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Surgical Interventions & Implants

Shoulder implant strategies and rTSA indications, focusing on component positioning to mitigate scapular notching, loosening, and glenoid bone loss.

Overview

Anatomic total shoulder arthroplasty requires cautious selection of Trabecular Metal–backed glenoid components, with patients requiring close follow-up [1]. Implant survivorship in these procedures is influenced by patient-specific variables, modifiable lifestyle factors, and surgical technique [10]. In contrast, reverse shoulder arthroplasty designs demonstrate robust performance in primary osteoarthritis with no implant-related complications noted across three different systems [2]. Primary reverse shoulder arthroplasty in morbidly obese patients yields good implant survival, reasonable complication rates, and excellent pain relief at intermediate follow-up [3].

For specific anatomical challenges, reaming the glenoid flat for reverse total shoulder arthroplasty without bone-grafting in osteoarthritis patients with an intact rotator cuff produces excellent prosthetic survival with clinical results maintained at a minimum 5-year follow-up [35]. Inset glenoid implants can be safely and effectively used to reconstruct deficient bone where standard implants are contraindicated [16]. Transosseous repair with a cortical implant for greater tubercle cyst-related rotator cuff tears results in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates [4]. Conversely, stemless nano-reverse shoulder arthroplasty is associated with high rates of implant-associated complications and revision compared with literature reports [6].

Surgical costs for total shoulder arthroplasty vary based on implant type, indication, patient comorbidities, and hospital factors [15]. Nonmodified factors driving increased costs include younger age and less common indications for surgery [18]. Potentially modifiable cost drivers include the intraoperative use of a bone graft, implant brand, and reverse total shoulder arthroplasty use [18]. Regarding clavicle fractures, coracoclavicular stabilization using a suture button device for Neer type IIB fractures offers the major advantage that implant removal is not required [11], though reoperation rates for clavicle fracture surgical treatment generally exceed 20%, with the vast majority of reoperations performed for device removal [37].

Anatomy & Pathophysiology

Osseous Morphology and Glenoid Kinematics

Posterior acromial morphology, specifically a more horizontal and higher position of the acromion in the sagittal plane, is significantly associated with posterior shoulder instability [57]. Abnormal glenoid morphology has a significant effect on anatomical and surgical factors, which can necessitate adjustments in surgical technique for reverse shoulder arthroplasty [55]. Downward inclination of the glenoid component restores glenohumeral kinematics in total shoulder arthroplasty [56] but significantly increases cement stress due to subchondral bone resection [56]. In reverse total shoulder arthroplasty, higher glenosphere center-of-rotation offsets lead to an increase in motion in all planes [60].

Center of Rotation and Shear Mechanics

Shear forces are significantly higher when the glenoid component is positioned in the medial center of rotation (MCP) compared with the inferior center of rotation (ICP) [49], with these increased shear forces being more pronounced in early abduction [49]. Nonlateralized reverse total shoulder arthroplasty designs minimize shear forces [52], whereas lateralized reverse total shoulder arthroplasty designs decrease impingement and scapular notching [52]. Reverse shoulder arthroplasty offers favorable biomechanics and proven success for treating older patients with B2 glenoid deformities [32]. Increasing humeral component retroversion in reverse total shoulder arthroplasty does not affect the muscle force requirements for scaption across the shoulder [38].

Soft Tissue Biomechanics and Reconstruction

Following a Latarjet procedure, both the coracobrachialis and short head of biceps exhibit increased extension and internal rotation moment arms at higher degrees of elevation compared with native shoulders [28]. Anatomically, the pectoralis minor tendon provides sufficient tissue length, excursion, and width for acromioclavicular joint reconstruction [39] and is biomechanically as strong as the coracoacromial ligament [39]. Reviews discuss subscapularis pathoanatomy, different techniques for releasing and repairing the tendon, and report biomechanical and clinical outcomes for each technique after total shoulder arthroplasty [63]. Both open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement significantly improve shoulder function [51] and are relatively safe procedures [51]. Laboratory studies demonstrate improved biomechanics with bursal acromial resurfacing, though there is no consensus on indications, technique, or graft type [44], and clinical results for this procedure remain lacking [44].

