Clinical outcomes and temporal changes in the range of motion following reverse total shoulder arthroplasty

Published:October 12, 2022DOI:



      Reverse total shoulder arthroplasty is a definitive solution for the treatment of massive rotator cuff tear and shoulder pseudoparalysis since it can improve shoulder function, especially in elderly individuals. For many elderly individuals, the concern is when they can return to their daily lives after surgery. This study aimed to clarify the characteristics of temporal postoperative values following reverse total shoulder arthroplasty and investigate the factors that affect clinical outcomes.


      This study included 52 patients (mean 79.2 years, range 70–87 years) who underwent primary reverse total shoulder arthroplasty for shoulder pseudoparalysis at a single institution by a single surgeon using the same implant between October 2014 and June 2019. We divided 52 patient into the following groups (1) female (n = 34)vs. male (n = 18) patients; (2) with (n = 19) vs. without (n = 33) arthritic changes in glenohumeral joints (Hamada grade 2, 3 vs. 4, 5); (3) with (n = 23) vs. without (n = 29) subscapularis tendon repair; and investigated the temporal changes in the range of motion (flexion, abduction, external rotation, and internal rotation) and American Shoulder and Elbow Surgeons scores.


      Significant differences were observed in postoperative shoulder flexion (P = .046) and abduction (P = .049) between the female and male groups. The male patients were able to obtain quick functional recovery. However, no significant differences were observed in postoperative American Shoulder and Elbow Surgeons scores, and the shoulder range of motion between patients with Hamada grade 2, 3 and 4, 5, and between the subscapularis repair and no repair groups.


