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Clinical Updates on Shoulder Arthroplasty
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Clinical Updates on Shoulder Arthroplasty

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 October 2025 | Viewed by 5182

Special Issue Editors

Dr. Pietro Gregori

E-Mail Website
Guest Editor
1. Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
2. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
Interests: reverse shoulder arthroplasty (RSA); total shoulder arthroplasty (TSA); hemiarthroplasty; rotator cuff arthropathy; osteoarthritis
Dr. Edoardo Franceschetti

E-Mail Website
Guest Editor
1. Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
2. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
Interests: reverse shoulder arthroplasty (RSA); total shoulder arthroplasty (TSA); hemiarthroplasty; rotator cuff arthropathy; osteoarthritis
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Rocco Papalia

E-Mail Website
Guest Editor
1. Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
2. Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
Interests: reverse shoulder arthroplasty (RSA); total shoulder arthroplasty (TSA); hemiarthroplasty; osteoarthritis; knee surgery; hip surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Umile Giuseppe Longo

E-Mail Website
Guest Editor
1. Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
2. Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
Interests: reverse shoulder arthroplasty (RSA); total shoulder arthroplasty (TSA); rotator cuff arthropathy; osteoarthritis; proximal humeral fractures
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Medical practices are increasingly influenced by technological advancements and more personalized approaches to the care of each patient. In shoulder arthroplasty surgery, the constant evolution of the implant design and combinations aims to achieve improved clinical outcomes in the shortest possible time. Also, precise indications and specific surgical techniques are used to select the right treatment for the patient, while more studies are needed to define patient satisfaction, cost-effectiveness, safety, and optimal ways of increasing functional recovery and minimizing complications. For reverse shoulder arthroplasty, the most-discussed themes are the benefits of artificial intelligence, the role of preoperative 3D planning software, lateralization, and optimal humeral size and inclination. For anatomic arthroplasty, more precise indications and implant configurations are needed to reduce revsion rates. This Special Issue will improve knowledge of clinical, technical, and epidemiological advances that could lead to improvements in the diagnosis and treatment of shoulder arthroplasty.

Dr. Pietro Gregori
Dr. Edoardo Franceschetti
Prof. Dr. Rocco Papalia
Prof. Dr. Umile Giuseppe Longo
Guest Editors

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Keywords

  • reverse shoulder arthroplasty (RSA)
  • rotator cuff arthropathy
  • revisions
  • hemiarthroplasty
  • proximal humeral fractures
  • osteoarthritis
  • 3D planning
  • complications
  • total shoulder arthroplasty (TSA)

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Published Papers (5 papers)

