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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.

76 citationsUpdated Jul 2026

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

Overview

Total shoulder arthroplasty encompasses anatomic and reverse configurations, with the latter experiencing a rapid rise in use driven by expanded indications, improved surgical technique, and enhanced implant design [14]. Reverse total shoulder arthroplasty use has notably increased among patients younger than 60 years of age [48]. While reverse total shoulder arthroplasty yields outcomes comparable to anatomic total shoulder arthroplasty with very low reoperation rates [14], it 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 [7]. Return rates for total shoulder arthroplasty are slightly higher than those reported for reverse total shoulder arthroplasty and hemiarthroplasty [9].

Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty [6]. 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 [17]. Shoulder replacement remains a viable treatment option regardless of patient tobacco usage at short-term follow-up, although conclusions may vary depending on the replacement type used [5].

Long-term management and prognosis are influenced by specific patient factors. Consensus recommendations for long-term follow-up and surveillance of elective primary shoulder arthroplasty were developed using a real-time Delphi technique [1]. The outcome of revision shoulder arthroplasty can be predicted based on the indication for the procedure [3]. 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 [4]. Regarding contralateral outcomes, early results after first reverse total shoulder arthroplasty better prognosticate contralateral success compared with early outcomes after anatomic total shoulder arthroplasty [10]. Success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year [10].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Shoulder arthroplasty to address sequelae of anterior instability arthropathy and stabilization procedures is challenging due to distorted anatomy and severe glenohumeral joint pathology [2]. Reverse total shoulder arthroplasty (rTSA) restores forward elevation primarily via compensatory scapulothoracic motion and deltoid-driven neuromuscular strategies rather than normalization of glenohumeral mechanics [32]. The scapulothoracic contribution to overall shoulder movement is significantly increased in patients with an rTSA compared with a healthy shoulder [37]. 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 [36]. Significant changes from preoperative to postoperative conditions were not demonstrated for other kinematic parameters beyond the increased scapulothoracic contribution [46].

Isolated humeral distalization in rTSA caused 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 [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 [52]. Clavicle hook plate fixation changes scapular kinematics and scapulohumeral rhythm [49].

Preoperative Planning and Imaging

Preoperative planning using supine CT may inaccurately pose bones, with consequent effects on the surgical plan, resultant shoulder biomechanics, and clinical outcomes [35]. Predicted impingement-free motion amplitudes in rTSA differ between supine computed tomography and standing biplanar x-ray imaging [45]. 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 [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].

Classification

Indication-Based Stratification: The outcome of revision shoulder arthroplasty is predictable based on the specific indication for the procedure [3]. A model utilizing specific patient characteristics demonstrates good predictive properties for identifying patients likely to achieve better outcomes from shoulder arthroplasty [8].

Anatomic and Pathologic Subtypes: Shoulder arthroplasty to address sequelae of anterior instability arthropathy and prior stabilization procedures is challenging due to distorted anatomy and severe glenohumeral joint pathology [2]. 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 [7].

Risk and Resource Stratification: Patient-level variables (age, comorbidity burden, ASA score, and trauma indication) and system-level variables (weekend surgery and surgeon volume) are independently associated with prolonged length of stay following shoulder arthroplasty [51]. Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty [6]. Preoperative 3-dimensional computed tomography bone density measures provide objective bone quality classifications for stemless anatomic total shoulder arthroplasty [23].

Other Considerations: Long-term follow-up and surveillance recommendations for elective primary shoulder arthroplasty were established using a real-time Delphi technique [1]. Shoulder replacement is a viable treatment option regardless of patient tobacco usage at short-term follow-up, though this may vary depending on the replacement type used [5]. Substantial variation exists in implant selection and surgical technique for reverse shoulder replacement in the United Kingdom [15]. The decision to revise a total shoulder arthroplasty requires rigorous assessment regarding infection, instability, wear, loosening, and rotator cuff status [16]. 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 [20]. Data on health care resource utilization in the 2 years prior to total shoulder arthroplasty provide a baseline for understanding trends regarding nonarthroplasty treatment of shoulder pathology before replacement [28]. Studies with higher levels of evidence may overtake the most-cited articles in reverse total shoulder arthroplasty as the procedure continues to grow [29].

