to mitigate risks of errors in the surgical procedure [54].

Isolated humeral distalization in rTSA causes dramatic increases in the muscle forces required to perform scapular-plane abduction, with joint reaction forces increasing correspondingly [39]. A general decrease in the degree of rotational range of motion was observed with higher glenohumeral abduction angles for both elliptical and spherical head designs in shoulder arthroplasty [40]. 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 [50].

Classification

Indication-Based Prognosis: The outcome of revision shoulder arthroplasty is predicted based on the specific indication for the procedure [2]. A model incorporating specific patient characteristics demonstrates good predictive properties for identifying patients likely to achieve better outcomes from shoulder arthroplasty [6].

Instability Sequelae: Complication and reoperation rates for shoulder arthroplasty addressing anterior instability arthropathy sequelae are higher compared to primary glenohumeral joint arthritis, although this difference is not statistically significant [1]. Patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values at mid-term follow-up [3]. The Latarjet procedure is associated with the highest odds of future total shoulder arthroplasty [31].

Implant Type and Indication: Reverse total shoulder arthroplasty does not offer functional benefits over anatomic total shoulder arthroplasty for primary osteoarthritis with an intact rotator cuff and no glenoid deformity [5].

Bone Quality Assessment: Preoperative 3-dimensional computed tomography bone density measures provide objective classifications of bone quality for stemless anatomic total shoulder arthroplasty [24].

Other Considerations: Surgical Decision Axes: The decision to revise a total shoulder arthroplasty requires rigorous assessment regarding infection, instability, wear, loosening, and rotator cuff status [19].

Cost and Comorbidity Factors: Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty [8]. Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty [11].

Age and Complication Risk: Reverse total shoulder arthroplasty use has increased among patients younger than 60 years of age, who experience significantly higher rates of 90-day surgical complications compared to older patients [16].

Infection Management: Retention of osseointegrated prosthetic implants during surgical management of chronic infections following reverse total shoulder arthroplasty results in better shoulder function than conventional GS-type management [12].

Technological Availability: Robotic-assisted arthroplasty is available for shoulder arthroplasty with some limitations [17].

Clinical Presentation

Patients with anterior shoulder instability arthropathy sequelae undergoing total shoulder arthroplasty (TSA) face higher, though not statistically significant, complication and reoperation rates compared to those with primary glenohumeral arthritis [1]. Mid-term follow-up demonstrates continued functional improvement from preoperative values in this population [3]. Surgical implant type, indication, patient comorbidities, and hospital factors drive differential surgical costs [8].

The decision to revise TSA requires rigorous assessment addressing five key questions: Infection, Instability, Wear, Loosening, and Rotator cuff status [19]. Revision outcomes are predicted by the indication for the procedure [2]. While long-term anatomic TSA shows high prevalence of radiographic rotator cuff failure and glenoid wear, these signs do not translate to high complication rates or inferior outcomes [21]. Current comorbidity indices inadequately identify patients at risk for early adverse outcomes [11].

Early outcomes after first reverse TSA better prognosticate contralateral success than early outcomes after anatomic TSA [4]. Success after first anatomic TSA does not reliably predict contralateral success until 1 year postoperatively [4]. A model based on specific patient characteristics shows good predictive properties for identifying patients likely to have better outcomes [6]. Gender differences in outcomes are minimal, with both sexes achieving similar long-term pain relief and function [23].

Nonagenarians face increased risks of medical complications, longer hospital stays, periprosthetic fractures, and death following TSA [14]. Return-to-activity rates for TSA are slightly higher than those for reverse TSA and hemiarthroplasty [10]. Activities entailing greater shoulder demands may hinder a patient's ability to return [13]. Most patients undergoing shoulder stabilization regain fundamental strength and range of motion [9].

Ultrasound imaging serves as an efficient, inexpensive tool for diagnosing and managing the painful shoulder, offering advantages over other modalities for evaluating the postoperative shoulder [15]. Two PROMIS measures—Physical function and Pain interference—can estimate high-impact chronic pain in patients receiving TSA [22].

Investigations

Plain radiography: Routine radiographs are overused and typically do not lead to any changes in asymptomatic patients in the first 2 years after total shoulder arthroplasty [68]. Radiographic measurements are generally valid for evaluating postoperative parameters in reverse total shoulder arthroplasty [59].

CT: Preoperative 3-dimensional computed tomography bone density measures provide objective bone quality classifications for stemless anatomic total shoulder arthroplasty [24].

Tomosynthesis: Tomosynthesis may be a new and effective modality for evaluating glenoid loosening in the context of a hybrid ingrowth glenoid in anatomic total shoulder arthroplasty [66].

