Elshahhat A. Prevention and management of reverse shoulder arthroplasty complications: A structured current concepts review. World J Orthop 2026; 17(9): 125587 [DOI: 10.5312/wjo.125587]
Corresponding Author of This Article
Amr Elshahhat, MD, PhD, Lecturer, Department of Orthopedic Surgery, Mansoura University, Algomhoria Street, Mansoura 33516, Dakahlia, Egypt. amrelshahat@mans.edu.eg
Research Domain of This Article
Orthopedics
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review-article
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Elshahhat A. Prevention and management of reverse shoulder arthroplasty complications: A structured current concepts review. World J Orthop 2026; 17(9): 125587 [DOI: 10.5312/wjo.125587]
World J Orthop. Sep 18, 2026; 17(9): 125587 Published online Sep 18, 2026. doi: 10.5312/wjo.125587
Prevention and management of reverse shoulder arthroplasty complications: A structured current concepts review
Amr Elshahhat
Amr Elshahhat, Department of Orthopedic Surgery, Mansoura University, Mansoura 33516, Dakahlia, Egypt
Author contributions: Elshahhat A conceived the review, performed the literature search and analysis, and drafted and approved the final manuscript.
AI contribution statement: During manuscript preparation, AI-assisted techniques were utilized for minor language refining. No AI tool was utilized to create scientific content, plan the study, or make inferences. The author takes full responsibility for the scientific content of the manuscript. This manuscript did not contain any AI-generated figures or pictures.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Amr Elshahhat, MD, PhD, Lecturer, Department of Orthopedic Surgery, Mansoura University, Algomhoria Street, Mansoura 33516, Dakahlia, Egypt. amrelshahat@mans.edu.eg
Received: July 14, 2026 Revised: July 23, 2026 Accepted: August 28, 2026 Published online: September 18, 2026 Processing time: 61 Days and 0.2 Hours
Abstract
Recently, reverse shoulder arthroplasty (RSA) has been implemented in a variety of shoulder disorders including revision surgeries, challenging proximal humeral fractures, post-traumatic sequelae, or the classic rotator cuff tear arthropathy. With the objective of formulating prevailing preventative and treatment strategies, this review offers a rigorous, evidence-based appraisal of RSA complications by incorporating recent clinical literature and long-term worldwide registry data. Problems are arranged chronologically into three separate phases to offer a useful clinical framework: (1) Intraoperative mechanical problems, with an emphasis on metaphyseal fractures and component mispositioning; (2) Early postoperative including acute instability, neurological damage, and early periprosthetic infection; and (3) Long-term biological and fixation failures represented in scapular notching, chronic aseptic loosening, and stress shielding. Importantly, this review highlights how these complication profiles in all three phases have been substantially altered through the widespread biomechanical shift from traditional medialized designs to contemporary lateralized configurations, which has mitigated late scapular notching while concurrently increasing vulnerabilities to early and mid-term acromial stress fractures. Furthermore, recent algorithms that compare single-stage vs two-stage revision procedures for low-virulence infections that emerge late are thoroughly assessed. In the contemporary era, minimizing failures necessitates precision surgical execution, an extensive awareness of implant biomechanics, and patient-specific risk factors. To optimize patient selection, mitigate intraoperative risks, and properly address postoperative challenges, this review aims to demonstrate systematic timeline-based algorithmic strategies.
Core Tip: As clinical indications for reverse shoulder arthroplasty continue to expand globally, navigating associated failures requires a highly systematic approach. This structured narrative review provides a practical timeline-based framework for the prevention and management of reverse shoulder arthroplasty complications. Such approach categorizes complications into intraoperative, early, and late postoperative phases. This article details how modern implant design’s shifts have altered complication paradigms and deliver clear actionable clinical algorithms to guide surgeons through revision procedures.