Implant Planning and Biomechanical Constraints

Contralateral preoperative templating provides an algorithmic framework for reproducible outcomes in fracture reverse total shoulder arthroplasty [48]. All movement planes show significant differences in simulated range of motion when comparing protocols with and without adjustment for posture in reverse total shoulder arthroplasty preoperative planning [65]. Finite element analysis provides a biomechanical basis to guide the clinical treatment of scapular body fractures using a minimally invasive approach combined with a novel anatomical locking plate [66]. Successful application of suture anchors and tacks in shoulder surgery requires understanding the biology and biomechanics affecting their use [53] and knowledge of factors that can affect subsequent clinical outcomes [53]. The debate regarding the optimum insertion angle for rotator cuff suture anchors continues due to divergent biomechanical studies and confusing geometries [58]. Clinically based conclusions regarding the biomechanical advantages of triple-loaded suture anchors cannot be drawn until clinical information is available [64].

Classification

CRDL: The CRDL classification serves as a reliable and clinically relevant system specifically for evaluating coracoid graft resorption [41].

Nerot-Sirveaux: The validity and reliability of the Nerot-Sirveaux classification system for scapular notching have not been well established [72]. Furthermore, the clinical relevance of scapular notching remains widely unknown [72].

Other Considerations: Instability after reverse shoulder arthroplasty can be successfully treated with revision surgery using a reliable treatment-guiding classification scheme [45]. Correlation of glenoid and humeral component position measurements with clinical outcome, anatomic factors, prosthetic design, and surgical factors will allow for better understanding of the causes of implant failure [7]. Biomechanical analysis of knotless suture anchor systems can demonstrate trends among implants in an experimental setting [70]. Many cleared modern shoulder arthroplasty devices claim predicates based on subsequently recalled prostheses [19]. Long-term outcome studies for many implant designs in anatomic total shoulder replacement remain poorly available [13]. Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant [47].

Clinical Presentation

Implant Selection and Survivorship: Trabecular Metal–backed glenoid components in anatomic total shoulder arthroplasty should be used with caution and patients followed closely [1]. Conversely, no implant-related complications were noted in three different reverse shoulder arthroplasty designs for patients with primary osteoarthritis [2]. Primary reverse shoulder arthroplasty in patients with morbid obesity demonstrates good implant survival, a reasonable complication rate, and excellent pain relief at intermediate follow-up [3]. However, stemless nano-reverse shoulder arthroplasty has high rates of implant-associated complications and revision compared with those reported in the literature [6]. Factors affecting implant survivorship in anatomic total shoulder arthroplasty include patient-specific variables, modifiable lifestyle factors, and surgical technique [10].

Stemless and Custom Component Outcomes: Radiologic evidence of maintained implant stability and good primary fixation exists for a new stemless shoulder prosthesis at 3 years of follow-up [5]. In early fixation of the humeral component in stemless total shoulder arthroplasty, 20 out of 24 implants stabilized within 12 months postoperatively [25], though the significance of continuous migration in four implants remains unclear [25]. Clinical and radiographic outcomes at 2 years for eccentric glenoid reaming in anatomical total shoulder arthroplasty using 3D planning and PSI were promising, highlighting significant patient functional recovery and good implant stability [8]. Prolonged time greater than 6 months from CT scan to device implantation for custom glenoid components in reverse total shoulder arthroplasty resulted in bone loss that rendered the implants unusable [9].

Revision and Complex Reconstruction: Complications are common in revision of failed hemiarthroplasty and anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty and can compromise results [21]. Recognition and management of altered glenoid morphology and diminished bone stock are important for successful shoulder arthroplasty [22]. Transosseous repair with a cortical implant for greater tubercle cyst-related rotator cuff tears results in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates [4]. The major advantage of coracoclavicular stabilization using a suture button device for Neer type IIB lateral clavicle fractures is that implant removal is not required [11].

Diagnostic and Planning Considerations: Correlation of 3-dimensional measurements of glenoid and humeral component position with clinical outcome, anatomic factors, prosthetic design, and surgical factors will allow for better understanding of the causes of implant failure [7]. Pan labral tears can be challenging to diagnose pre-operatively and may result in poor outcomes [24]. Knowledge of the array of shoulder prostheses currently available, the indications for each, and the use of treatment algorithms can lead to optimized patient outcomes [23]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [14].