Ultrasound: Ultrasound imaging is an efficient, easy to use, and inexpensive tool for the diagnosis and management of the painful shoulder, with advantages over other modalities for evaluating the postoperative shoulder [15].

Other Considerations: Glenoid exposure is a difficult but key step in total shoulder arthroplasty that conditions correct component positioning [7]. Navigation increases the accuracy of glenoid component implantation in reverse total shoulder arthroplasty in shoulders with severe glenoid wear [27]. Navigation applicability in standard cases is debatable for experienced shoulder surgeons, but it could prove valuable for patients with severe bone defects [27]. A model based on specific patient characteristics had good predictive properties for identifying patients likely to have a better outcome from shoulder arthroplasty [6]. The outcome of revision shoulder arthroplasty can be predicted based on the indication for the procedure [2]. Complication and reoperation rates for shoulder arthroplasty addressing anterior instability arthropathy sequelae are higher compared to primary glenohumeral joint arthritis, though the difference is not statistically significant [1].

Prognostic Factors: Patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values at mid-term follow-up [3]. Early outcomes after first reverse total shoulder arthroplasty better prognosticate contralateral success compared with early outcomes after anatomic total shoulder arthroplasty [4]. Success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year [4]. Smoking has a negative effect on anatomical total shoulder arthroplasty functional outcomes that may persist even after quitting [71].

Implant-Specific Imaging Findings: Anatomic total shoulder arthroplasty using an all-polyethylene cemented glenoid component showed a high prevalence of radiographic signs associated with rotator cuff failure and glenoid wear at minimum 10-year follow-up, but this did not translate to a high complication rate or inferior outcome [21]. Reverse shoulder arthroplasty showed a high prevalence of radiographical signs associated with loosening at minimum 10-year follow-up, which did not seem to translate to high complication rates or inferior results [65]. Radiographic loosening over time remains a concern for an all-polyethylene fluted central peg glenoid component implanted utilizing an off-label, uncemented technique, potentially jeopardizing long-lasting fixation despite initial bony osseointegration [33].

Treatment

Non-Operative

Data on health care resource utilization in the 2 years prior to total shoulder arthroplasty provide a baseline for understanding current trends regarding nonarthroplasty treatment of shoulder pathology before shoulder replacement [30]. Ultrasound imaging is an efficient, easy to use, and inexpensive tool for the diagnosis and management of the painful shoulder, with advantages over other modalities for evaluating the postoperative shoulder [15].

Operative

Indications: The rapid rise in reverse total shoulder arthroplasty (RTSA) use is a product of expanded indications, improvements in surgical technique, implant design, and surgeon experience, resulting in outcomes comparable to anatomic total shoulder arthroplasty (TSA) with very low reoperation rates [18]. RTSA does not appear to offer functional benefits over anatomic TSA for primary osteoarthritis with an intact rotator cuff in patients with no glenoid deformity [5]. Nonagenarians are at an increased risk of medical complications, longer hospital stays, periprosthetic fractures, and death following total shoulder arthroplasty [14]. There are minimal gender differences in shoulder arthroplasty outcomes, with both genders achieving similar longterm results in pain relief and function [23].

Surgical Approach / Technique: Glenoid exposure is a difficult but key step in total shoulder arthroplasty that conditions correct component positioning [7]. Strict operative technique during prosthesis implantation for reverse shoulder arthroplasty in recent proximal humerus fractures is crucial to obtain reliable and reproducible outcomes, as inadequate tuberosity repair or inappropriate humeral stem position are associated with poorer outcomes [35].

Implant Selection: Radiographic loosening over time remains a concern for all-polyethylene fluted central peg glenoid components implanted utilizing an off-label, uncemented technique, potentially jeopardizing long-lasting fixation [33]. Shoulder metallosis is an infrequent but significant potential complication in patients who have undergone shoulder arthroplasty with retained metal suture anchors [60].

Pain Management: Intraoperative tranexamic acid does not improve range of motion or pain after total shoulder arthroplasty [64]. Two PROMIS measures commonly administered in orthopedic surgery settings, physical function and pain interference, can be used to estimate high-impact chronic pain for patients receiving total shoulder arthroplasty [22].

Adjuncts: Robotic-assisted arthroplasty is available for shoulder arthroplasty with some limitations, and shoulder surgeons should become familiar with the nature of this technology, potential benefits and disadvantages, and the surgical techniques employed [17].

Setting of Care: Outpatient total shoulder arthroplasty is a safe and effective option for appropriately selected patients, offering reduced costs, improved access, and high patient satisfaction compared to inpatient procedures [20].

