Reverse Shoulder Arthroplasty: History, Indications, Design, Outcomes, and Complications

Abstract

The reverse total shoulder arthroplasty (rTSA) has become an increasingly common procedure with rapidly expanding indications. The purpose of this review is to summarize the history of the rTSA, provide an overview of modern implant design, and discuss the expanding indications for primary rTSA, rTSA in the revision setting, and the associated outcomes. The Grammont rTSA was introduced in 1985 for the treatment of cuff tear arthroplasty (CTA). Due to complications including scapular notching, stress fracture of the acromion and scapular spine, and instability, subsequent iterations have included glenoid component lateralization, changes in glenoid baseplate positioning, variations in humeral neck shaft angle, and inlay vs onlay humeral component design. Modernization of the rTSA design has resulted in expanding indications beyond CTA, including irreparable cuff tear, primary osteoarthritis, and fracture. Modern rTSA designs have demonstrated improvement in patient reported outcomes and pain from preoperative baseline with high patient satisfaction. However, rates of scapular notching increase over time and functional outcomes remain limited by deficits in range of motion, especially with internal rotation. An ideal implant configuration has not been identified, but navigation and extended reality are emerging areas of study that may improve implant placement and patient outcomes.