Shoulder Arthroplasty Guidelines

Anatomical Design Differences

The American College of Radiology notes that a regular total shoulder replacement preserves normal shoulder anatomy, with a ball on the humerus and socket on the glenoid, requiring an intact rotator cuff for stabilization and active motion 1
The American College of Radiology states that a reverse shoulder replacement inverts this design, placing a metal ball on the glenoid and a cup on the humerus, allowing the deltoid muscle to power shoulder movement and compensate for a deficient or absent rotator cuff 1

The American Academy of Orthopaedic Surgeons recommends reverse shoulder arthroplasty for patients with massive, unrepairable rotator cuff tears with pseudoparalysis, who have failed other treatments 2, 3, 4
The American Academy of Orthopaedic Surgeons suggests that reverse shoulder arthroplasty is indicated for rotator cuff tear arthropathy, a combination of massive rotator cuff tear and glenohumeral arthritis 2, 3, 4

The American College of Radiology reports that glenoid loosening is the most common complication of regular total shoulder replacement, occurring in 14.3% of cases 1
The American College of Radiology notes that scapular notching is the most common complication of reverse shoulder replacement 1

The American Academy of Orthopaedic Surgeons notes that severely impaired deltoid function is an absolute contraindication to reverse shoulder arthroplasty, as the deltoid must power shoulder motion 5
The American Academy of Orthopaedic Surgeons suggests that age is a concern for shoulder arthroplasty, with potential risks of increased prosthetic loosening and decreased survivorship in patients under 50 years 5