Clinical Presentation

Shoulder arthroplasty to address the sequelae of anterior instability arthropathy and stabilization procedures is challenging due to distorted anatomy and severe glenohumeral joint pathology [2]. 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 [4]. Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion [12].

Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty [33]. However, a model based on specific patient characteristics had good predictive properties for identifying patients likely to have a better outcome from shoulder arthroplasty [8]. Shoulder replacement is a viable treatment option regardless of patient tobacco usage at short-term follow-up, though conclusions may vary depending on the replacement type used [5]. There are minimal gender differences in shoulder arthroplasty outcomes, with both genders achieving similar long-term results in pain relief and function [22].

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 [21]. Nonagenarians are at an increased risk of medical complications, longer hospital stays, periprosthetic fractures, and death following total shoulder arthroplasty [13].

Glenoid Morphology and Implant Selection

Good functional results can be achieved in cases with a B1 and a B2 glenoid after anatomic shoulder arthroplasty using a metal back glenoid component [24]. Although a high prevalence of radiographic signs associated with rotator cuff failure and glenoid wear were reported after anatomic total shoulder arthroplasty with an all-polyethylene cemented glenoid component at minimum 10-year follow-up, this did not translate to a high complication rate or inferior outcome [18].

Functional Outcomes and Return to Activity

Rates of return to play after total shoulder arthroplasty are slightly higher than those reported for reverse total shoulder arthroplasty and hemiarthroplasty [9]. Activities entailing greater shoulder demands may hinder a patient's ability to return to outdoorsman sports after primary total shoulder arthroplasty [19].

Revision Assessment

Revision of total shoulder arthroplasty requires a rigorous assessment regarding Infection, Instability, Wear, Loosening, and Rotator cuff status [16]. Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty [6].

Investigations

Plain radiography: Radiographic measurements are generally valid for evaluating postoperative parameters in reverse total shoulder arthroplasty [58]. However, routine radiographs are overused and typically do not lead to any changes in asymptomatic patients in the first 2 years after total shoulder arthroplasty [72].

CT: Preoperative 3-dimensional computed tomography bone density measures provide objective bone quality classifications for stemless anatomic total shoulder arthroplasty [23]. Preoperative shoulder CT may be associated with a small but quantifiable projected cancer risk, most pronounced in younger women [62]. Navigation increases the accuracy of glenoid component implantation in reverse total shoulder arthroplasty in shoulders with severe glenoid wear [69].

Tomosynthesis: Tomosynthesis may be a new and effective modality for evaluating glenoid loosening [68].

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 [67].

Other Considerations: Consensus recommendations exist for long-term follow-up and surveillance of elective primary shoulder arthroplasty [1].

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 [28].

Operative

Indications: Shoulder arthroplasty to address sequelae of anterior instability arthropathy and prior stabilization procedures is challenging due to distorted anatomy and severe glenohumeral joint pathology [2]. 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 [4]. A predictive model based on specific patient characteristics can identify patients likely to have a better outcome from shoulder arthroplasty [8]. Nonagenarians are at an increased risk of medical complications, longer hospital stays, periprosthetic fractures, and death following total shoulder arthroplasty [13].

Surgical Approach / Technique: Glenoid exposure is a difficult but key step in total shoulder arthroplasty that conditions correct component positioning [11]. Strict operative technique during reverse shoulder arthroplasty for recent proximal humerus fractures is crucial to obtain reliable outcomes, as inadequate tuberosity repair or inappropriate humeral stem position are associated with poorer outcomes [34]. Robotic-assisted arthroplasty is available for shoulder arthroplasty with some limitations, and surgeons should become familiar with its nature, potential benefits, disadvantages, and surgical techniques [31].

