Prevention and management of reverse shoulder arthroplasty complications: A structured current concepts review

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.