Revision: Complication and reoperation rates for shoulder arthroplasty addressing anterior instability arthropathy sequelae are higher compared to primary glenohumeral joint arthritis, though the difference is not statistically significant [1]. Clinical outcomes of revision shoulder arthroplasty can be predicted based on the indication for the procedure [2]. Retrospective analysis shows comparable infection eradication rates after two-stage revision, resection arthroplasty, or permanent spacer implant for the treatment of septic shoulder prosthesis [32]. Functional improvement was obtained after reimplantation of a reverse total shoulder prosthesis for staged revision with antibiotic spacers for shoulder prosthetic joint infections, but was not seen after hemiarthroplasty and cement spacer [58]. Retention of osseointegrated prosthetic implants during surgical management of chronic infections following reverse total shoulder arthroplasty resulted in better shoulder function than conventional GS-type management [12].

Other Considerations: Patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values at mid-term follow-up [3]. Early outcomes after first reverse total shoulder arthroplasty better prognosticate contralateral success compared with early outcomes after anatomic total shoulder arthroplasty [4]. Success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year [4]. A model based on specific patient characteristics had good predictive properties for identifying patients likely to have a better outcome from shoulder arthroplasty [6]. Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty [8]. Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion [9]. Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme [25]. Acute and chronic recovery after total shoulder arthroplasty can be assessed via maximum elevation and time above 90 degrees of elevation, respectively [28]. Rehabilitation guidelines for reverse total shoulder replacement aim to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery [29]. Newer rehabilitation regimes permit immediate shoulder mobilization after reverse shoulder arthroplasty but may not be applied to every patient [62].

Complications

Infection (PJI): Infection eradication rates are comparable after two-stage revision, resection arthroplasty, or permanent spacer implant for the treatment of septic shoulder prosthesis [32]. Non-cefazolin antibiotic prophylaxis is associated with increased rates of acute infectious, medical, and surgical complications following primary total shoulder arthroplasty [76]. Prescription testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after primary total shoulder arthroplasty in male patients [81].

Aseptic loosening: A low rate of humeral component loosening was observed with the cement-within-cement technique in revision reverse total shoulder arthroplasty, but higher rates of complications and re-revision surgery were observed over time secondary to aseptic glenoid component loosening and instability [57]. A pressfit short humeral stem for total shoulder arthroplasty showed low rates of revision for humeral stem loosening, though a subset of stems were at risk of radiographic loosening [74]. No glenoid implant failures were reported and complication rates were similar between second-generation uncemented trabecular metal-backed and cemented polyethylene glenoid components in total shoulder arthroplasty at 5-year follow-up [80].

Instability: Instability is a challenging complication with high failure rates after revision procedures for anatomic total shoulder arthroplasty [73]. Higher rates of complications and re-revision surgery were observed over time secondary to aseptic glenoid component loosening and instability [57].

Periprosthetic fracture: Nonagenarians are at an increased risk of medical complications, longer hospital stays, periprosthetic fractures, and death following total shoulder arthroplasty [14]. Patients from areas of high social deprivation had increased rates of humeral fracture and dislocation following primary total shoulder arthroplasty [75].

Other Considerations: Complication and reoperation rates are higher for shoulder arthroplasty addressing sequelae of anterior instability arthropathy and stabilization procedures compared to shoulder arthroplasty for primary glenohumeral joint arthritis, though the difference is not statistically significant [1]. Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty [11]. Patients younger than 60 years of age experience significantly higher rates of 90-day surgical complications following reverse total shoulder arthroplasty compared to older patients [16]. The Latarjet procedure was associated with the highest odds of future total shoulder arthroplasty [31]. Revision rates and patient-reported outcomes are similar between cemented and uncemented humeral stems in reverse total shoulder arthroplasty for acute proximal humerus fracture [69]. Spin is highly prevalent in the abstracts of systematic reviews and meta-analyses studying glenoid augmentation with total shoulder arthroplasty [70]. Transfusion rates are higher in patients with fracture arthroplasty than after primary arthroplasty [77]. Overall clinical outcomes for reverse total shoulder arthroplasty in elderly patients are comparable to a younger population with low complication and revision rates [78]. Average total complication and revision rates for reverse total shoulder arthroplasty for proximal humeral fractures were relatively low but showed wide variability, with some studies reporting rates as high as 46% and 28%, respectively [79].

Recovery

Light activity (weeks): Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme [25]. Rehabilitation guidelines for reverse total shoulder replacement aim to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery [29].