Implant Selection: 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 [7]. The rapid rise in reverse total shoulder arthroplasty (RTSA) use is driven by expanded indications, improvements in surgical technique, implant design, and surgeon experience, resulting in outcomes comparable to anatomic total shoulder arthroplasty with very low reoperation rates [14]. Substantial variation exists in implant selection and surgical technique for reverse shoulder replacement despite it being the predominant form of shoulder arthroplasty in the United Kingdom [15]. Radiographic loosening over time remains a concern for all-polyethylene fluted central peg glenoid components implanted using an off-label, uncemented technique, potentially jeopardizing long-lasting fixation [57]. Shoulder metallosis is an infrequent but significant potential complication in patients who have undergone shoulder arthroplasty with retained metallic suture anchors [59].

Pain Management: Intraoperative tranexamic acid does not improve range of motion or pain after total shoulder arthroplasty [64].

Adjuncts: 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 [17]. Shoulder replacement is a viable treatment option regardless of patient tobacco usage at short-term follow-up, though conclusions may vary depending on the replacement type used [5].

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 [17].

Revision: The outcome of revision shoulder arthroplasty can be predicted based on the indication for the procedure [3]. Comparable infection eradication rates are achieved after two-stage revision, resection arthroplasty, or permanent spacer implant for the treatment of septic shoulder prosthesis [30]. Functional improvement was obtained after reimplantation of a reverse total shoulder prosthesis for staged revision with antibiotic spacers, but was not seen after hemiarthroplasty and cement spacer [56].

Other Considerations: Long-term follow-up and surveillance guidelines for elective primary shoulder arthroplasty have been established using a real-time Delphi technique [1]. Most patients undergoing shoulder stabilization procedures regain fundamental strength and range of motion [12]. There are minimal gender differences in shoulder arthroplasty outcomes, with both genders achieving similar long-term results in pain relief and function [22]. Acute recovery after total shoulder arthroplasty can be assessed via maximum elevation, while chronic recovery can be assessed via time spent above 90 degrees of elevation [26]. Two Patient-Reported Outcomes Measurement Information System (PROMIS) measures, physical function and pain interference, can be used to estimate high-impact chronic pain for patients receiving total shoulder arthroplasty [21]. Rehabilitation guidelines for reverse total shoulder replacement aim to achieve optimal pain relief and maximize functional outcomes while mitigating surgical risks [27]. Newer rehabilitation regimes permit immediate shoulder mobilization following reverse shoulder arthroplasty but may not be applied to every patient [61]. Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty [6].

Complications

Infection (PJI): Non-cefazolin antibiotic prophylaxis is associated with increased rates of acute infectious, medical, and surgical complications following primary total shoulder arthroplasty [80]. Perioperative testosterone use is associated with a significantly higher risk of periprosthetic joint infection (PJI) following primary total shoulder arthroplasty, but no differences are found in rates of other major complications including revision rates, dislocation, aseptic loosening, periprosthetic fracture, and stiffness [83]. Prescription testosterone is associated with an increased risk of infection-related and all-cause reoperations after primary total shoulder arthroplasty in male patients [82]. Comparable infection eradication rates exist after two-stage revision, resection arthroplasty, or permanent spacer implant for the treatment of septic shoulder prosthesis [30].

Instability: Instability is a challenging complication with high failure rates after revision procedures, prompting a movement toward reverse shoulder arthroplasty [77]. The cement-within-cement technique in revision reverse total shoulder arthroplasty is associated with a low rate of humeral component loosening but higher rates of complications and re-revision surgery over time secondary to aseptic glenoid component loosening and instability [55].

Periprosthetic fracture: Nonagenarians are at increased risk of medical complications, longer hospital stays, periprosthetic fractures, and death following total shoulder arthroplasty [13]. Patients from areas of high social deprivation have increased rates of humeral fracture and dislocation following primary total shoulder arthroplasty [79].