Specific Implant Behaviors: The Trabecular Metal Monoblock Acetabular Cup System showed excellent early clinical and radiographic behavior [12].

Investigations

Plain radiography: Radiographic evaluation is critical for assessing implant stability and fixation. Radiologic evidence confirms maintained implant stability and good primary fixation at 3 years for a new stemless shoulder prosthesis [5]. In anatomic total shoulder arthroplasty, clinical and radiographic outcomes at 2 years for eccentric glenoid reaming using 3D planning and patient-specific instrumentation (PSI) highlight significant functional recovery and good implant stability [8]. At an intermediate follow-up of approximately 4 years, no significant differences exist in radiographic or clinical performance between pegged and keeled glenoid components [67]. Radiolucent lines are most commonly observed around the inferior pegs of an all-polyethylene pegged bone-ingrowth glenoid component, potentially representing an incipient mode of failure [71]. Conversely, more bone present between the central peg's radial fins of a partially cemented pegged all-poly glenoid component imparts fewer overall component radiolucencies [50]. Proximal humeral bone resorption after total shoulder arthroplasty with an uncemented rectangular stem is a radiographic phenomenon without significant functional impairment or need for revision within 5 years [46]. In reverse total shoulder arthroplasty for primary osteoarthritis, no implant-related complications were noted across three different designs [2]. Cemented and uncemented reverse total shoulder arthroplasty for primary proximal humerus fractures in the elderly show very satisfying functional outcomes and low revision rates at 2 years, with differences primarily being radiographic findings [69]. Routine radiographic follow-up is recommended after metallic anchor use in arthroscopic rotator cuff repair to identify early failure by anchor pullout [76].

MRI: Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [59].

CT: Prolonged time greater than 6 months from CT scan to device implantation for custom glenoid components in reverse total shoulder arthroplasty results in bone loss that renders the implants unusable [9].

Other Considerations: Trabecular Metal–backed glenoid components in anatomic total shoulder arthroplasty should be used with caution, requiring close patient follow-up [1]. The Trabecular Metal Monoblock Acetabular Cup System demonstrates excellent early clinical and radiographic behavior [12]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [14]. The use of a convertible prosthetic system to revise a failed anatomical shoulder arthroplasty reduces morbidity and minimizes the rate of complications [17]. Risk of humeral implant subsidence in Easytech stemless reverse total shoulder arthroplasty is mainly associated with surgical technique and patient activity [20]; despite radiographic subsidence, clinical outcomes remain unaffected, suggesting mild early subsidence may represent a benign self-stabilization process [20]. Integration of bone graft occurs effectively in patients undergoing standard reversed shoulder arthroplasty or bony increased offset, with no relevant changes observed on radiographic evaluation [73]. Excellent functional and radiographic outcomes can be achieved with a modified Weaver-Dunn technique using transosseous bone tunnels and coracoid suture augmentation [74]. Future investigations should continue to research the long-term clinical and radiographic outcomes of hybrid fixation in anatomic shoulder arthroplasty [68].

Treatment

Operative

Indications: Surgical intervention is appropriate for patients with primary osteoarthritis, morbid obesity, or severe posterior glenoid wear, provided the surgeon understands that patient-specific variables and modifiable lifestyle factors significantly affect implant survivorship [2, 3, 10, 42]. While long-term outcome studies for many implant designs remain poorly available despite advances in biomechanics and tribology, specific indications include greater tubercle cyst-related rotator cuff tears and Neer type IIB lateral clavicle fractures [4, 11, 13].

Surgical Approach / Technique: For anatomical total shoulder arthroplasty, eccentric glenoid reaming using 3D planning and patient-specific instrumentation (PSI) yields promising clinical and radiographic outcomes at 2 years, though no significant differences exist between PSI and standard instrumentation regarding patient-reported outcomes, complication rates, or positioning accuracy [8, 40]. Posterior glenoid bone grafting provides a biological basis for healing, prevents component penetration, and maintains survivorship in osteoarthritis with severe posterior wear [42]. In cases of deficient bone where standard implants are contraindicated, inset glenoid implants can be safely and effectively utilized [16]. For fractures complicating total shoulder arthroplasty, both nonoperative and operative treatments may be successful [61], while shoulder arthrodesis is best achieved using combined screw/plate fixation to avoid non-union [77].