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Research

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11 pages, 2306 KiB  
Article
Lateralization and Distalization Shoulder Angles in Reverse Shoulder Arthroplasty: Are They Still Reliable and Accurate in All Patients and for All Prosthetic Designs?
by Koray Şahin, Hakan Batuhan Kaya, Christos Koukos, Mehmet Kapıcıoğlu and Kerem Bilsel
J. Clin. Med. 2025, 14(4), 1393; https://doi.org/10.3390/jcm14041393 - 19 Feb 2025
Viewed by 683
Abstract
Background: Recently, the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) have been proposed to assess lateralization and distalization in reverse shoulder arthroplasty (RSA). However, there is insufficient evidence about the influence of patient anatomy and prosthesis design on these measurements. This [...] Read more.
Background: Recently, the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) have been proposed to assess lateralization and distalization in reverse shoulder arthroplasty (RSA). However, there is insufficient evidence about the influence of patient anatomy and prosthesis design on these measurements. This study aims to investigate the impact of patient anatomy and implant design on LSA and DSA measurements and to assess the validity of the previously reported “optimal” ranges for these parameters. Methods: Patients who underwent the RSA procedure using four different prosthetic designs between April 2014 and June 2023 were retrospectively evaluated. Postoperative LSA and DSA measurements were compared according to implant design, preoperative glenoid morphology (Favard classification), and the Hamada grade. The correlation of LSA and DSA with preoperative shoulder anatomy (critical shoulder angle, CSA, and acromial index, AI) was also assessed. Results: In total, 135 shoulders were included in the study, with a mean age of 71.7 ± 7.9 years. The mean LSA was 88.4 ± 11.8° and mean DSA was 40.6 ± 12.5°. According to prosthetic design, both mean LSA and DSA values differed significantly (p < 0.05). Lateralized designs (Groups I and IV) had significantly higher mean LSA values. The Favard classification and Hamada grade of shoulders did not show a significant influence on LSA and DSA measurements (p > 0.05). DSA was observed to be significantly correlated with CSA and AI (p < 0.05; r = −0.27 and −0.189, respectively). Conclusions: Prosthetic design and preoperative shoulder anatomy had a significant influence on LSA and DSA measurements in RSA. Optimal LSA and DSA values may lack validity and reliability and should not be applied to all patients. Full article
(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)
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10 pages, 416 KiB  
Article
Testosterone Replacement Therapy Is Not Associated with Greater Revision Rates in Reverse Total Shoulder Arthroplasty
by Romir P. Parmar, Austin Cronen, Clayton Hui, Michael Stickels, Evan Lederman and Anup Shah
J. Clin. Med. 2025, 14(4), 1341; https://doi.org/10.3390/jcm14041341 - 18 Feb 2025
Viewed by 668
Abstract
Background/Objectives: Testosterone replacement therapy (TRT) has become increasingly common, particularly for patients with symptomatic hypogonadism or individuals undergoing gender-affirming therapy. The current literature is inconclusive on the association between TRT and orthopedic surgery. This study sought to examine outcomes of reverse total [...] Read more.
Background/Objectives: Testosterone replacement therapy (TRT) has become increasingly common, particularly for patients with symptomatic hypogonadism or individuals undergoing gender-affirming therapy. The current literature is inconclusive on the association between TRT and orthopedic surgery. This study sought to examine outcomes of reverse total shoulder arthroplasty (RSA) in patients receiving TRT. Methods: A retrospective cohort of RSA patients from 2010 to 2022 was queried using the PearlDiver database. Patients were included if they underwent RSA with at least 2 years of follow-up. Patients who underwent at least 90 days of TRT prior to their surgery were matched by Charlson Comorbidity Index, age, and gender to a control cohort. Univariate analysis using chi-squared tests and Student’s t-tests were used to compare demographics outcomes between groups. Results: A total of 1906 patients were identified who used TRT within 90 days of undergoing RSA, and these patients were matched to a control cohort of 1906 patients. Patients who used TRT within 90 days did not have significantly different rates of revision RSA (12.01%) compared to those without use (11.02%) (p = 0.335). Furthermore, between the TRT group and the control group, PJI rates (1.42% vs. 1.63%; p = 0.597) and periprosthetic fracture rates (0.58% vs. 1.05%, p = 0.105) were not significantly different. Conclusions: This study demonstrated that TRT use within 90 days of RSA does not increase the rates of revision, fracture, or infection. These results can assist surgeons when evaluating patients on TRT who also may be candidates for RSA. Full article
(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)
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11 pages, 1390 KiB  
Article
Comparison of Short Uncemented Metaphyseal Stem and Long-Stem Reverse Shoulder Arthroplasty in Proximal Humerus Fractures: Preliminary Study at 2-Year Follow-Up
by Giorgio Ippolito, Riccardo Maria Lanzetti, Sergio Ferraro, Valerio Pace, Marco Damo, Michele Francesco Surace, Alessio Davide Enrico Giai Via, Michele Crivellaro, Giancarlo De Marinis and Marco Spoliti
J. Clin. Med. 2024, 13(16), 4665; https://doi.org/10.3390/jcm13164665 - 8 Aug 2024
Viewed by 1262
Abstract
