Reverse Total Shoulder Arthroplasty in the Setting of an Intact Rotator Cuff: A Contemporary Review of Current Indications, Outcomes, and Surgical Considerations

Abstract Purpose of Review Reverse total shoulder arthroplasty (rTSA) was designed for rotator cuff tear arthropathy but is now used in patients with an intact rotator cuff, most often for primary glenohumeral osteoarthritis (GHOA). This review examines the current evidence for rTSA in cuff-intact patients, focusing on the indications, functional outcomes, complications, implant design considerations and surgical technique. Recent Findings In matched cohorts and meta-analyses restricted to cuff-intact GHOA, rTSA and aTSA produce comparable pain relief, patient-reported outcomes, satisfaction, and overhead elevation. ATSA restores greater external and internal rotation, but this difference often falls below clinically important thresholds and narrows over time. RTSA generally has a lower overall complication and revision rate, with baseplate loosening as the leading though still rare reason for revision surgery. Instability, acromial and scapular spine stress fracture, and revision surgery rates are all lower when the rotator cuff is intact. Current studies on the cuff-intact population are limited to 10-year outcomes, with registry survivorship of rTSA for GHOA approximately 96.1% at 10 years. Summary RTSA is an efficacious and durable option for patients with glenohumeral arthritis and an intact rotator cuff, providing consistent pain relief and function. Patient outcomes are influenced by surgical technique, implant design and positioning, and avoidance of complications. Long-term follow-up and further comparative studies are needed to define the role of rTSA versus aTSA in this population.