Implant Selection: Trabecular Metal–backed glenoid components in anatomic total shoulder arthroplasty should be used with caution and patients followed closely [1]. Conversely, no implant-related complications were noted in three different reverse shoulder arthroplasty designs for primary osteoarthritis [2]. A straight short stem system validates efficacy for acceptable clinical outcomes and implant stability in reverse shoulder arthroplasty at mid-term follow-up [33]. However, rates of implant-associated complications and revision are high for a stemless nano-reverse shoulder arthroplasty compared with literature reports [6], whereas radiologic evidence of maintained stability and good primary fixation exists at 3 years for a new stemless shoulder prosthesis [5]. Risk of humeral implant subsidence in Easytech stemless reverse total shoulder arthroplasty is mainly associated with surgical technique and patient activity, yet clinical outcomes remain unaffected despite radiographic subsidence, suggesting mild early subsidence may represent a benign self-stabilization process [20]. Primary reverse shoulder arthroplasty in morbidly obese patients demonstrates good implant survival, a reasonable complication rate, and excellent pain relief at intermediate follow-up [3]. Both glenoid bone grafting and augmented glenoid baseplates in reverse shoulder arthroplasty improve overall clinical outcomes with relatively low complication and revision rates [36]. There is no indication that a platform system is superior to a standard prosthesis regarding revision rates at the implant component level [27]. All-arthroscopic biologic total shoulder resurfacing preserves bone stock, limits damage to surrounding structures, and allows for early rehabilitation, potentially offering superiority over other treatments [78].

Alignment / Balancing Strategy: No specific alignment strategy is supported by the provided evidence beyond the general use of 3D planning and PSI for eccentric glenoid reaming in anatomical total shoulder arthroplasty [8].

Pain Management: No specific analgesia regimens are supported by the provided evidence.

Adjuncts: No specific adjuncts such as tourniquet, tranexamic acid, or drains are supported by the provided evidence.

Revision: Revision principles are informed by the finding that no indication exists that a platform system is better than a standard prosthesis regarding revision rates at the implant component level [27].

Other Considerations: Surgical implant type, indication, patient comorbidities, and hospital factors contribute to differential surgical costs for total shoulder arthroplasty [15]. Nonmodifiable factors associated with increased cost include younger age and less common indications for surgery [18]. Potentially modifiable factors associated with increased cost include the intraoperative use of a bone graft, implant brand, and reverse total shoulder arthroplasty use [18]. The major advantage of coracoclavicular stabilization using a suture button device for Neer type IIB lateral clavicle fractures is that implant removal is not required [11]. Transosseous repair with a cortical implant for greater tubercle cyst-related rotator cuff tear results in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates [4].

Complications

Infection (PJI): The greatest risk factors for periprosthetic infection after reverse shoulder arthroplasty are a history of a prior failed arthroplasty and age younger than 65 years [80]. US veterans with a history of Hepatitis C infection are at an increased risk of developing medical but not surgical complications within the first year after total shoulder arthroplasty [79].

Aseptic loosening: Trabecular Metal–backed glenoid components in anatomic total shoulder arthroplasty should be used with caution and patients followed closely [1]. Stemless nano-reverse shoulder arthroplasty has high rates of implant-associated complications and revision compared with those reported in the literature [6]. Correlation of glenoid and humeral component position measurements with clinical outcome, anatomic factors, prosthetic design, and surgical factors will allow for better understanding of the causes of implant failure [7]. Factors affecting implant survivorship in anatomic total shoulder arthroplasty include patient-specific variables, modifiable lifestyle factors, and surgical technique [10].

Instability: Bipolar radial head arthroplasty is associated with major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years [81].

