Routine neutral glenoid version targets in reverse shoulder arthroplasty: Time for a patient-specific, fixation-oriented approach

Abstract

Routine correction of glenoid retroversion to neutral remains common practice in reverse total shoulder arthroplasty (rTSA), despite increasing uncertainty about whether strict neutralization is clinically necessary. This editorial synthesizes current biomechanical, clinical and imaging-based evidence on glenoid version in rTSA, with particular attention to functional outcomes, implant fixation and the growing role of precision technologies such as three-dimensional (3D) planning and patient-specific instrumentation. Contemporary clinical studies do not show consistent associations between residual glenoid retroversion and patient-reported outcomes, range of motion, complication rates or revision risk when key biomechanical parameters are maintained. Available biomechanical data further support a functional ‘safe window’ of roughly 0°–20° of combined component retroversion. In this context, routine correction to neutral may drive avoidable bone removal, increase implant cost and compromise fixation without a clear clinical advantage. Neutral glenoid version, therefore, should not be viewed as a universal surgical target in rTSA. A patient-specific, fixation-aware strategy that respects pre-arthritic anatomy and leverages accurate 3D planning may be more rational than rigid angular correction paradigms.