Evolution and Breakthroughs of Reverse Total Shoulder Arthroplasty—A Systematic Review Based on the Treatment of Massive Rotator Cuff Tears

巨大肩袖撕裂(massive rotator cuff tear, MRCT)及其继发的肩袖撕裂关节病(Cuff Tear Arthropathy, CTA)常导致肩关节功能丧失。反肩关节置换术(Reverse Total Shoulder Arthroplasty, RTSA)通过“倒置球臼”设计重塑肩关节生物力学，利用三角肌代偿肩袖功能，现已成为不可修复性MRCT和老年复杂肩关节疾病的核心治疗手段。本文基于巨大肩袖撕裂的肩关节置换治疗，阐明RTSA从功能代偿到生物力学适配的转型逻辑，综述RTSA假体的演进、适应症、临床疗效及并发症，为临床实践提供理论依据，并展望智能精准化发展方向。Massive rotator cuff tear (MRCT) and its secondary cuff tear arthropathy (CTA) often lead to severe dysfunction of the shoulder joint. Reverse total shoulder arthroplasty (RTSA), with its “reversing the position of the convex and concave surface” design, reconstructs shoulder biomechanics by utilizing the deltoid muscle to compensate for rotator cuff deficiency, and has become the cornerstone treatment for irreparable MRCT and complex shoulder pathologies in elderly patients. This review focuses on shoulder arthroplasty for MRCT, elucidating the transformative rationale of RTSA from functional compensation to biomechanical adaptation. It comprehensively summarizes the evolution of RTSA prostheses, expanded indications, clinical efficacy, and complications, providing theoretical support for clinical practice. Future perspectives on intelligent and precision-oriented development directions are also discussed.