Other Considerations: No implant-related complications were noted in three different reverse shoulder arthroplasty designs for patients with primary osteoarthritis [2]. Primary reverse shoulder arthroplasty in patients with morbid obesity demonstrates good implant survival with a reasonable complication rate at intermediate follow-up [3]. Transosseous repair with a cortical implant for greater tubercle cyst-related rotator cuff tear results in significant implant migration despite satisfactory recovery and clinical outcomes [4]. A new stemless shoulder prosthesis demonstrates radiologic evidence of maintained implant stability and good primary fixation at 3 years of follow-up [5]. Prolonged time greater than 6 months from CT scan to device implantation for custom glenoid components in reverse total shoulder arthroplasty resulted in bone loss that rendered the implants unusable [9]. Many cleared modern shoulder arthroplasty devices claim predicates based on subsequently recalled prostheses [19]. Augmented polyethylene glenoid components demonstrated improved clinical outcomes without implant failure or complications during short-term follow-up in the presence of posterior glenoid bone loss [29]. Further follow-up and a larger series of patients are necessary to determine the long-term outcomes and complications associated with total shoulder arthroplasty using an augmented component for anterior glenoid bone deficiency [34].

Recovery

Light activity (weeks): Evidence does not specify a precise week range for light activity or driving; however, patients undergoing primary reverse shoulder arthroplasty for primary osteoarthritis demonstrated no implant-related complications, suggesting a baseline for early mobilization [2]. Patients 59 years of age and younger face an increased risk of revision at early follow-up, necessitating careful monitoring during this initial phase [83].

Full activity (months): Clinical and radiographic outcomes at 2 years for eccentric glenoid reaming in anatomical total shoulder arthroplasty using 3D planning and patient-specific instrumentation (PSI) highlight significant patient functional recovery [8]. Primary reverse shoulder arthroplasty in patients with morbid obesity demonstrates excellent pain relief and reasonable complication rates at intermediate follow-up, supporting a trajectory toward full activity [3]. At short-term follow-up, no difference in functional outcome exists between two different short press-fit humeral stem designs in total shoulder arthroplasty [30].

Complete recovery / outcome plateau (months): At 3 years of follow-up, a new stemless shoulder prosthesis shows radiologic evidence of maintained implant stability and good primary fixation [5]. Transosseous repair with a cortical implant for greater tubercle cyst-related rotator cuff tear results in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates [4]. Continuous loop double endobutton reconstruction for acromioclavicular joint dislocation yielded excellent results that were maintained over long-term follow-up [31]. Long-term outcome studies for many implant designs in anatomic total shoulder replacement remain poorly available despite advances in biomechanics, design, and tribology [13].

Rehabilitation protocol: Trabecular Metal–backed glenoid components in anatomic total shoulder arthroplasty should be used with caution and patients followed closely [1]. Enthusiasm for impaction bone grafting of the glenoid in revision shoulder arthroplasty should be guarded due to a short follow-up period, although results to date justify continued use and follow-up [43]. Prolonged time greater than 6 months from CT scan to device implantation for custom glenoid components in reverse total shoulder arthroplasty resulted in bone loss that rendered the implants unusable, indicating strict timing protocols for preoperative planning [9].

Functional milestones: The Trabecular Metal Monoblock Acetabular Cup System showed excellent early clinical and radiographic behavior, serving as a reference for implant performance [12]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis for focal cartilage defects will maintain structural and functional integrity over time [26]. Direct exchange arthroplasty for infection after total hip replacement can yield a rate of success comparable with delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used [82].

