What is a significant risk associated with reverse total shoulder arthroplasty (TSA)?

The heightened risk of dislocation associated with reverse total shoulder arthroplasty primarily stems from the alteration in shoulder biomechanics and the dependence on the deltoid muscle for joint stability. In a reverse TSA, the normal ball-and-socket configuration is flipped, which can result in an increased rate of dislocations, particularly in individuals who have pre-existing rotator cuff deficiencies.

This is crucial to understand because the reverse shoulder design compensates for the lack of a functional rotator cuff by shifting the center of rotation and utilizing the deltoid for abduction and rotation. However, without adequate rotator cuff function, the stability of the joint can be compromised, making it more susceptible to dislocation during movement. Therefore, it is essential to weigh these risks while considering surgical options, particularly in patients with compromised rotator cuff integrity.

Recognizing this risk helps healthcare providers to better prepare patients and tailor postoperative rehabilitation, thereby minimizing the chances of complications associated with dislocations in this specific population.