Reverse shoulder arthroplasty (rTSA) provides reliable outcomes, but postoperative range of motion (ROM) varies. This study examined factors influencing the ROM after rTSA.
Methods
Seventy-three shoulders (70 patients) undergoing primary rTSA between 2014 and 2023 with ≥1-year follow-up were reviewed. Demographic, clinical, perioperative, and radiographic data were analyzed. Forward flexion (FF), external rotation (ER), and internal rotation (IR) were evaluated using multivariable linear regression to identify predictors.
Results
FF improved from 70° to 119° (p < 0.001), and ER from 12° to 22° (p = 0.002), whereas IR decreased from L3 to L4 (p = 0.009). Older age (β = −1.26, p = 0.003) and greater postoperative global lateralization, measured as lateral offset (β = −1.88, p = 0.001), predicted poorer FF, while taller height (β = 0.88, p = 0.015) and higher preoperative abduction (β = 0.26, p = 0.002) were favorable. For ER, older age was detrimental, whereas prior arthroscopic repair (β = 11.06, p = 0.031) and greater preoperative ER (β = 0.19, p = 0.041) were beneficial. No predictors were identified for IR.
Discussion
Older age and increased global lateralization limit elevation, whereas taller stature, preoperative abduction, and prior arthroscopic repair predict better motion.
GalvinJWKimRMentA, et al.Outcomes and complications of primary reverse shoulder arthroplasty with minimum of 2 years’ follow-up: a systematic review and meta-analysis. J Shoulder Elbow Surg2022; 31: e534–e544.
2.
DoyleTRDowneySHurleyET, et al.Midterm outcomes of primary reverse shoulder arthroplasty: a systematic review of studies with minimum 5-year follow-up. JSES Rev Rep Tech2024; 4: 1–7.
3.
NazzalEMReddyRPComoM, et al.Reverse shoulder arthroplasty with preservation of the rotator cuff for primary glenohumeral osteoarthritis has similar outcomes to anatomic total shoulder arthroplasty and reverse shoulder arthroplasty for cuff arthropathy. J Shoulder Elbow Surg2023; 32: S60–S68.
4.
FriedmanRJEichingerJSchochB, et al.Preoperative parameters that predict postoperative patient-reported outcome measures and range of motion with anatomic and reverse total shoulder arthroplasty. JSES Open Access2019; 3: 266–272.
5.
CollinPMatsukawaTDenardPJ, et al.Pre-operative factors influence the recovery of range of motion following reverse shoulder arthroplasty. Int Orthop2017; 41: 2135–2142.
6.
SchwartzDGCottrellBJTeusinkMJ, et al.Factors that predict postoperative motion in patients treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg2014; 23: 1289–1295.
7.
MonirJGTamsCWrightTW, et al.Preoperative factors associated with loss of range of motion after reverse shoulder arthroplasty. J Shoulder Elbow Surg2021; 30: e621–e628.
8.
BaekCHKimJGKimBT, et al.Healed subscapularis and its clinical implications for internal rotation in humeral lateralized reverse shoulder arthroplasty. J Shoulder Elbow Surg2025; 34: 1532–1542.
9.
De FineMSartoriMGiavaresiG, et al.The role of subscapularis repair following reverse shoulder arthroplasty: systematic review and meta-analysis. Arch Orthop Trauma Surg2022; 142: 2147–2156.
10.
HaoKADeanEWHonesKM, et al.Influence of humeral lengthening on clinical outcomes in reverse shoulder arthroplasty. Orthop Traumatol Surg Res2023; 109: 103502.
11.
LadermannATayECollinP, et al.Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res2019; 8: 378–386.
12.
FranceschettiEPerriconeGDe RosaA, et al.Eccentricity and greater size of the glenosphere increase impingement-free range of motion in glenoid lateralized reverse shoulder arthroplasty: a computational study. J Clin Orthop Trauma2024; 56: 102527.
13.
MahendrarajKAShieldsMVGrubhoferF, et al.Reassessing glenoid inclination in reverse total shoulder arthroplasty with glenosphere lateralization. Bone Joint J2021; 103-B: 360–365.
14.
BoileauPGonzalezJFChuinardC, et al.Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elbow Surg2009; 18: 600–606.
15.
ShieldsEJWKoueiterDMMaerzT, et al.Previous rotator cuff repair is associated with inferior clinical outcomes after reverse total shoulder arthroplasty. Orthop J Sports Med2017; 5: 2325967117730311.
16.