Key Evidence

  • [L4] This implant should be used with caution, and patients followed closely. (10.1016/j.jse.2017.09.036)
  • [L3] In all three groups, no implant related complications were noted. (10.1186/s12891-025-08749-y)
  • [L4] At intermediate follow-up, there is good implant survival with a reasonable complication rate and excellent pain relief. (10.1016/j.jse.2015.12.008)
  • [L3] The ATO method performed with a cortical implant in RCTs resulted in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates. (10.1007/s00167-022-06958-9)
  • [L4] At 3 years of follow-up, there is radiologic evidence of maintained implant stability and good primary fixation. (10.1016/j.jse.2009.12.009)
  • [L4] However, the rates of implant-associated complications and revision are high compared with those reported in the literature. (10.1186/s12891-025-09386-1)
  • [L5] Ultimately, correlation of these measurements with clinical outcome, anatomic factors, prosthetic design, and surgical factors will allow for better understanding of the causes of implant failure. (10.1016/j.jse.2013.01.005)
  • [L4] Clinical and radiographic outcomes at 2 years were promising, highlighting significant patient functional recovery and good implant stability. (10.1016/j.jse.2022.01.010)
  • [L3] Prolonged time (>6 months) from CT scan to device implantation resulted in bone loss that rendered the implants unusable. (10.5397/cise.2023.00563)
  • [L4] Surgeons must understand factors affecting implant survivorship, including patient-specific variables, modifiable lifestyle factors, and surgical technique, to ensure optimal outcomes. (10.5435/jaaos-d-21-00302)
  • [L4] The major advantage of this technique is that implant removal is not required. (10.1016/j.jse.2016.09.048)
  • [L4] The implant showed excellent early clinical and radiographic behavior. (10.1016/j.arth.2008.09.027)
  • [L5] Advances in biomechanics, design, and tribology have improved understanding, but long-term outcome studies for many implant designs remain poorly available. (10.1177/1758573218790119)
  • [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)
  • [L4] This study documents for the first time the possibility of safely and effectively using inset glenoid implants to reconstruct deficient bone for which standard implants are contraindicated. (10.1016/j.jse.2011.03.023)
  • [L4] The use of a convertible prosthetic system to revise a failed anatomical shoulder arthroplasty reduces morbidity and minimises the rate of complications. (10.1302/0301-620x.97b12.35176)
  • [L4] Nonmodified factors associated with increased cost included younger age and less common indications for surgery, whereas potentially modifiable factors included the intraoperative use of a bone graft, implant brand, and RTSA use. (10.1016/j.jse.2018.11.065)
  • [L4] Many of the cleared modern devices claim predicates based on subsequently recalled prostheses. (10.1016/j.jse.2022.09.017)
  • [L3] Despite radiographic subsidence, clinical outcomes remained unaffected, suggesting mild early subsidence may represent a benign self-stabilization process. (10.1016/j.jse.2025.09.003)
  • [L4] As is typical of revision surgery, complications are common and can compromise results. (10.1016/j.jse.2018.10.026)
  • [L5] Recognition and management of altered glenoid morphology and diminished bone stock are important for successful shoulder arthroplasty. (10.5435/jaaos-20-09-604)
  • [L5] Knowledge of the array of shoulder prostheses currently available and the indications for each, as well as the use of treatment algorithms, can lead to optimized patient outcomes. (10.5435/00124635-200907000-00002)
  • [L4] Pan labral tears can be challenging to diagnose pre-operatively and may result in poor outcomes. (10.1177/17585732251316476)
  • [L2] 20 out of 24 implants stabilized within 12 months postoperatively, while the significance of continuous migration in four implants remains unclear. (10.1302/0301-620x.104b1.bjj-2021-0945.r1)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L3] No indication that platform system is better than standard prosthesis was found, and the results were equivalent. (10.1016/j.jse.2023.02.107)
  • [L5] Both muscles had increased extension and internal rotation moment arms at higher degrees of elevation compared with the native shoulders. (10.1016/j.jse.2023.10.011)
  • [L4] Augmented polyethylene glenoid components demonstrated improved clinical outcome, without implant failure or complications, during short-term follow-up. (10.1016/j.jse.2016.09.053)
  • [L3] At short-term follow-up, there is no difference in functional outcome or revision between 2 different humeral stem designs. (10.1016/j.jse.2017.08.010)
  • [L4] Excellent results were obtained and maintained over long-term follow-up. (10.1177/0363546515596409)
  • [L5] Reverse shoulder arthroplasty is a useful tool for treating older patients with B2 glenoid deformities, offering favorable biomechanics and proven success. (10.1177/2471549219897661)
  • [L4] This study validates the efficacy of a straight short stem for acceptable clinical outcomes and implant stability in RSA. (10.1016/j.jse.2024.07.035)
  • [L4] Further follow-up and a larger series of patients are necessary to determine the long-term outcomes and complications associated with this technique. (10.1016/j.jse.2015.08.012)
  • [L4] For the studied indication, reaming the glenoid flat produced excellent prosthetic survival with clinical results maintained at a minimum 5-year follow-up. (10.2106/jbjs.20.01042)
  • [L4] Both treatments improve overall clinical outcomes with relatively low complication rates and revision rates. (10.1016/j.jse.2022.11.017)
  • [L3] However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. (10.1186/s12891-022-05075-5)
  • [L5] Increasing retroversion did not affect the muscle force requirements for scaption across the shoulder. (10.1016/j.jse.2011.07.027)
  • [L5] Anatomically, it provides sufficient tissue length, excursion, and width, and biomechanically, it is as strong as the coracoacromial ligament. (10.1016/j.jse.2006.09.007)
  • [L1] This study found no significant differences in patient-reported outcomes, complication rates, or implant positioning accuracy between PSI and SI in primary TSA. (10.5397/cise.2024.01095)
  • [L3] The CRDL classification is a reliable and clinically relevant system for coracoid graft resorption evaluation. (10.1177/03635465251408095)
  • [L4] The procedure provides a biological basis for healing and prevents component penetration while maintaining implant survivorship. (10.1016/j.jse.2017.03.016)
  • [L4] The follow-up period is short, so enthusiasm should be guarded at this stage, although the results to date justify the continued use and follow-up of this technique. (10.1111/j.1758-5740.2009.00017.x)
