RSA vs. TSA: Impact on Daily Living After Shoulder Surgery

Patients considering shoulder replacement surgery often weigh their options carefully, and a recent study sheds light on a key difference between two common procedures: reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA). While both can effectively relieve pain and improve function, research presented at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting suggests individuals undergoing RSA may experience more difficulty with certain everyday activities compared to those receiving anatomic TSA.

The findings, presented in New Orleans in early March 2026, don’t indicate one surgery is definitively “better” than the other, but rather highlight the trade-offs patients and surgeons should discuss. “Patients want to know the best-case scenario and the worst-case scenario,” explained Jie J. Yao, MD, of NYU Langone Health, in a statement. “Understanding the types of things they may or may not be able to do is important.”

Comparing RSA and TSA: What’s the Difference?

Both RSA and TSA aim to restore shoulder function, but they differ in their approach. Anatomic TSA mimics the natural shoulder joint, replacing both the ball and socket with prosthetic components. RSA, reverses this – the ball component is placed on the shoulder blade (glenoid) and the socket component on the upper arm (humerus). RSA is often favored for patients with severe rotator cuff tears, where the muscles responsible for shoulder movement are significantly damaged.

Study Details and Findings

Dr. Yao and colleagues retrospectively analyzed data from 253 patients who underwent either primary anatomic TSA (177 patients) or RSA (76 patients). The researchers focused on assessing patients’ ability to perform a range of activities of daily living (ADL), including tasks like sleeping comfortably, reaching behind the back, washing the back, putting on a coat, and performing personal hygiene.

The study found that both groups generally experienced improvements in function after surgery. However, patients who had undergone RSA reported more difficulty with certain ADLs, particularly those requiring extreme ranges of motion. “Things that might require you putting your arm in more unconventional or more extremes of motion,” Dr. Yao noted. “There is a difference, but how much that difference matters is different for every patient.”

What Does This Mean for Patients?

The research underscores the importance of a thorough discussion between patients and their surgeons to determine the most appropriate procedure. The choice isn’t simply about which surgery is “best,” but rather which surgery best aligns with a patient’s individual needs and lifestyle. For example, someone who frequently engages in overhead activities or requires a wide range of motion might be better suited for anatomic TSA, while someone with a severely damaged rotator cuff might benefit more from RSA.

It’s crucial to understand that these findings represent an average trend across the study population. Individual experiences can vary significantly. Factors such as age, overall health, activity level, and adherence to post-operative rehabilitation can all influence outcomes.

Understanding the Limitations of the Study

As a retrospective study, the research has inherent limitations. Retrospective studies analyze existing data, which means researchers don’t have control over how the data was originally collected. This can introduce potential biases and make it hard to establish a definitive cause-and-effect relationship. The study abstract, published by Healio, doesn’t detail the specific methods used to assess ADL function, which could also influence the results. Further research is needed to confirm these findings and explore the underlying reasons for the observed differences.

The Ongoing Evolution of Shoulder Replacement

Dr. Yao’s team plans to continue investigating this topic, focusing on implant design and how patients are doing long-term. “Implant design and how patients are doing are things that feed off each other,” he said. “The more we understand how patients are doing, the more People can think critically about the implants that we are putting in people and how we are putting them in people.” This iterative process of research and refinement is essential for improving the outcomes of shoulder replacement surgery.

The field of shoulder arthroplasty is constantly evolving, with ongoing efforts to develop new implant designs and surgical techniques. Researchers are also exploring ways to personalize treatment plans based on individual patient characteristics. Staying informed about the latest advancements can empower patients to make informed decisions about their care.

What Comes Next: Continued Research and Patient-Centered Care

The future of shoulder replacement surgery lies in a deeper understanding of how different factors influence outcomes. Researchers will continue to investigate the long-term performance of RSA and TSA, as well as explore new approaches to rehabilitation and pain management. The goal is to provide patients with the best possible care, tailored to their individual needs and goals. Patients considering shoulder replacement are encouraged to discuss their options thoroughly with a qualified orthopedic surgeon and to ask questions about the potential benefits and risks of each procedure.

For more information: Jie J. Yao, MD, can be contacted through Marlene Naanes at [email protected].