Symptomatic subscapularis failure after anatomic total shoulder arthroplasty is uncommon and hard to treat. This single-institution retrospective study compared revision subscapularis repair with revision to reverse shoulder arthroplasty. It asks which reoperation strategy gives better outcomes and fewer complications.
When a subscapularis fails after anatomic TSA, you have two realistic salvage options: revision repair or conversion to reverse shoulder arthroplasty. This paper shows they land at the same functional endpoint (ASES ~59), but repair reoperates in over half of patients while RSA reoperated in none. That difference should dominate your counseling.
The practical split follows patient factors. A younger, healthy patient with an acute traumatic failure caught early is the best candidate for an attempted repair. An older patient with poor tissue, insidious atraumatic onset, or fatty infiltration is better served by RSA, which does not depend on subscapularis healing for stability.
Remember pec major transfer for irreparable subscapularis carries a high failure rate, especially with anterior subluxation. Set expectations honestly: both paths leave function well below a routine TSA.
Symptomatic subscapularis failure after anatomic total shoulder arthroplasty is uncommon and hard to treat. This single-institution retrospective study compared revision subscapularis repair with revision to reverse shoulder arthroplasty. It asks which reoperation strategy gives better outcomes and fewer complications.
When a subscapularis fails after anatomic TSA, you have two realistic salvage options: revision repair or conversion to reverse shoulder arthroplasty. This paper shows they land at the same functional endpoint (ASES ~59), but repair reoperates in over half of patients while RSA reoperated in none. That difference should dominate your counseling.
The practical split follows patient factors. A younger, healthy patient with an acute traumatic failure caught early is the best candidate for an attempted repair. An older patient with poor tissue, insidious atraumatic onset, or fatty infiltration is better served by RSA, which does not depend on subscapularis healing for stability.
Remember pec major transfer for irreparable subscapularis carries a high failure rate, especially with anterior subluxation. Set expectations honestly: both paths leave function well below a routine TSA.