Other Considerations: Shoulder arthroplasty to address sequelae of anterior instability arthropathy and stabilization procedures is challenging due to distorted anatomy and severe glenohumeral joint pathology [2]. The Latarjet procedure is associated with the highest odds of future total shoulder arthroplasty [78]. Revision shoulder arthroplasty outcomes can be predicted based on the indication for the procedure [3]. Shoulder replacement is a viable treatment option regardless of patient tobacco usage at short-term follow-up, though conclusions may vary depending on the replacement type [5]. Return-to-play rates are slightly higher for total shoulder arthroplasty compared to reverse total shoulder arthroplasty and hemiarthroplasty [9]. Success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year, whereas early outcomes after first reverse total shoulder arthroplasty do [10]. Direct costs of revision shoulder arthroplasty are primarily driven by implant-related costs, and the cost per improvement in patient-reported outcomes is high compared to primary arthroplasty [25]. Elevated preoperative international normalized ratio (INR) is associated with an increased risk of postoperative complications following total shoulder arthroplasty [71]. Revision rates and patient-reported outcomes are similar between cemented and uncemented humeral stems in reverse total shoulder arthroplasty for acute proximal humerus fracture [73]. Pseudoaneurysm is an uncommon but possible complication after shoulder arthroplasty [81].

Recovery

Long-term follow-up and surveillance of elective primary shoulder arthroplasty are recommended via consensus guidelines [1].

Light activity (weeks): Acute recovery after total shoulder arthroplasty can be assessed via maximum elevation [26]. Rehabilitation guidelines for reverse total shoulder replacement aim to achieve optimal pain relief and maximize functional outcomes while mitigating surgical risks [27]. Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme [38].

Full activity (months): A high return to sport can be expected after total shoulder arthroplasty [43]. Return to sports after reverse shoulder arthroplasty is possible and highly frequent [65]. Patients can be counseled that they can expect to successfully return to sporting and recreational activities following surgical reconstruction of their shoulder [70]. Activities entailing greater shoulder demands may hinder a patient's ability to return after arthroplasty [19].

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 [60]. Success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year, whereas early outcomes after first reverse total shoulder arthroplasty better prognosticate contralateral success [10].

Rehabilitation protocol: A progression of exercises for patients after reverse shoulder arthroplasty can be based on increased muscle activity [47].

Functional milestones: Chronic recovery after total shoulder arthroplasty can be assessed via time spent above 90 degrees of elevation [26]. 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 [50].

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 [4]. Return rates for total shoulder arthroplasty are slightly higher than those reported for reverse total shoulder arthroplasty and hemiarthroplasty [9]. Direct costs of revision shoulder arthroplasty are primarily driven by implant-related costs, and the cost per improvement in patient-reported outcomes is high compared to primary arthroplasty [25].