Full activity (months): A high return to sport can be expected after total shoulder arthroplasty [43]. Patients can be counseled that they can expect to successfully return to sporting and recreational activities following surgical reconstruction of their shoulder [52]. Return to sports after reverse shoulder arthroplasty is possible and highly frequent [53]. In patients age 55 and younger undergoing total shoulder arthroplasty, there was a 96.4% rate of return to sports at an average of 6.7 months [67]. Electromyographic analysis offers a progression of exercises for patients after reverse shoulder arthroplasty based on increased muscle activity [47]. Activities entailing greater shoulder demands may hinder a patient's ability to return after arthroplasty [13]. Return rates for total shoulder arthroplasty are slightly higher than those reported for reverse total shoulder arthroplasty and hemiarthroplasty [10].

Complete recovery / outcome plateau (months): The plateau of maximum recovery following rotator cuff repair occurred at 1 year with high satisfaction rates at all time points [61]. Strength of the shoulder increased significantly between six and twelve months postoperatively after repair of a torn rotator cuff, supporting the contention that continuing rehabilitation beyond six months is advisable [55]. Success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year [4]. Patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values at mid-term follow-up [3].

Rehabilitation protocol: Acute recovery after total shoulder arthroplasty can be assessed via maximum elevation [28]. Chronic recovery after total shoulder arthroplasty can be assessed via time spent above 90 degrees of elevation [28].

Functional milestones: Among shoulder arthroplasty patients who perceive their shoulder as normal, anatomic total shoulder arthroplasty (aTSA) patients outperform reverse total shoulder arthroplasty (rTSA) patients with better motion and greater ability to return to work, return to sport, and perform higher demand activities without difficulty [49]. Reverse total shoulder arthroplasty 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 [5]. Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion [9].

