Reverse Total Shoulder Arthroplasty Research Articles

Improving outcomes in shoulder arthroplasty: A case series on the GPS-navigated bulk humeral autograft technique.

The purpose of this case series is to evaluate the efficacy and safety of the GPS-navigated humeral head (HH) autograft technique in the setting of primary reverse total shoulder arthroplasty (rTSA) for severe glenoid bone loss. A database of prospectively enrolled patients was reviewed to identify patients who underwent GPS navigated primary rTSA with HH autograft (N = 8). Variables collected pre-operatively and at last follow up included demographics, active range of motion (ROM), patient reported outcome measures radiographic measures, complications, and revisions. Mean age was 59.5 (range: 45-80), mean BMI was 26.8 (range: 18-37) and 5 patients were male. At final follow up (median: 24 months), patients had a mean increase in forward flexion of 44 (p = 0.003), external rotation of 27 (p = 0.039), internal rotation score of 1.1 (p = 0.048), global function score of 4.8 (p < 0.001), American Shoulder and Elbow Surgeons score of 44 (p < 0.001), and decrease in visual analog scale pain of 5 (p < 0.001). Two patients had evidence of glenoid component loosening at 3 years post-operatively, however only one was symptomatic requiring a revision operation. Our findings demonstrate significant improvement in ROM, pain relief, and shoulder function following GPS-navigated primary rTSA with bulk HH autograft. IV.

The Effect of Socioeconomic Status and Social Deprivation on Outcomes Following Reverse Shoulder Arthroplasty: Data From an Urban Academic Center.

Rotator cuff tear arthropathy (CTA) and glenohumeral osteoarthritis pose notable financial and symptomatic burdens on the aging population. This study aims to determine how social determinants of health affect patient-reported outcomes following reverse total shoulder arthroplasty (rTSA), the surgical treatment for cuff tear arthropathy and glenohumeral osteoarthritis. A single-center retrospective review was conducted for patients who underwent rTSA between 2017 and 2022. Zip codes were used to determine income levels, as defined by the U.S. Department of Housing and Urban Development (HUD) and the Federal Reserve (FED). Social disadvantage was quantified using Social Deprivation Index (SDI). The American Shoulder and Elbow Score (ASES) was obtained by chart review or calls at a minimum 2-year follow-up. Statistical analysis was notable done using analysis of variance, Kruskal-Wallis, and Pearson chi-square tests. A total of 121 patients met inclusion criteria. Of those included, 101 patients (83%) had 2-year ASES scores. Patients were divided into three cohorts based on HUD income status, FED income status, and SDI score. A difference was observed in 2-year ASES scores when stratified by HUD subgroups (P = 0.011); however, no difference was observed in 2-year ASES scores between FED or SDI subgroups. Analysis yielded no differences in pain scores, range of motion, total length of hospital stay, complications, or revision rates between all subgroups (all, P > 0.05). The results of this study yielded no notable difference in postoperative ASES scores between FED classes or SDI subgroups. Although a difference was observed in ASES scores between HUD classes, it may be clinically negligible. Contrary to previous literature, socioeconomic status and social deprivation did not affect postoperative outcomes within our patient population. Social determinants of health did not affect outcomes of patients undergoing a rTSA within the first 2 years after surgery. III.

Trends in Shoulder Arthroplasty: A Narrative Review of Predominant Indications and the Most Commonly Employed Implant Designs

Background: Over the past few decades, shoulder arthroplasty has evolved rapidly, driven by a growing demand for surgical solutions to degenerative, traumatic, and irreparable rotator cuff-related pathologies, particularly in an aging but increasingly active population. Objective: This narrative review aims to examine the main clinical indications and the most commonly used implant designs, highlighting differences in functional outcomes, complication rates, and revision rates between anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA). Methods: Articles published between 2011 and 2025 were selected through PubMed and the Australian Joint Replacement Registry reports from 2023 and 2024. The included studies comprised randomized controlled trials, systematic reviews, and meta-analyses involving adult patients treated for primary osteoarthritis, proximal humerus fractures, and massive irreparable rotator cuff tears. Results: ATSA remains the preferred option in younger patients with an intact rotator cuff, due to superior outcomes in mobility and prosthesis longevity. However, glenoid component loosening remains a significant limitation. Initially reserved for irreparable cuff tears and complex fractures, RTSA has seen a progressive expansion of its indications, offering lower revision rates and satisfactory functional results, particularly in elderly patients. Recent prosthetic innovations include stemless implants, augmented glenoid components, and convertible platforms. Conclusions: The choice between ATSA and RTSA should be individualized, based on patient-specific factors such as age, rotator cuff integrity, functional demands, and bone quality. Advances in implant materials and design, together with improved patient selection, have significantly enhanced clinical outcomes.

