AANA25 Shoulder Access Pass-CONCURRENT SESSION 3F: Shoulder Arthroplasty

Video Transcription

Video Summary

The Arthroscopy Association meeting focused on the evolving role of anatomic total shoulder arthroplasty (TSA) versus reverse shoulder arthroplasty (RSA) in 2025. Presentations highlighted that while RSAs have rapidly increased—from 55% in 2016 to 70% in 2020 of shoulder replacements in the U.S.—anatomics still have a place, especially in younger active patients with intact rotator cuffs and osteoarthritis. Challenges with anatomic TSA include complications like rotator cuff failure and glenoid loosening, which often lead to revisions. Careful patient selection, surgical technique, and preoperative planning, including advanced imaging and use of augmented or inlay glenoid implants, are critical for success.<br /><br />Mike Amini discussed subscapularis-sparing approaches in TSA, noting improved early recovery and fewer complications compared to traditional takedown methods, though the technique has a learning curve. A study on postoperative RSA angles found no significant correlation between glenoid baseplate inclination and patient outcomes, challenging previous concerns about superior inclination, particularly with modern lateralized implants.<br /><br />Greg Satanovich emphasized optimizing humeral reconstruction and cautious use of stemless implants, with the importance of proper planning and technical precision. Dan Song advocated for RSA as the preferred option in many cases, particularly in older patients with cuff arthropathy, significant glenoid bone loss, or complex fractures, due to its predictability and durability despite some serious but relatively rare complications.<br /><br />Ilya Voloshin provided practical tips on glenoid exposure in TSA, emphasizing thorough soft tissue releases and arm positioning for optimal implant placement. The panel discussed a challenging 52-year-old patient with a complex glenoid deformity, debating options including anatomic TSA with or without augmented glenoid component, hemiarthroplasty with pyrocarbon, or reverse TSA—underscoring the nuanced patient-specific decision-making.<br /><br />Despite the rise of RSA, anatomics remain relevant for selected patients, requiring ongoing education and technical advancements to improve outcomes and durability in an evolving shoulder arthroplasty landscape.

Asset Caption

Moderator: Stephen A. Parada, M.D.
Michael H. Amini, M.D. | Noah E. DiNapoli, B.S. | Gregory Cvetanovich, M.D. | Daniel J. Song, M.D., FAANA | Ilya Voloshin, M.D.

Keywords

Anatomic total shoulder arthroplasty

Reverse shoulder arthroplasty

Rotator cuff integrity

Glenoid loosening

Subscapularis-sparing technique

Glenoid baseplate inclination

Stemless implants

Cuff arthropathy

Glenoid exposure techniques

Augmented glenoid implants