**3. Outcome timeline**

notching and impingement between the greater tuberosity and the coracoacromial arch and

These advancements contributed directly to the increased utilization of Reverse Total Shoulder Arthroplasty (RTSA) [4]. In fact, in the last ten years, the number of RTSAs nearly tripled in the United States [5]. Reverse Total Shoulder Arthroplasty (RTSA) is a popular treatment for patients with rotator cuff damage, glenohumeral arthritis, complex fractures, and previously failed total shoulder arthroplasty given its ability to alleviate pain and increase range of motion and function. Although RTSA significantly improves functionality, pain, and satisfaction, patients need to be given realistic expectations for when to expect improvements, peak performance, and plateaus as well as potential risks for negative outcomes. As with any surgical procedure, patients are at risk for intraoperative, perioperative, short-term, and long-term complications. Thus, the purpose of this review is to discuss the short-term and long-term complications, metrics, and length of follow-up for patients who have undergone RTSA. In addition, we provide recommendations for a cut-off point between short-term and long-term

Ease range of motion and function in patients with glenohumeral joint disease, displaced proximal humeral fractures, rotator cuff tear arthropathy, severe irreparable rotator cuff tears,

The surgical technique for RTSA can be accomplished via two approaches: deltopectorally or superolaterally [3, 9]. The deltopectoral approach is the most common and requires an experienced surgeon [10]. This surgical technique begins with an incision overlying the deltopectoral interval, preserving the cephalic vein, then tenotomizing the biceps tendon and the subscapularis if still intact [3, 11, 12]. Next, the joint capsule is circumferentially released and humeral head exposed to perform a humeral head osteotomy. The humeral head is then reamed and broached. Subsequently, the glenoid is exposed, the labrum excised, and the glenoid prepared. The guidewire for the glenoid reamer is placed inferiorly so that the glenoid baseplate will be flush with the inferior border of the native glenoid rim. This will help decrease the risk of scapular notching. By adding an inferior tilt to the position of the baseplate, the risk of scapular notching can be decreased, which in turn, improves compressive forces and helps avoid shear forces on the glenoid component. The baseplate is impacted in place, and secured with screws to securely fix the baseplate to the patient's native glenoid. The selected glenosphere is then secured to the baseplate with a Morse Taper fixation mechanism. The selection of the appropriately sized glenosphere is multifactorial. It is based on the patient's size (i.e., 42 mm for larger patients, 39 mm for average size patients, 36 mm for smaller patients) and individual patient pathologies. Glenosphere components are available

Next, the humeral stem is prepared by sounding the inner diameter of the humeral shaft and broaching it to the appropriate size. The final implant is tested with the spacer trials in

to maximize compressive forces while minimizing shear forces [2, 3].

rheumatoid arthritis, and failed shoulder arthroplasty [1–3, 6–8].

in central, lateral offset, and inferior offset designs.

outcomes for RTSA.

86 Advances in Shoulder Surgery

**2. Surgical approach**

What constitutes a short-term versus a long-term outcome? One of the objectives of this review is to address the lack of clarity in the literature regarding the timeline of shortterm and long-term outcomes [15]. Bacle and colleagues [15] identified that the majority of mechanical loosening reports occurred outside of the first 2 years following a reverse total shoulder arthroplasty. In contrast, dislocation, infection, and poor seating of the glenoid component were reported within the first 2 years postoperatively; a ratio of 3 to 1 for complications reported before and after the two-year mark [15]. Furthermore, Bacle and colleagues [15] defined medium-term follow-up as a mean of 39 months and long-term follow-up as a mean of 150 months. Similarly, Otto and colleagues [16] argued that a follow-up of period of 24 months was a relatively short time frame to adequately capture long-term complications. Thus, 2 years may be a respectable partition between short-term and long-term outcomes.