Introduction: In the last few years, short metaphyseal-socket prosthetic humeral stems have been introduced for reverse shoulder arthroplasty (RSA). A short stem may have advantages in humeral force distribution, reducing shear stress and preserving bone stock, keeping in mind the need for [...] Read more.
Introduction: In the last few years, short metaphyseal-socket prosthetic humeral stems have been introduced for reverse shoulder arthroplasty (RSA). A short stem may have advantages in humeral force distribution, reducing shear stress and preserving bone stock, keeping in mind the need for possible future revision surgery. The main objective of our study was to validate the use of a short stem prosthesis in the surgical treatment of humeral fractures by comparing clinical and radiological outcomes of our studied implant with those obtained with the use of traditional long-stem implants. Methods: In this multicentric, controlled prospective study, 125 patients with proximal three- or four-fragment humerus fractures were selected and treated with RSA. A short stem was used in group A (n = 53, mean age: 75.6 ± 5.6 years old), and a long stem was used in group B (n = 72, mean age: 71.76 ± 3). Active range of motion (ROM), Constant score (CS), Quick DASH, American Shoulder and Elbow Surgeons Shoulder (ASES) score, and Visual Analog Scale (VAS) scores were collected and analyzed at 2 years mean follow-up, as well as humeral and glenoid bone resorption (sum Inoue scores and Sirveaux scores were used). Results: No statistically significant differences were observed between group A and B in ROM, Constant score (51.69 ± 15.8 vs. 53.46 ± 15.96, p > 0.05), Quick DASH (31.5 ± 21.81 vs. 28.79 ± 13.72, p = 0.85), ASES (82.53 ± 17.79 vs. 84.34 ± 15.24, p = 0.57), or the VAS (0.53 ± 1 vs. 0.56 ± 1.07, p = 0.14) at the final follow-up. No statistically significant differences were found in the radiographic parameters between the two groups. No statistically significant differences were found for the average degree of humeral and glenoid bone resorption either. Conclusions: The use of a short metaphyseal-socket stem can be considered a safe, effective, and feasible option in reverse shoulder arthroplasty for treating proximal humerus fractures. Our results are encouraging, with no statistically significant differences identified between the proposed treatment and traditional long stems. Full article
(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)
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11 pages, 2590 KiB  
Article
Bone Density Changes at the Origin of the Deltoid Muscle following Reverse Shoulder Arthroplasty
by Antonio Caldaria, Edoardo Giovannetti de Sanctis, Luca Saccone, Angelo Baldari, Danila Azzolina, Luca La Verde, Alessio Palumbo and Francesco Franceschi
J. Clin. Med. 2024, 13(13), 3695; https://doi.org/10.3390/jcm13133695 - 25 Jun 2024
Viewed by 1519
Abstract
Background: Reverse total shoulder arthroplasty (RSA) significantly impacts deltoid length, tension, and structure. Studies have extensively investigated various modifications in deltoid characteristics, such as perfusion, elasticity, caliber, histological changes, and strength post-RSA. However, to date, there is a notable absence of research evaluating [...] Read more.
Background: Reverse total shoulder arthroplasty (RSA) significantly impacts deltoid length, tension, and structure. Studies have extensively investigated various modifications in deltoid characteristics, such as perfusion, elasticity, caliber, histological changes, and strength post-RSA. However, to date, there is a notable absence of research evaluating changes in bone mineral density (BMD) at the deltoid muscle origin after the RSA procedure. Methods: A retrospective analysis of a consecutive series of RSAs performed between May 2011 and May 2022 was conducted. Inclusion criteria comprised primary RSAs with both preoperative and last follow-up shoulder CT scans and a minimum follow-up of 12 months. Trabecular attenuation measured in Hounsfield units (HU) was calculated using a rapid region-of-interest (ROI) method. BMD analysis involved segmenting three ROIs in both pre- and postoperative CT scans of each patient: the acromion, clavicle, and spine of the scapula. Results: A total of 44 RSAs in 43 patients, comprising 29 women and 14 men, were included in this study. The mean follow-up duration was 49 ± 22.64 months. Significant differences were observed between preoperative and postoperative HU values in all analyzed regions. Specifically, BMD increased in the acromion and spine, while it decreased in the clavicle (p-values 0.0019, <0.0001, and 0.0088, respectively). Conclusions: The modifications in shoulder biomechanics and, consequently, deltoid tension post-implantation result in discernible variations in bone quality within the analyzed regions. This study underscores the importance of thorough preoperative patient planning. By utilizing CT images routinely obtained before reverse shoulder replacement surgery, patients at high risk for fractures of the acromion, clavicle, and scapular spine can be identified. Full article
(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)
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Review

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11 pages, 1462 KiB  
Review
Computer-Assisted Navigation in Shoulder Arthroplasty: A Narrative Review
by Marina Marescalchi, Alessandro El Motassime, Luca Andriollo, Alberto Polizzi, Giuseppe Niccoli and Vincenzo Morea
J. Clin. Med. 2025, 14(8), 2763; https://doi.org/10.3390/jcm14082763 - 17 Apr 2025
Viewed by 346
Abstract
Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore [...] Read more.
Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty. Full article
(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)
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