WiaterJMLeeJYJShieldsEJW, et al.Humeral component version has no effect on outcomes following reverse total shoulder arthroplasty: a prospective, double-blinded, randomized controlled trial. J Bone Joint Surg Am2024; 106: 1181–1188.
17.
GulottaLVChoiDMarinelloP, et al.Humeral component retroversion in reverse total shoulder arthroplasty: a biomechanical study. J Shoulder Elbow Surg2012; 21: 1121–1127.
18.
LevyJCAshukemMTFormainiNT. Factors predicting postoperative range of motion for anatomic total shoulder arthroplasty. J Shoulder Elbow Surg2016; 25: 55–60.
19.
WalchGBadetRBoulahiaA, et al.Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty1999; 14: 756–760.
20.
SirveauxFFavardLOudetD, et al.Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br2004; 86: 388–395.
21.
FriedmanRJHawthorneKBGenezBM. The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am1992; 74: 1032–1037.
22.
MaurerAFucenteseSFPfirrmannCW, et al.Assessment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder. J Shoulder Elbow Surg2012; 21: 1096–1103.
23.
KidaHUritaAMommaD, et al.Implications of navigation system use for glenoid component placement in reverse shoulder arthroplasty. Sci Rep2022; 12: 21190.
24.
KimSCLeeJELeeSM, et al.Factors affecting internal rotation after reverse shoulder arthroplasty. J Orthop Sci2022; 27: 131–138.
25.
ValentiPSauzieresPKatzD, et al.Do less medialized reverse shoulder prostheses increase motion and reduce notching?Clin Orthop Relat Res2011; 469: 2550–2557.
26.
HeckerAAguirreJEichenbergerU, et al.Deltoid muscle contribution to shoulder flexion and abduction strength: an experimental approach. J Shoulder Elbow Surg2021; 30: e60–e68.
27.
PietroskiAZhouYKastoJ, et al.Surface electromyography reveals middle deltoid as the functionally dominant shoulder muscle after reverse total shoulder arthroplasty. Cureus2025; 17: e80229.
28.
GiphartJEBrunkhorstJPHornNH, et al.Effect of plane of arm elevation on glenohumeral kinematics: a normative biplane fluoroscopy study. J Bone Joint Surg Am2013; 95: 238–245.
29.
WernerBSChaouiJWalchG. The influence of humeral neck shaft angle and glenoid lateralization on range of motion in reverse shoulder arthroplasty. J Shoulder Elbow Surg2017; 26: 1726–1731.
30.
BoutsiadisALenoirHDenardPJ, et al.The lateralization and distalization shoulder angles are important determinants of clinical outcomes in reverse shoulder arthroplasty. J Shoulder Elbow Surg2018; 27: 1226–1234.
31.
HelmkampJKBullockGSAmiloNR, et al.The clinical and radiographic impact of center of rotation lateralization in reverse shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg2018; 27: 2099–2107.
32.
EricksonBJWernerBCGriffinJW, et al.A comprehensive evaluation of the association of radiographic measures of lateralization on clinical outcomes following reverse total shoulder arthroplasty. J Shoulder Elbow Surg2022; 31: 963–970.
33.
StatzJMWagnerERHoudekMT, et al.Outcomes of primary reverse shoulder arthroplasty in patients with morbid obesity. J Shoulder Elbow Surg2016; 25: e191–e198.
34.
CrutsenJRWLambers HeerspinkFOvan LeentEAP, et al.Predictive factors for postoperative outcomes after reverse shoulder arthroplasty: a systematic review. BMC Musculoskelet Disord2024; 25: 439.
35.
ParsonsMRoutmanHDRocheCP, et al.Preoperative external rotation deficit does not predict poor outcomes or lack of improvement after reverse total shoulder arthroplasty. J Orthop2020; 21: 379–383.
36.
BerglundDDRosasSTripletJJ, et al.Restoration of external rotation following reverse shoulder arthroplasty without latissimus dorsi transfer. JB JS Open Access2018; 3: e0054.
37.
DucharneLGodenecheANerotC, et al.Factors that affect external rotation following reverse shoulder arthroplasty: a retrospective multi-centre study on 501 shoulders. Arch Orthop Trauma Surg2023; 143: 6487–6496.
38.
PolioWPHajekBBrolinTJ, et al.Muscle activation patterns during active external rotation after reverse total shoulder arthroplasty: an electrophysiological study of the teres minor and associated musculature. J Shoulder Elbow Surg2024; 33: 583–592.
39.
ShimadaNInoueJTakeiR, et al.Clinical results of reverse shoulder arthroplasty after failed arthroscopic rotator cuff repair compared to primary cases: a case-control study. Arthroplasty2025; 7: 38.