Evaluation and Management of Rotator Cuff Tears Following Shoulder Dislocation.

This review aims to summarize the epidemiology, associated pathology, and treatment options for rotator cuff tears following shoulder dislocations and to provide a treatment algorithm for these complex injuries. Rotator cuff tears after shoulder dislocations most often occur in patients older than 40 and may be more prevalent in women. Up to 50% of these patients may have concomitant Bankart lesions. Patients treated nonoperatively generally have worse functional outcomes and higher pain scores than those who undergo rotator cuff repair. However, further studies are needed to elucidate when the rotator cuff can be repaired in isolation versus in combination with capsulolabral stabilization. Reverse total shoulder arthroplasty is a viable treatment option for elderly patients with irreparable cuff tears after dislocation or post-instability arthropathy. Patients who sustain a shoulder dislocation should be evaluated for a rotator cuff tear, particularly if older than 40. Those with post-instability full-thickness rotator cuff tears benefit from surgical treatment. Further research is needed to clarify when additional stabilization procedures should be performed alongside rotator cuff repair.

Treatment of B2 type glenoids with anatomic vs. reverse total shoulder arthroplasty: a retrospective review.

Treatment of B2 type glenoids with anatomic vs. reverse total shoulder arthroplasty: a retrospective review.

Biomechanical effects of different rotator cuff tear conditions and mediolateral offset in lateralized reverse total shoulder arthroplasty (Coralis Reverse Shoulder System).

Biomechanical effects of different rotator cuff tear conditions and mediolateral offset in lateralized reverse total shoulder arthroplasty (Coralis Reverse Shoulder System).

Isolated humeral distalization in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study

Isolated humeral distalization in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study

Acromion and Scapular Spine Fractures in Reverse Total Shoulder Arthroplasty An XFEM Study.

Acromion and Scapular Spine Fractures in Reverse Total Shoulder Arthroplasty An XFEM Study.

Lower Socioeconomic Status is not Associated with Worse 2-year Outcomes Following Reverse Total Shoulder Arthroplasty

Lower Socioeconomic Status is not Associated with Worse 2-year Outcomes Following Reverse Total Shoulder Arthroplasty

Proximal humerus fractures: Treatment controversies.

The treatment of proximal humerus fractures is challenging, and significant controversy exists even regarding which patients are indicated for surgical treatment. When surgery is indicated, open reduction and internal fixation is the most common type of treatment. Arthroplasty is reserved for unreconstructible fractures. Hemiarthroplasty may not provide good, reliable function but may be the best option in younger or middle-aged patients when fracture fixation is not feasible. While several studies reported no benefit of surgical treatment in elderly patients, more recent literature showed better outcomes with reverse total shoulder arthroplasty.

Stemless reverse total shoulder arthroplasty: a systematic review and meta-analysis.

Stemless reverse total shoulder arthroplasty: a systematic review and meta-analysis.

A Novel Percutaneous Device Enabling both Local Anesthetic Delivery and Electrical Stimulation (Neuromodulation) of Peripheral Nerves for Pain Following Orthopaedic Surgery: An Initial Feasibility Technical Report

Introduction Pain following orthopaedic surgical procedures remains undertreated due to inadequate analgesic options. One possible solution is a novel device currently under investigation. The RELAY system (Gate Science, Moultonborough, NH) is comprised of a basic catheter-over-needle device to allow ultrasound-guided percutaneous insertion, leaving a perineural catheter after simple withdrawal of the internal needle. A single-injection bolus of local anesthetic may be quickly administered. Following surgery, the catheter may be attached to a portable infusion pump to provide an ambulatory continuous peripheral nerve block. Unlike previously described perineural catheters, the RELAY has an embedded wire and integrated pulse generator that permit stimulation of the targeted peripheral nerve(s) for up to 28 days. We here provide the first description of this novel device when used to provide postoperative analgesia. Case Report A 67-year-old woman undergoing unilateral (right), primary reverse total shoulder arthroplasty provided written, informed consent and had a RELAY inserted under ultrasound guidance with a single pass. A single-injection nerve block was induced with lidocaine 2% (10 mL) and bupivacaine 0.5% (10 mL), both with epinephrine. A ropivacaine 0.2% infusion was initiated with a portable infusion pump via the catheter. Following surgery, the patient reported no surgical pain and her pulse stimulator initiated with a current of 2.2 mA. She was discharged home with the device in situ. Postoperative day (POD) 1 her maximum and average pain measured with a numeric rating scale (NRS) were 3 and 1. During her ropivacaine infusion her worst and average pain scores were 1 and 0, respectively. Following POD 4 (ropivacaine reservoir exhaustion on POD 3) she experienced no pain with active stimulation. The catheter/lead was removed at home by her caretaker without difficulty on POD 7. Conclusions This new device represents a feasible intervention for postoperative pain management in ambulatory settings and further investigation is warranted.