Key Evidence

  • [L1] Complication and reoperation rates are higher compared to shoulder arthroplasty for primary glenohumeral joint arthritis; however, the difference is not statistically significant. (10.1007/s00402-020-03400-y)
  • [L3] At mid-term follow-up, patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values. (10.1016/j.jse.2023.07.005)
  • [L4] In contrast, success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year. (10.1016/j.jse.2023.10.007)
  • [L3] Reverse total shoulder arthroplasty does not appear to offer functional benefits over anatomic total shoulder arthroplasty in this population. (10.1016/j.jse.2025.01.038)
  • [L2] A model based on these characteristics had good predictive properties for identifying patients likely to have a better outcome from shoulder arthroplasty. (10.1007/s11999-016-4990-1)
  • [Paper] Glenoid exposure is a difficult but key step in total shoulder arthroplasty that conditions correct component positioning. (10.1016/j.otsr.2017.10.008)
  • [L3] Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty. (10.1016/j.jse.2025.02.055)
  • [L1] Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion. (10.1016/j.asmr.2024.100978)
  • [L4] The literature reports that rates of return for total shoulder arthroplasty are slightly higher than those reported for reverse total shoulder arthroplasty and hemiarthroplasty. (10.1016/j.csm.2018.06.002)
  • [L3] Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty. (10.5397/cise.2025.00584)
  • [Paper] This technique resulted in better shoulder function than a conventional GS-type management. (10.1016/j.otsr.2021.102906)
  • [L4] Activities entailing greater shoulder demands may hinder a patient's ability to return after arthroplasty. (10.1177/23259671251326076)
  • [L3] Nonagenarians are at an increased risk of medical complications, longer hospital stays, periprosthetic fractures, and death following total shoulder arthroplasty. (10.1177/17585732241269174)
  • [Paper] Ultrasound imaging is an efficient, easy to use, and inexpensive tool for the diagnosis and management of the painful shoulder, with advantages over other modalities for evaluating the postoperative shoulder. (10.1016/j.otsr.2018.07.011)
  • [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. (10.1016/j.jseint.2025.05.020)
  • [L5] Robotic-assisted arthroplasty is now available for shoulder arthroplasty with some limitations, and shoulder surgeons should become familiar with the nature of this technology, potential benefits and disadvantages, and the surgical techniques employed. (10.1016/j.xrrt.2025.08.013)
  • [L5] The rapid rise in RTSA use is a product of expanded indications, improvements in surgical technique, implant design, and surgeon experience, resulting in outcomes comparable to anatomic total shoulder arthroplasty (ATSA) with very low reoperation rates. (10.1016/j.jse.2023.08.009)
  • [Paper] The decision to revise a total shoulder arthroplasty requires a rigorous assessment to answer five key questions regarding infection, instability, wear, loosening, and rotator cuff status. (10.1016/j.otsr.2012.11.010)
  • [L5] Outpatient total shoulder arthroplasty is a safe and effective option for appropriately selected patients, offering reduced costs, improved access, and high patient satisfaction compared to inpatient procedures. (10.1016/j.jse.2024.08.003)
  • [L4] Although a high prevalence of radiographic signs associated with rotator cuff failure and glenoid wear were reported, this did not translate to a high complication rate or inferior outcome. (10.1016/j.jse.2025.03.036)
  • [L4] Two PROMIS measures commonly administered in orthopedic surgery settings, physical function and pain interference, can be used to estimate high-impact chronic pain for patients receiving total shoulder arthroplasty. (10.1016/j.jseint.2024.07.005)
  • [L3] This study shows minimal gender differences in shoulder arthroplasty outcomes, with both genders achieving similar longterm results in pain relief and function. (10.1016/j.jse.2025.02.035)
  • [L4] Preoperative 3-dimensional CT bone density measures provide objective classifications of bone quality for stemless anatomic total shoulder arthroplasty. (10.1016/j.jse.2023.11.005)
  • [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. (10.1177/1758573220937394)
  • [Paper] Good functional results can be achieved in cases with a B1 and a B2 glenoid after anatomic shoulder arthroplasty using the described metal back glenoid. (10.1007/s00402-020-03454-y)
  • [L3] While its applicability in standard cases is debatable for experienced shoulder surgeons, it could prove valuable for patients with severe bone defects. (10.1016/j.jseint.2024.11.009)
  • [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. (10.1016/j.jse.2019.01.003)
  • [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. (10.1111/j.1758-5740.2011.00138.x)
  • [L3] These data provide a baseline for understanding current trends regarding nonarthroplasty treatment of shoulder pathology before shoulder replacement. (10.1016/j.jse.2024.11.033)
  • [L3] The Latarjet procedure was associated with the highest odds of future total shoulder arthroplasty. (10.1177/2325967125s00104)
  • [L4] This retrospective analysis shows comparable infection eradication rates after two-stage revision, resection arthroplasty, or permanent spacer implant for the treatment of septic shoulder prosthesis. (10.1007/s00264-011-1467-4)
  • [L4] Despite initial bony osseointegration in the majority of cases, radiographic loosening over time remains a concern, potentially jeopardizing long-lasting fixation of this type of glenoid component when implanted in an off-label uncemented fashion. (10.1016/j.jse.2020.02.027)
  • [L1] rTSA restores forward elevation primarily via compensatory scapulothoracic motion and deltoid-driven neuromuscular strategies rather than normalization of glenohumeral mechanics. (10.1016/j.jse.2026.03.002)
  • [L5] Strict operative technique during prosthesis implantation is crucial to obtain reliable and reproducible outcomes, as inadequate tuberosity repair or inappropriate humeral stem position are associated with poorer outcomes. (10.1016/j.otsr.2018.07.003)
  • [L4] Thus, preoperative planning using supine CT may inaccurately pose bones, with consequent effects on the surgical plan, the resultant shoulder biomechanics, and clinical outcomes. (10.1016/j.xrrt.2025.08.006)
  • [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. (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. (10.1016/j.jse.2024.12.018)
  • [L5] Isolated humeral distalization caused dramatic increases in the muscle forces required to perform scapular-plane abduction, with joint reaction forces increasing correspondingly. (10.1016/j.jse.2024.07.055)
  • [Paper] A general decrease in the degree of rotational ROM was observed with higher glenohumeral abduction angles for both head designs. (10.1007/s00402-020-03587-0)
