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Related Experiment Video

Updated: May 22, 2025

Reverse Total Shoulder Arthroplasty
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Bilateral reverse shoulder arthroplasty: functional outcomes and technical considerations.

Peter Boufadel1, Ryan Lopez1, Mohammad Daher1

  • 1Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.

Clinics in Shoulder and Elbow
|March 13, 2025
PubMed
Summary

Bilateral reverse total shoulder arthroplasty (RSA) shows favorable functional outcomes, comparable to other shoulder replacements. While most daily activities are manageable, challenges in extreme internal rotation tasks persist, influenced by specific risk factors and implant positioning.

Keywords:
Activities of daily livingFunctional outcomesImplant positioningInternal rotationReverse shoulder arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomechanics
  • Rehabilitation Medicine

Background:

  • Reverse total shoulder arthroplasty (RSA) incidence is rising with expanded indications.
  • Bilateral RSA is increasingly considered for suitable patient populations.
  • Understanding functional outcomes and limitations after bilateral RSA is crucial.

Purpose of the Study:

  • To review functional outcomes in patients undergoing bilateral RSA.
  • To identify risk factors affecting internal rotation after RSA.
  • To examine the impact of implant positioning on internal rotation.

Main Methods:

  • Systematic review of studies on bilateral RSA outcomes.
  • Analysis of patient-reported and clinical outcome measures.
  • Evaluation of factors influencing internal rotation deficits.

Main Results:

  • Bilateral RSA demonstrates significantly improved outcomes and functional independence.
  • Patients retain ability for most activities of daily living, with limitations in extreme internal rotation.
  • Outcomes are comparable to bilateral anatomic total shoulder arthroplasty or mixed arthroplasty procedures.
  • Risk factors for poor internal rotation include preoperative deficits, high BMI, opioid use, and rotator cuff tears.
  • Glenoid lateralization/inferior positioning and humeral retroversion may improve internal rotation; subscapularis repair shows no significant benefit.

Conclusions:

  • Bilateral RSA offers significant functional benefits, enabling independence in daily living.
  • Internal rotation deficits can occur, influenced by patient-specific and surgical factors.
  • Optimizing implant positioning may enhance functional internal rotation.
  • Further research is needed to fully understand and mitigate internal rotation deficits.