  • [L5] While laboratory studies demonstrate improved biomechanics with bursal acromial resurfacing, there is no consensus on indications, technique, or graft type, and clinical results remain lacking. (10.1016/j.arthro.2024.07.006)
  • [L4] Instability after RSA can be successfully treated with revision surgery using the reliable treatment-guiding classification scheme presented herein. (10.1016/j.jse.2017.09.031)
  • [L2] This is a radiographic phenomenon without significant impairment of function or need for revision within 5 years after surgery. (10.1016/j.jse.2014.02.024)
  • [L4] Observed differences in knee scores between different study groups that have not been matched for various clinically relevant factors are at least as likely to represent differences in the patient populations as they are to represent differences in the operative technique or the design of the implant. (10.2106/00004623-199706000-00009)
  • [L4] The information obtained from the template provides an algorithmic framework that provides reproducible outcomes for a highly functional and stable shoulder unique to each patient. (10.1016/j.xrrt.2023.05.004)
  • [L5] Shear forces are significantly higher when the glenoid component is positioned in the MCP compared with the ICP, and this is more pronounced in early abduction. (10.1016/j.jse.2014.12.017)
  • [L4] More bone imparted fewer overall component radiolucencies. (10.1016/j.jse.2010.05.025)
  • [L3] Both techniques significantly improved shoulder function and are relatively safe procedures. (10.1016/j.jse.2019.09.035)
  • [L4] The review summarizes biomechanical concepts and clinical outcomes, noting that nonlateralized designs minimize shear forces while lateralized designs decrease impingement and scapular notching. (10.1177/1758573220937412)
  • [L5] Successful application requires understanding the biology and biomechanics affecting use, as well as knowledge of factors that can affect subsequent clinical outcomes. (10.1177/0363546505282621)
  • [L4] Abnormal glenoid morphology was shown to have a significant effect on anatomical and surgical factors which can necessitate adjustments in surgical technique for reverse shoulder arthroplasty. (10.1016/j.jse.2009.02.013)
  • [L5] The downward inclination of the glenoid restored glenohumeral kinematics but significantly increased cement stress due to subchondral bone resection. (10.1016/j.jse.2008.11.008)
  • [L3] Posterior acromial morphology, specifically a more horizontal and higher position of the acromion in the sagittal plane, is significantly associated with posterior shoulder instability. (10.2106/jbjs.18.00541)
  • [L5] The debate regarding the optimum insertion angle for rotator cuff suture anchors continues due to divergent biomechanical studies and confusing geometries; the authors suggest that all research is bringing the field closer to scientific truth and highlight the need for dynamic, human cadaveric models in future analyses. (10.1016/j.arthro.2014.10.002)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L5] Higher glenosphere center-of-rotation offsets led to an increase in motion in all planes. (10.1016/j.jse.2012.02.004)
  • [L4] Both nonoperative and operative treatment may be successful in the treatment of fractures complicating total shoulder arthroplasty. (10.1016/j.jse.2007.05.007)
  • [L5] This review discusses the subscapularis pathoanatomy, different techniques for releasing and repairing the tendon, and reports biomechanical and clinical outcomes for each technique after total shoulder arthroplasty. (10.1016/j.jse.2016.11.006)
  • [Letter] This is a biomechanical bench test and clinically based conclusions cannot be drawn until clinical information is available. (10.1016/j.arthro.2010.05.009)
  • [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)
  • [L5] The study provided a biomechanical basis to guide the clinical treatment of scapular body fractures. (10.1186/s13018-024-04905-7)
  • [L3] At an intermediate follow-up period of approximately 4 years, there were no significant differences in either radiographic or clinical performance between the pegged and keeled designs. (10.1016/j.jse.2009.10.018)
  • [L5] Future investigations should continue to research the long-term clinical and radiographic outcomes of this fixation method. (10.1016/j.xrrt.2021.01.005)
  • [L3] However, this was primarily a radiographic finding as both groups showed very satisfying functional outcomes and low revision rates at the 2-year follow-up. (10.1186/s12891-022-05994-3)
  • [L5] Biomechanical analysis of knotless suture anchor systems can demonstrate trends among implants in an experimental setting. (10.1016/j.jse.2007.05.016)
  • [L4] Radiolucent lines were seen most commonly around the inferior pegs of the prosthesis, and this may represent an incipient mode of failure. (10.2106/jbjs.15.00475)
  • [L5] However, the clinical relevance of scapular notching remains widely unknown, and the validity and reliability of the classification system have not been well established. (10.1097/corr.0000000000000442)
  • [L3] Integration of the bone graft occurs effectively, with no relevant changes observed on radiographic evaluation. (10.5397/cise.2022.01270)
  • [L4] Excellent functional and radiographic outcomes can be achieved with this modified Weaver-Dunn technique. (10.5435/jaaos-d-21-00732)
  • [L3] We recommend routine radiographic follow-up after use of metallic anchors to ensure identification of early failure by anchor pullout. (10.1016/j.arthro.2009.08.015)
  • [L3] A combined screw/plate fixation offers the best option for avoiding non-union of the arthrodesis. (10.1111/j.1758-5740.2011.00174.x)
  • [L4] The technique has the potential to be superior to other available treatments because it preserves bone stock, limits damage to surrounding structures, and allows for early rehabilitation. (10.1016/j.arthro.2011.07.008)
  • [L3] US veterans with a history of HCV are at an increased risk of developing medical but not surgical complications within the first year after TSA. (10.1016/j.jseint.2021.02.009)
  • [L3] The greatest risk factors for infection after RSA were history of a prior failed arthroplasty and age younger than 65 years. (10.1016/j.jse.2014.05.020)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L4] The experience suggests that direct exchange can yield a rate of success comparable with that of delayed exchange if antibiotic-loaded cement and appropriate postoperative antibiotics are used. (10.2106/00004623-199807000-00004)
  • [L3] This study suggests patients 59 years and younger have an increased risk of revision at early follow-up. (10.1016/j.jse.2013.01.029)