  • [L4] All movement planes showed significant differences in simulated range of motion when comparing protocols with and without adjustment for posture. (10.1302/0301-620x.106b11.bjj-2024-0110.r1)
  • [L1] There is an increased contribution of scapulothoracic rotation relative to glenohumeral motion throughout arm elevation following TSA compared to asymptomatic shoulders. (10.1016/j.jse.2025.08.010)
  • [L1] A high return to sport can be expected after total shoulder arthroplasty. (10.1016/j.jseint.2025.05.028)
  • [L4] Adjusting patient-specific scapula posture significantly impacts predicted impingement-free motion amplitudes and range of motion in reverse total shoulder arthroplasty. (10.1016/j.xrrt.2025.05.022)
  • [L4] However, significant changes from the preoperative to postoperative conditions were not demonstrated for other kinematic parameters. (10.1016/j.jseint.2025.04.025)
  • [L4] This study offers a progression of exercises for patients after reverse shoulder arthroplasty based on increased muscle activity. (10.1016/j.jse.2024.03.050)
  • [L3] Clavicle hook plate fixation changes the scapular kinematics and scapulohumeral rhythm; thus, when clavicle hook plate fixation is complete, the implant should be promptly removed. (10.1007/s00264-018-4003-y)
  • [L3] Among shoulder arthroplasty patients who perceive their shoulder as normal, aTSA patients outperform rTSA patients with better motion and greater ability to return to work, return to sport, and perform higher demand activities without difficulty. (10.1016/j.jse.2025.02.010)
  • [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. (10.1016/j.jse.2025.03.027)
  • [L3] Patients can be counseled that they can expect to successfully return to sporting and recreational activities following surgical reconstruction of their shoulder. (10.1177/2325967117s00296)
  • [L4] Return to sports after reverse shoulder arthroplasty is possible and highly frequent. (10.1136/jisakos-2020-000581)
  • [L5] Shoulder surgeons must understand the key aspects of 3D preoperative planning software, including segmentation techniques, landmark definition, and potential limitations, to make informed decisions and mitigate risks of errors in the surgical procedure. (10.1016/j.jseint.2024.09.006)
  • [L3] Strength of the shoulder increased significantly between six and twelve months postoperatively, supporting the contention that continuing rehabilitation beyond six months is advisable. (10.2106/00004623-198870080-00027)
  • [L4] Overall, patients undergoing IB-rTSA can expect good and stable long-term clinical outcomes with low complication and revision rates, making it a viable choice for different shoulder pathologies. (10.1016/j.jse.2025.02.051)
  • [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. (10.1016/j.xrrt.2024.08.006)
  • [L3] Functional improvement was obtained after reimplantation of a reverse total shoulder prosthesis but was not seen after hemiarthroplasty and cement spacer. (10.1007/s11999.0000000000000049)
  • [L3] The study confirms that radiographic measurements are generally valid for evaluating postoperative parameters in reverse total shoulder arthroplasty. (10.1016/j.jse.2024.10.016)
  • [Case_report] Shoulder metallosis is an infrequent but significant potential complication in patients who have undergone shoulder arthroplasty with retained metal suture anchors. (10.1016/j.xrrt.2024.12.004)
  • [L4] The plateau of maximum recovery following rotator cuff repair occurred at 1 year with high satisfaction rates at all time points. (10.1016/j.arthro.2017.04.033)
  • [L1] Newer regimes permit immediate shoulder mobilization but may not be applied to every patient. (10.1177/17585732221144007)
  • [Paper] However, it does not prevent the development of shoulder osteoarthritis, since a high number of patients had (mainly mild) radiological osteoarthritis. (10.1007/s00402-017-2866-9)
  • [L3] Intraoperative TXA does not improve ROM or pain after TSA. (10.5435/jaaos-d-24-00737)
  • [L4] Interestingly, the radiographical analysis showed high prevalence of signs associated with loosening, which did not seem to translate to high complication rates or inferior results. (10.1016/j.jse.2023.09.015)
  • [L3] Tomosynthesis may be a new and effective modality for evaluating glenoid loosening. (10.1016/j.jseint.2025.05.003)
  • [L4] In patients age 55 and younger undergoing total shoulder arthroplasty, there was a 96.4% rate of return to sports at an average of 6.7 months. (10.1177/2325967117s00295)
  • [L4] Routine radiographs are overused and typically do not lead to any changes in asymptomatic patients in the first 2 years after TSA. (10.1016/j.jse.2024.11.010)
  • [L3] Revision rates and patient-reported outcomes are similar between cemented and uncemented humeral stems. (10.1016/j.jseint.2025.10.009)
  • [L4] Spin is highly prevalent in the abstracts of systematic reviews and meta-analyses studying glenoid augmentation with TSA. (10.1016/j.jseint.2025.02.021)
  • [L3] Smoking has a negative effect on anatomical total shoulder arthroplasty functional outcomes that may persist even after quitting. (10.1302/0301-620x.106b11.bjj-2024-0202.r1)
  • [L5] Instability is a challenging complication with high failure rates after revision procedures, prompting a movement toward reverse shoulder arthroplasty, though this may not be ideal for all patients. (10.5435/jaaos-d-23-01072)
  • [L4] The study reports a 2-year minimum survivorship and radiographic analysis showing significant improvements in functional outcome scores and low rates of revision for humeral stem loosening, though a subset of stems were at risk of radiographic loosening. (10.1016/j.jseint.2023.10.011)
  • [L3] Patients from areas of high social deprivation had increased rates of humeral fracture and dislocation following primary total shoulder arthroplasty. (10.1302/0301-620x.106b2.bjj-2023-0785.r1)
  • [L3] The results of this study support the use of cefazolin monotherapy as the current standard for patients undergoing primary total shoulder arthroplasty. (10.1016/j.jseint.2025.04.001)
  • [L3] Transfusion rates are higher in patients with fracture arthroplasty than after primary arthroplasty. (10.1007/s00264-018-4047-z)
  • [L3] Overall clinical outcome is comparable to a younger population with low complication and revision rates. (10.1016/j.jseint.2025.01.006)
  • [L4] While the average total complication and revision rates were relatively low, there was wide variability, with some studies reporting rates as high as 46% and 28%, respectively. (10.1016/j.xrrt.2024.08.007)
  • [L1] No glenoid implant failures were reported, and complication rates were similar between groups. (10.1016/j.jse.2023.12.004)
  • [L2] Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty. (10.1016/j.jseint.2026.101634)