Early complications and risk factors following reverse versus anatomic total shoulder arthroplasty for osteoarthritis: a nationwide registry study.

Reverse shoulder arthroplasty (RSA) is an alternative to anatomic total shoulder arthroplasty (TSA) for treating glenohumeral osteoarthritis (OA), particularly in elderly patients. This study evaluates 90-day postoperative complication rates and identifies risk factors for adverse outcomes in RSA and TSA patients. A retrospective cohort study was conducted using the TriNetX Research NLP Network to identify patients aged 65-90 years who underwent RSA or TSA for OA from 2006 to 2024. 1:1 propensity score matching controlled for demographics and comorbidities. Orthopedic and infectious complications were compared using multivariate logistic regression. The final matched cohort included 4,117 RSA and TSA patients. RSA was associated with significantly higher odds of orthopedic complications (odds ratio [OR], 2.251; P<0.001) and musculoskeletal infections (OR, 2.908; P<0.001) compared to TSA. Significant risk factors for orthopedic complications in RSA included nicotine dependence (OR, 1.592; P=0.001) and hypertension (OR, 1.545; P=0.001). In TSA, risk factors included male sex (OR, 0.702; P=0.005), chronic obstructive pulmonary disease (OR, 1.650; P=0.016), and obesity (OR, 1.776; P<0.001). For infections, RSA risk factors were male sex (OR, 1.698; P=0.005), heart failure (OR, 2.396; P<0.001), and diabetes (OR, 1.525; P=0.039). Diabetes was the only significant risk factor in TSA (OR, 2.453; P=0.003). RSA carries a higher risk of orthopedic complications and infection than TSA within 90 days. Distinct risk factors for each procedure highlight the need for patient-specific risk stratification to optimize preoperative assessment and surgical decision-making. Level of evidence: III.

Endoprosthesis in proximal humerus fractures -What is important?

In cases of complex proximal humeral fractures a fracture prosthesis is an established treatment option. In the geriatric patient population, the use of reverse total shoulder arthroplasty is gaining in relevance. This article focuses on the specific requirements and challenges associated with the application of reverse total shoulder arthroplasty. Decisive for the success are a structured perioperative management, meticulous preoperative planning, thorough patient education and standardized protocols for infection and bleeding prophylaxis. Intraoperatively, emphasis is placed on precise implantation techniques and stable tuberosity fixation, of which the latter is essential for postoperative function. Ahumeral inclination of 135° has been shown to be associated with better tuberosity healing. Complications, such as scapular notching or instability can be minimized through an accurate surgical technique and optimized implant management. Postoperative care is tailored to the individual, employing either ashoulder abduction brace or an early functional rehabilitation approach. Overall, reverse shoulder arthroplasty provides an effective fracture treatment for geriatric patients, ensuring long-term functional and clinical benefits.

Reverse total shoulder arthroplasty polyethylene percentage capture: a descriptive analysis of commercially available reverse shoulder arthroplasty systems.

Reverse total shoulder arthroplasty polyethylene percentage capture: a descriptive analysis of commercially available reverse shoulder arthroplasty systems.

Revision Reverse Total Shoulder Arthroplasty as an Outpatient Procedure.

Revision Reverse Total Shoulder Arthroplasty as an Outpatient Procedure.

Learning curve of augmented reality surgical application for reverse shoulder arthroplasty.