Key Evidence

  • [L4] We anticipate that these recommendations, in addition to the limited applicable published evidence available, can contribute to guidelines on long-term follow-up and surveillance of elective primary shoulder arthroplasty. [1] (10.1177/17585732251356963)
  • [L1] Shoulder arthroplasty to address the sequelae of instability arthropathy and stabilization procedures can be a challenging procedure as a consequence of the distorted anatomy and severe glenohumeral joint pathology. [2] (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. [4] (10.1016/j.jse.2023.07.005)
  • [L3] Overall, these findings indicate that shoulder replacement in general is a viable treatment option regardless of patient tobacco usage at short-term follow-up, but this conclusion may vary depending on the replacement type used. [5] (10.1177/17585732221102393)
  • [L3] Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical cost for total shoulder arthroplasty. [6] (10.1016/j.jse.2025.02.055)
  • [L3] Reverse total shoulder arthroplasty does not appear to offer functional benefits over anatomic total shoulder arthroplasty in this population. [7] (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. [8] (10.1007/s11999-016-4990-1)
  • [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. [9] (10.1016/j.csm.2018.06.002)
  • [L4] In contrast, success after first anatomic total shoulder arthroplasty does not reliably predict contralateral success until 1 year. [10] (10.1016/j.jse.2023.10.007)
  • [Paper] Glenoid exposure is a difficult but key step in total shoulder arthroplasty that conditions correct component positioning. [11] (10.1016/j.otsr.2017.10.008)
  • [L1] Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion. [12] (10.1016/j.asmr.2024.100978)
  • [L3] Nonagenarians are at an increased risk of medical complications, longer hospital stays, periprosthetic fractures, and death following total shoulder arthroplasty. [13] (10.1177/17585732241269174)
  • [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. [14] (10.1016/j.jse.2023.08.009)
  • [L4] Substantial variation exists in implant selection and surgical technique despite reverse shoulder replacement being the predominant form of shoulder arthroplasty in the United Kingdom. [15] (10.1177/17585732261437401)
  • [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. [16] (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. [17] (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. [18] (10.1016/j.jse.2025.03.036)
  • [L4] Activities entailing greater shoulder demands may hinder a patient's ability to return after arthroplasty. [19] (10.1177/23259671251326076)
  • [Paper] This technique resulted in better shoulder function than a conventional GS-type management. [20] (10.1016/j.otsr.2021.102906)
  • [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. [21] (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. [22] (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. [23] (10.1016/j.jse.2023.11.005)
  • [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. [24] (10.1007/s00402-020-03454-y)
  • [L3] Direct costs of revision shoulder arthroplasty are primarily driven by implant-related costs, and the cost per improvement in patient-reported outcomes is high compared to primary arthroplasty. [25] (10.1177/17585732251404026)
  • [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. [26] (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. [27] (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. [28] (10.1016/j.jse.2024.11.033)
  • [Paper] As reverse total shoulder arthroplasty continues to grow over the next decade, studies with higher levels-of-evidence may overtake articles included in this analysis. [29] (10.1177/17585732231155123)
  • [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. [30] (10.1007/s00264-011-1467-4)
  • [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. [31] (10.1016/j.xrrt.2025.08.013)
  • [L1] rTSA restores forward elevation primarily via compensatory scapulothoracic motion and deltoid-driven neuromuscular strategies rather than normalization of glenohumeral mechanics. [32] (10.1016/j.jse.2026.03.002)
  • [L3] Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty. [33] (10.5397/cise.2025.00584)
  • [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. [34] (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. [35] (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. [36] (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. [37] (10.1016/j.jse.2024.12.018)
  • [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. [38] (10.1177/1758573220937394)
  • [L5] Isolated humeral distalization caused dramatic increases in the muscle forces required to perform scapular-plane abduction, with joint reaction forces increasing correspondingly. [39] (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. [40] (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. [41] (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. [42] (10.1016/j.jse.2025.08.010)
  • [L1] A high return to sport can be expected after total shoulder arthroplasty. [43] (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. [45] (10.1016/j.xrrt.2025.05.022)
  • [L4] However, significant changes from the preoperative to postoperative conditions were not demonstrated for other kinematic parameters. [46] (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. [47] (10.1016/j.jse.2024.03.050)
  • [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. [48] (10.1016/j.jseint.2025.05.020)
  • [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. [49] (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. [50] (10.1016/j.jse.2025.02.010)
  • [L3] This large population-based study of over 45,000 shoulder arthroplasty cases identifies patient-level (age, comorbidity burden, ASA score and trauma indication) and system-level (weekend surgery and surgeon volume) variables that are independently associated with prolonged LOS following shoulder arthroplasty. [51] (10.1177/17585732261425994)
  • [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. [52] (10.1016/j.jse.2025.03.027)
  • [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. [54] (10.1016/j.jseint.2024.09.006)
  • [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. [55] (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. [56] (10.1007/s11999.0000000000000049)
  • [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. [57] (10.1016/j.jse.2020.02.027)
  • [L3] The study confirms that radiographic measurements are generally valid for evaluating postoperative parameters in reverse total shoulder arthroplasty. [58] (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. [59] (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. [60] (10.1016/j.arthro.2017.04.033)
  • [L1] Newer regimes permit immediate shoulder mobilization but may not be applied to every patient. [61] (10.1177/17585732221144007)
  • [L4] Preoperative shoulder CT may be associated with a small but quantifiable projected cancer risk most pronounced in younger women. [62] (10.1177/17585732261453604)
  • [L3] Intraoperative TXA does not improve ROM or pain after TSA. [64] (10.5435/jaaos-d-24-00737)
  • [L4] Return to sports after reverse shoulder arthroplasty is possible and highly frequent. [65] (10.1136/jisakos-2020-000581)
  • [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. [67] (10.1016/j.otsr.2018.07.011)
  • [L3] Tomosynthesis may be a new and effective modality for evaluating glenoid loosening. [68] (10.1016/j.jseint.2025.05.003)
  • [L3] While its applicability in standard cases is debatable for experienced shoulder surgeons, it could prove valuable for patients with severe bone defects. [69] (10.1016/j.jseint.2024.11.009)
  • [L3] Patients can be counseled that they can expect to successfully return to sporting and recreational activities following surgical reconstruction of their shoulder. [70] (10.1177/2325967117s00296)
  • [L3] Elevated preoperative INR is associated with increased risk of postoperative complications following total shoulder arthroplasty. [71] (10.1177/17585732221088974)
  • [L4] Routine radiographs are overused and typically do not lead to any changes in asymptomatic patients in the first 2 years after TSA. [72] (10.1016/j.jse.2024.11.010)
  • [L3] Revision rates and patient-reported outcomes are similar between cemented and uncemented humeral stems. [73] (10.1016/j.jseint.2025.10.009)
  • [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. [77] (10.5435/jaaos-d-23-01072)
  • [L3] The Latarjet procedure was associated with the highest odds of future total shoulder arthroplasty. [78] (10.1177/2325967125s00104)
  • [L3] Patients from areas of high social deprivation had increased rates of humeral fracture and dislocation following primary total shoulder arthroplasty. [79] (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. [80] (10.1016/j.jseint.2025.04.001)
  • [L5] Pseudoaneurysm after shoulder arthroplasty should be acknowledged as an uncommon but possible complication. [81] (10.1177/17585732221077968)
  • [L2] Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty. [82] (10.1016/j.jseint.2026.101634)
  • [L3] Perioperative testosterone use was associated with a significantly higher risk of PJI following primary TSA, but no differences were found in rates of other major complications including revision rates, dislocation, aseptic loosening, periprosthetic fracture, and stiffness. [83] (10.1177/17585732261437972)