See Also

References

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[2] Retrospective, single-centre analysis comparing clinical outcomes of reverse total shoulder replacement for fracture, degenerative changes and revision procedure. 2025.

[3] Outcomes of total shoulder arthroplasty in patients with prior anterior shoulder instability: minimum 5-year follow-up. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.07.005

[4] 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

[5] 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

[6] What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties. Clinical Orthopaedics & Related Research. 2016. DOI: 10.1007/s11999-016-4990-1

[7] Glenoid exposure in total shoulder arthroplasty. Orthopaedics & Traumatology: Surgery & Research. 2018. DOI: 10.1016/j.otsr.2017.10.008

[8] Same reimbursement, different cost: risk factors for high-cost total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.055

[9] Objective Measures for Assessing Readiness to Return to Sport After Shoulder Instability Procedures Are Not Standardized: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2024.100978

[10] Return to Play After Shoulder Replacement Surgery. Clinics in Sports Medicine. 2018. DOI: 10.1016/j.csm.2018.06.002

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[12] Does the retention of osseointegrated prosthetic implants during the surgical management of chronic infections following reverse total shoulder arthroplasty (RTSA) influence functional outcomes without impacting the efficacy of the infection treatment?. Orthopaedics & Traumatology: Surgery & Research. 2021. DOI: 10.1016/j.otsr.2021.102906

[13] Return to Outdoorsman Sports After Primary Total Shoulder Arthroplasty. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251326076

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[18] Why has reverse total shoulder arthroplasty become the procedure of choice for primary shoulder arthroplasty?. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.08.009

[19] Revision of total shoulder arthroplasty. Orthopaedics & Traumatology: Surgery & Research. 2013. DOI: 10.1016/j.otsr.2012.11.010

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[22] Can Patient-Reported Outcomes Measurement Information System estimate high-impact chronic pain after total shoulder arthroplasty?. JSES International. 2024. DOI: 10.1016/j.jseint.2024.07.005

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[24] Preoperative 3-dimensional computed tomography bone density measures provide objective bone quality classifications for stemless anatomic total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.11.005

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[29] Rehabilitation following Reverse Total Shoulder Replacement. Shoulder & Elbow. 2011. DOI: 10.1111/j.1758-5740.2011.00138.x

[30] Health care resource utilization in the 2 years prior to total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.11.033

[31] Paper 47: Subsequent Total Shoulder Arthroplasty Following Common Shoulder Stabilization and Reconstructive Procedures. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00104

[32] What treatment for periprosthetic shoulder infection? Results from a multicentre retrospective series. International Orthopaedics. 2012. DOI: 10.1007/s00264-011-1467-4

[33] Clinical and radiographic outcomes of an all-polyethylene fluted central peg glenoid component, implanted utilizing an off-label, uncemented technique, at a minimum 5-year follow-up. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.02.027

[34] Biomechanical Changes After Reverse Total Shoulder Arthroplasty: A Systematic Review of Advanced Measurement Technologies. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.03.002

[35] Reverse shoulder arthroplasty in recent proximal humerus fractures. Orthopaedics & Traumatology: Surgery & Research. 2018. DOI: 10.1016/j.otsr.2018.07.003

[36] Shoulder joint angles in supine and upright imaging of the preoperative reverse total shoulder arthroplasty patient. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.08.006

[37] 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

[38] 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

[39] Isolated humeral distalization in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.07.055

[40] Rotational range of motion of elliptical and spherical heads in shoulder arthroplasty: a dynamic biomechanical evaluation. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03587-0

[41] SECEC Grammont Award 2024: The critical role of posture adjustment for range of motion simulation in reverse total shoulder arthroplasty preoperative planning. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0110.r1