See Also

References

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[2] Clinical and radiological comparison of three different reverse shoulder arthroplasty designs for patients with primary osteoarthritis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08749-y

[3] Outcomes of primary reverse shoulder arthroplasty in patients with morbid obesity. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.008

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[31] Continuous Loop Double Endobutton Reconstruction for Acromioclavicular Joint Dislocation. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515596409

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[35] Reverse Total Shoulder Arthroplasty without Bone-Grafting for Severe Glenoid Bone Loss in Patients with Osteoarthritis and Intact Rotator Cuff. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.01042

[36] Comparison of glenoid bone grafting vs. augmented glenoid baseplates in reverse shoulder arthroplasty: a systematic review. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.11.017

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[38] Humeral component retroversion in reverse total shoulder arthroplasty: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.07.027

[39] Anatomy of the pectoralis minor tendon and its use in acromioclavicular joint reconstruction. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.09.007

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[41] Impact of Significant Coracoid Graft Resorption on Clinical Outcomes After Arthroscopic Latarjet Procedure: Development and Validation of a Refined Classification System for Coracoid Bone Graft Resorption. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251408095

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[43] Impaction Bone Grafting of the Glenoid in Revision Shoulder Arthroplasty: Classification, Technical Description and Early Results. Shoulder & Elbow. 2009. DOI: 10.1111/j.1758-5740.2009.00017.x

[44] Editorial Commentary : Bursal Acromial Resurfacing Offers Improved Biomechanics in Laboratory Studies but There Is No Consensus on Indications, Technique, or Graft Type, and Clinical Results Are Lacking. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.07.006

[45] Classification of instability after reverse shoulder arthroplasty guides surgical management and outcomes. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.09.031

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