See Also

References

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[2] Shoulder arthroplasty to address the sequelae of anterior instability arthropathy and stabilization procedures: systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03400-y

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

[4] 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

[5] Impact of tobacco usage on readmission and complication rates following shoulder replacement surgery: A study of 164,527 patients. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221102393

[6] 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

[7] 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

[8] 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

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

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

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[12] 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

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[23] 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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[28] 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

[29] The 50 most-cited articles in reverse shoulder arthroplasty. Shoulder & Elbow. 2023. DOI: 10.1177/17585732231155123

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

[31] Robotic-assisted baseplate preparation in primary reverse total shoulder arthroplasty: surgical technique and contemporary review. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.08.013

[32] 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

[33] Current comorbidity indices inadequately identify patients who experience early adverse outcomes following total shoulder arthroplasty. Clinics in Shoulder and Elbow. 2025. DOI: 10.5397/cise.2025.00584

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

[35] 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

[36] 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

[37] 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] A randomised trial comparing two rehabilitation approaches following reverse total shoulder arthroplasty. Shoulder & Elbow. 2020. DOI: 10.1177/1758573220937394

[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

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[57] 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

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[59] 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

[60] 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] 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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[69] Navigation increases the accuracy of glenoid component implantation in reverse total shoulder arthroplasty in shoulders with severe glenoid wear: a comparative cohort study. JSES International. 2025. DOI: 10.1016/j.jseint.2024.11.009

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[73] 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

[77] 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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[80] 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

[81] Unexpected complication after reverse shoulder arthroplasty: Brachial artery pseudoaneurysm: A case report. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221077968

[82] 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

[83] Perioperative testosterone therapy linked to higher 5-year risk of periprosthetic joint infection without increased 90-day major complications or revision rates in total shoulder arthroplasty. Shoulder & Elbow. 2026. DOI: 10.1177/17585732261437972

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