[42] Impact of reverse total shoulder arthroplasty on scapulohumeral rhythm: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.08.010

[43] Why do patients not return to sports or work after anatomical or reverse total shoulder arthroplasty? A systematic review and meta-analysis. JSES International. 2025. DOI: 10.1016/j.jseint.2025.05.028

[45] Predicted impingement-free motion amplitudes in reverse total shoulder arthroplasty differs between supine computed tomography and standing biplanar x-ray imaging: a pilot study. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.05.022

[46] Do shoulder kinematics change after reverse total shoulder arthroplasty?. JSES International. 2025. DOI: 10.1016/j.jseint.2025.04.025

[47] Electromyographic analysis of selected shoulder muscles during shoulder rehabilitation exercises in patients after reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.03.050

[48] Evaluation of three-dimensional in vivo scapular kinematics and scapulohumeral rhythm between shoulders with a clavicle hook plate and contralateral healthy shoulders. International Orthopaedics. 2018. DOI: 10.1007/s00264-018-4003-y

[49] Evaluation of new normal after shoulder arthroplasty: comparison of anatomic vs. reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.010

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[52] Return to Recreational Sporting Activities Following Total Shoulder Arthroplasty. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00296

[53] Return to sport after reverse total shoulder arthroplasty is highly frequent: a systematic review. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2020-000581

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[55] Isokinetic strength of the shoulder after repair of a torn rotator cuff.. The Journal of Bone & Joint Surgery. 1988. DOI: 10.2106/00004623-198870080-00027

[56] Long-term clinical and radiographic outcomes after inverted-bearing reverse total shoulder arthroplasty: a multicenter study with the Affinis Inverse prosthesis. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.051

[57] Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.08.006

[58] Staged Revision With Antibiotic Spacers for Shoulder Prosthetic Joint Infections Yields High Infection Control. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1007/s11999.0000000000000049

[59] The validity of radiographic measurements compared to 3-dimensional-surface model-based measurements in shoulders with reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.10.016

[60] Metallosis after anatomic total shoulder arthroplasty resulting from contact with retained metallic suture anchors: a case report. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.12.004

[61] Speed of Recovery After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.04.033

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[64] Does Tranexamic Acid Improve Early Postoperative Shoulder Motion After Total Shoulder Arthroplasty?. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00737

[65] Functional and radiographic outcomes of reverse shoulder arthroplasty with a minimum follow-up of 10 years. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.09.015

[66] Short-term results of a hybrid ingrowth glenoid in anatomic total shoulder arthroplasty: a radiographic analysis for radiolucent lines and osteointegration using tomosynthesis. JSES International. 2025. DOI: 10.1016/j.jseint.2025.05.003

[67] High Return to Sports after TSA Under 55. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00295

[68] Utility of radiographs for asymptomatic patients following primary anatomic and reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.11.010

[69] Do uncemented humeral components perform better than cemented humeral components in reverse total shoulder arthroplasty for acute proximal humerus fracture? A New Zealand Joint Registry study. JSES International. 2026. DOI: 10.1016/j.jseint.2025.10.009

[70] Evaluation of spin in systematic reviews and meta-analyses involving glenoid augmentation in total shoulder arthroplasty. JSES International. 2025. DOI: 10.1016/j.jseint.2025.02.021

[71] The effect of smoking on functional outcomes and implant survival of anatomical total shoulder arthroplasty. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0202.r1

[73] Instability and the Anatomic Total Shoulder Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-01072

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[75] Higher complication rates following primary total shoulder arthroplasty in patients presenting from areas of higher social deprivation. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b2.bjj-2023-0785.r1

[76] Non-cefazolin antibiotic prophylaxis is associated with increased rates of acute infectious, medical, and surgical complications following primary total shoulder arthroplasty: a database study. JSES International. 2025. DOI: 10.1016/j.jseint.2025.04.001

[77] Differences in total blood loss and transfusion rate between different indications for shoulder arthroplasty. International Orthopaedics. 2018. DOI: 10.1007/s00264-018-4047-z

[78] Reverse total shoulder arthroplasty outcomes in elderly patients. JSES International. 2025. DOI: 10.1016/j.jseint.2025.01.006

[79] Complications following reverse total shoulder arthroplasty for proximal humeral fractures: a systematic review. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.08.007

[80] A multicenter, randomized controlled trial comparing a second-generation uncemented trabecular metal-backed vs. cemented polyethylene glenoid component in total shoulder arthroplasty: 5-year results. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.12.004

[81] Prescription testosterone is associated with increased risk of infection-related and all-cause reoperations after primary total shoulder arthroplasty in male patients. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101634

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a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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