      The factor that affected the final and temporal values of range of motion after reverse total shoulder arthroplasty was sex, rather than the arthritic changes in glenohumeral joint and the treatment of the subscapularis tendon.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Berth A.
        • Neumann W.
        • Awiszus F.
        • Pap G.
        Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair.
        J Orthop Traumatol. 2010 Mar; 11 (PMID: 20198404): 13-20
        • Clark N.J.
        • Elhassan B.T.
        The role of tendon transfers for irreparable rotator cuff tears.
        Curr Rev Musculoskelet Med. 2018 Mar; 11 (PMID: 29411320): 141-149
        • Mihata T.
        • Lee T.Q.
        • Hasegawa A.
        • Fukunishi K.
        • Kawakami T.
        • Fujisawa Y.
        • et al.
        Five-year follow-up of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
        J Bone Joint Surg Am. 2019 Nov 6; 101 (PMID: 31567675): 1921-1930
        • Mihata T.
        • Lee T.Q.
        • Watanabe C.
        • Fukunishi K.
        • Ohue M.
        • Tsujimura T.
        • et al.
        Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
        Arthroscopy. 2013 Mar; 29 (PMID: 23369443): 459-470
        • Tokish J.M.
        • Alexander T.C.
        • Kissenberth M.J.
        • Hawkins R.J.
        Pseudoparalysis: a systematic review of term definitions, treatment approaches, and outcomes of management techniques.
        J Shoulder Elbow Surg. 2017 June; 26 (PMID: 28526423): e177-e187
        • Namdari S.
        • Yagnik G.
        • Ebaugh D.D.
        • Nagda S.
        • Ramsey M.L.
        • Williams Jr., G.R.
        • et al.
        Defining functional shoulder range of motion for activities of daily living.
        J Shoulder Elbow Surg. 2012 Sep; 21 (PMID: 22047785): 1177-1183
        • Mihata T.
        • Lee T.Q.
        • Hasegawa A.
        • Kawakami T.
        • Fukunishi K.
        • Fujisawa Y.
        • et al.
        Arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears.
        Am J Sports Med. 2018 Sep; 46 (PMID: 30080429): 2707-2716
        • Boileau P.
        • Chuinard C.
        Rationale and biomechanics of the reversed shoulder prosthesis: the French experience.
        in: Frankle M.A. Rotator cuff deficiency of the shoulder. Thieme, New York, NY2008: 105-119
        • Hamada K.
        • Fukuda H.
        • Mikasa M.
        • Kobayashi Y.
        Roentgenographic findings in massive rotator cuff tears: a long-term observation.
        Clin Orthop Relat Res. 1990 May; 254 (PMID: 2323152): 92-96
        • Goutallier D.
        • Bernageau J.
        • Patte D.
        Assessment of the trophicity of the muscles of the ruptured rotator cuff by CT scan.
        in: Post M. Morrey B. Hawkins R. Surgery of the shoulder. Mosby, St. Louis, MO1990: 11-13
        • Levy J.C.
        • Anderson C.
        • Samson A.
        Classification of postoperative acromial fractures following reverse shoulder arthroplasty.
        J Bone Joint Surg Am. 2013 Aug 7; 95 (PMID: 23925750): e104
        • Sirveaux F.
        • Favard L.
        • Oudet D.
        • Huquet D.
        • Walch G.
        • Molé D.
        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 Br. 2004 Apr; 86 (PMID: 15125127): 388-395
        • Schenk P.
        • Aichmair A.
        • Beeler S.
        • Ernstbrunner L.
        • Meyer D.C.
        • Gerber C.
        Acromial fractures following reverse total shoulder arthroplasty: a cohort controlled analysis.
        Orthopedics. 2020 Jan 1; 43 (PMID: 31693743): 15-22
        • Alsubheen S.A.
        • MacDermid J.C.
        • John Faber K.
        • James Overend T.
        Factors predicting postoperative range of motion and muscle strength one year after shoulder arthroplasty.
        Arch Bone Jt Surg. 2021 Jul; 9 (PMID: 34423087): 399-405
        • Simovitch R.W.
        • Helmy N.
        • Zumstein M.A.
        • Gerber C.
        Impact of fatty infiltration of the teres minor muscle on the outcome of reverse total shoulder arthroplasty.
        J Bone Joint Surg Am. 2007 May; 89 (PMID: 17473128): 934-939
        • Friedman R.J.
        • Cheung E.V.
        • Flurin P.H.
        • Wright T.
        • Simovitch R.W.
        • Bolch C.
        • et al.
        Are age and patient gender associated with different rates and magnitudes of clinical improvement after reverse shoulder arthroplasty?.
        Clin Orthop Relat Res. 2018 Jun; 476 (PMID: 29601384): 1264-1273
        • Wong S.E.
        • Pitcher A.A.
        • Ding D.Y.
        • Cashman N.
        • Zhang A.L.
        • Ma C.B.
        • et al.
        The effect of patient gender on outcomes after reverse total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2017 Nov; 26 (PMID: 28911814): 1889-1896
        • Wiater B.P.
        • Koueiter D.M.
        • Maerz T.
        • Moravek Jr., J.E.
        • Yonan S.
        • Marcantonio D.R.
        • et al.
        Preoperative deltoid size and fatty infiltration of the deltoid and rotator cuff correlate to outcomes after reverse total shoulder arthroplasty.
        Clin Orthop Relat Res. 2015 Feb; 473 (PMID: 25388633): 663-673
        • Takayama K.
        • Yamada S.
        • Kobori Y.
        Clinical outcomes and temporal changes in the range of motion following superior capsular reconstruction for irreparable rotator cuff tears: comparison based on the Hamada classification, presence or absence of shoulder pseudoparalysis, and status of the subscapularis tendon.
        J Shoulder Elbow Surg. 2021 Nov; 30 (S1058-2746(21):00399-2. PMID: 33930558): e659-e675
        • Collin P.
        • Matsumura N.
        • Lädermann A.
        • Denard P.J.
        • Walch G.
        Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion.
        J Shoulder Elbow Surg. 2014 Aug; 23 (PMID: 24433628): 1195-1202
        • Ernstbrunner L.
        • El Nashar R.
        • Favre P.
        • Bouaicha S.
        • Wieser K.
        • Gerber C.
        Chronic pseudoparalysis needs to be distinguished from pseudoparesis: a structural and biomechanical analysis.
        Am J Sports Med. 2021 Feb; 49 (PMID: 33253014): 291-297
        • Wieser K.
        • Rahm S.
        • Schubert M.
        • Fischer M.A.
        • Farshad M.
        • Gerber C.
        • et al.
        Fluoroscopic, magnetic resonance imaging, and electrophysiologic assessment of shoulders with massive tears of the rotator cuff.
        J Shoulder Elbow Surg. 2015 Feb; 24 (PMID: 25179370): 288-294
        • Matthewson G.
        • Kooner S.
        • Kwapisz A.
        • Leiter J.
        • Old J.
        • MacDonald P.
        The effect of subscapularis repair on dislocation rates in reverse shoulder arthroplasty: a meta-analysis and systematic review.
        J Shoulder Elbow Surg. 2019 May; 28 (PMID: 30827833): 989-997