Accurate positioning of the glenoid component in reverse total shoulder arthroplasty is important since it reduces prosthesis-related complications. Conventional instrumentation is still the gold standard. However, patient-specific instrumentation using 3-D printed guides, as well as computer-assisted navigation, is gaining more and more importance. Augmented reality has been established to enable the surgeon to have more precision in the positioning and inclination of the glenoid component. A new technique called "NextAR" (©Medacta) supports the surgeon during operation by guidance on bone preparation, instrument navigation, and implant placement, using virtual reality goggles or displays. The aim of this study was to determine a learning curve for reversed total shoulder arthroplasty by a high-volume single shoulder surgeon using the NextAR system. We performed retrospective data analysis of the first 20 cases of one high-volume single shoulder surgeon performing reversed total shoulder arthroplasty using the NextAR system. Parameters such as anesthesia time, surgical time, length of hospital stay, classification of the American Society of Anesthesiologists, body mass index, intraoperative blood loss, and complications were analyzed. We found significant decreases in measures like surgery time (p = 0,001), amount of blood loss during surgery (p = 0,005), and anesthesia time (p = 0,08). A remarkable turning point of blood loss occurs within the fifteenth surgery. A significant reduction of the operation time is shown at the fourteenth operation. Looking at blood loss and operation time together using a standardized cumulative curve, a significant reduction of the cumulative score is found within the fifteenth surgery. Significance was found in surgery time as well as in the amount of blood loss. However, these results may not be generalizable since they depend on further conditions. Future studies could provide information about other outcome parameters and learning curves of several surgeons performing reversed total shoulder arthroplasty with augmented reality applications.

The influence of glenosphere size and glenoid-sided offset on shoulder stability following reverse total shoulder arthroplasty using the Zimmer Trabecular Metal Reverse Plus Shoulder System.

The influence of glenosphere size and glenoid-sided offset on shoulder stability following reverse total shoulder arthroplasty using the Zimmer Trabecular Metal Reverse Plus Shoulder System.

Outcomes Following Total Shoulder Arthroplasty in Patients with Obstructive Sleep Apnea.

Outcomes Following Total Shoulder Arthroplasty in Patients with Obstructive Sleep Apnea.

Clinical study of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for treatment of Neer three/four-part proximal humeral fractures in elderly

To compare the effectiveness and shoulder function of reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) in the treatment of Neer three/four-part proximal humeral fractures in the elderly. Randomized controlled analysis was conducted on 68 patients over 70 years old with Neer three/four-part proximal humeral fractures treated with RTSA or ORIF between January 2020 and June 2022. The patients were randomly divided into RTSA group ( n=32) and ORIF group ( n=36). There was no significant difference ( P>0.05) in the baseline data such as age, gender, body mass index, injured side, Neer classification, and preoperative Charlson comorbidity index, visual analogue scale (VAS) score, Constant shoulder score, Oxford shoulder score (OSS), and hemoglobin (Hb). The operation time, intraoperative blood loss, reduction of Hb on the 3rd day after operation, hospital stay, total cost of hospitalization, complication incidence, range of motion of shoulder joint at 2 years after operation, VAS score before operation and at 5 days and 1 month after operation, Constant shoulder score and OSS score before operation and at 2 years after operation, and imaging results during follow-up were recorded and compared between the two groups. Compared with the ORIF group, the RTSA group had longer operation time, less intraoperative blood loss, and higher total cost of hospitalization ( P<0.05). There was no significant difference in Hb reduction on the 3rd day after operation between the two groups ( P>0.05). The VAS scores significantly improved in both groups at 5 days and 1 month after operation ( P<0.05), but there was no significant difference between the two groups ( P>0.05). All patients were followed up 26-35 months, with an average of 31.2 months. In the RTSA group, there were 2 cases of poor healing of superficial incision and 1 case of transient nerve injury. There was no complication such as bone resorption around the prosthesis, lucent band, prosthesis loosening, or periprosthetic fracture in all patients. In the ORIF group, there was 1 case of poor healing of superficial incision, 3 cases of nonunion of fracture, 1 case of arthritis secondary to humeral head necrosis, and 1 case of bone absorption of large tuberosity, and no displacement or fracture failure of internal fixation was found in all patients. There was no significant difference in the incidence of complications [9.4% (3/32) vs 16.7% (6/36)] between the two groups [ OR (95% CI): 0.828 (0.171, 4.014), P=0.814]. In the RTSA group, 28 cases were graded 0 and 4 cases were graded 1 at 2 years after operation. Constant and OSS scores of RTSA group were significantly better than those of ORIF group ( P<0.05). The Constant score was significantly better than ORIF group in activity and strength, range of motion, lifting, abduction, and external rotation ( P<0.05), and there was no significant difference in pain, daily function, and internal rotation between the two groups ( P>0.05). The RTSA group had a significantly greater range of motion in lifting, abduction, and external rotation than ORIF group ( P<0.05), but there was no significant difference in internal rotation between the two groups ( P>0.05). Application of RTSA as the initial treatment of Neer three/four-part proximal humeral fractures in the elderly can achieve better rehabilitation of joint activity and lower risk of early reoperation, and improve the quality of life of elderly fracture patients. However, the difficulty of revision and the high cost of treatment require the surgeon to pay full attention and strictly grasp the indications.