Indications for Reverse Shoulder Arthroplasty in Elderly Patients

Primary Indication: Irreparable Rotator Cuff Tears

The American Academy of Orthopaedic Surgeons explicitly states that TSA should NOT be performed in patients with glenohumeral osteoarthritis who have an irreparable rotator cuff tear (Consensus recommendation) 1
The presence of multiple tendon tears in an elderly patient likely represents an irreparable rotator cuff situation, making RSA the appropriate arthroplasty choice rather than traditional TSA, as recommended by the American Academy of Orthopaedic Surgeons 1

The degree of glenohumeral arthritis is secondary to the rotator cuff status when determining arthroplasty type, according to the American Academy of Orthopaedic Surgeons 1
RSA was originally designed for older adults with rotator cuff deficiency and has proven effective in this population, with a consensus recommendation from the American Academy of Orthopaedic Surgeons 3

Physical therapy and activity modifications should be attempted first unless symptoms are debilitating, although lacking high-quality evidence for glenohumeral OA specifically, as suggested by the American Academy of Orthopaedic Surgeons 2
Proceed to RSA when conservative treatment fails to provide adequate pain relief or functional improvement, as recommended by the American Academy of Orthopaedic Surgeons 2

Do not perform traditional TSA in the presence of irreparable rotator cuff tears - this is a consensus contraindication that will lead to poor outcomes and likely revision surgery, according to the American Academy of Orthopaedic Surgeons 1
Ensure surgery is performed by a surgeon who performs at least 2 shoulder arthroplasties per year to reduce complication rates, as recommended by the American Academy of Orthopaedic Surgeons 5

The American Academy of Orthopaedic Surgeons expresses concern about arthroplasty in patients under 50 years due to prosthetic loosening and decreased survivorship, but elderly patients are ideal candidates for RSA 5

Use mechanical and/or chemical venous thromboembolism prophylaxis for all shoulder arthroplasty patients, as recommended by the American Academy of Orthopaedic Surgeons (consensus recommendation) 2
Pre-operative imaging is essential to evaluate glenoid morphology, bone loss, retroversion, and bone quality, as suggested by the American Academy of Orthopaedic Surgeons 2