This editorial reviews how reverse total shoulder arthroplasty evolved from Grammont's medialized design to modern lateralized implants. It maps expanding indications, biomechanical principles, and the RTSA-specific complications that follow wider use. It outlines where the field is heading: AI planning, mixed reality, robotics, and soft-tissue integration.
Understand RTSA through its core mechanical trade-off. Grammont medialized the center of rotation to give the deltoid a working moment arm, but that same medialization drives scapular notching and limits rotation.
Modern lateralized designs push the reconstruction back out to reduce notching and improve rotation and stability. Knowing this cause-and-effect chain lets you predict why a given implant behaves the way it does.
For the elderly patient with concentric OA and an intact cuff, this editorial frames a real decision: RTSA and anatomic TSA perform similarly, but TSA preserves better internal and external rotation. Reserve reverse for the cuff-deficient or high fracture-risk shoulder when rotation matters.
With roughly 80% of registry shoulder replacements now reverse, the complications you must counsel patients on are notching, acromial and scapular spine stress fractures, instability, and rotational deficits.
This editorial reviews how reverse total shoulder arthroplasty evolved from Grammont's medialized design to modern lateralized implants. It maps expanding indications, biomechanical principles, and the RTSA-specific complications that follow wider use. It outlines where the field is heading: AI planning, mixed reality, robotics, and soft-tissue integration.
Understand RTSA through its core mechanical trade-off. Grammont medialized the center of rotation to give the deltoid a working moment arm, but that same medialization drives scapular notching and limits rotation.
Modern lateralized designs push the reconstruction back out to reduce notching and improve rotation and stability. Knowing this cause-and-effect chain lets you predict why a given implant behaves the way it does.
For the elderly patient with concentric OA and an intact cuff, this editorial frames a real decision: RTSA and anatomic TSA perform similarly, but TSA preserves better internal and external rotation. Reserve reverse for the cuff-deficient or high fracture-risk shoulder when rotation matters.
With roughly 80% of registry shoulder replacements now reverse, the complications you must counsel patients on are notching, acromial and scapular spine stress fractures, instability, and rotational deficits.