Reverse Total Shoulder Arthroplasty: Preoperative and Postoperative Imaging Findings

Reverse total shoulder arthroplasty (RTSA) is increasingly used for a variety of complex shoulder abnormalities, particularly in patients with rotator cuff deficiency. Design improvements with better biomechanics have led to improved clinical outcomes, but the radiographic appearance and complication profile of contemporary RTSA implants differ from those of a decade ago. Plain radiographs can be used to identify whether the prosthesis is medialized (primarily older prostheses) or lateralized. A standardized imaging protocol and a reporting checklist are vital for the identification of complications. Although most complications can be identified with standard radiography, CT and MRI performed with dedicated protocols to reduce metallic artifacts are helpful problem-solving adjuncts. US can be used to assess the surrounding muscles before and after RTSA, to evaluate for postoperative complications such as fluid collections, and to provide guidance for aspiration. Complications such as periprosthetic fracture, instability, loosening, scapular notching, and implant failure require focused search patterns for identification. More chronic complications such as stress fractures and tuberosity fragmentation require comparison with previously acquired images. Implant disassembly, rarely seen with other arthroplasties, can occur and requires familiarity with the expected appearance of the prosthesis components. A downloadable checklist for imaging evaluation of the prosthesis is provided, and imaging examples of common and uncommon complications are presented. After reviewing this article, the reader will have an improved understanding of the RTSA prosthesis and will be able to recognize the normal and abnormal imaging appearances of this increasingly popular type of shoulder replacement. ^©RSNA, 2025 Supplemental material is available for this article.