Bone grafting with a reverse total shoulder prosthesis for patients with severe glenoid bone loss has also been reported to be successful in these patients [13]. Our preferred method of surgery for most patients more than 80 years of age who have degenerative arthritis of the shoulder without a rotator cuff tear is to implant a reverse prosthesis. Patients more than 70 years of age who have major rotator cuff thinning on MRI scanning also may be considered good candidates for a reverse prosthesis, especially if there is marked rotator cuff disease on MRI.

If an RTSA is performed in patients with an intact rotator cuff, there is little need to reattach the subscapularis tendon back to the lesser tuberosity. The incidence of instability in RTSA is the same whether the subscapularis tendon is reattached or not [22]. Edwards et al. [23] found that, with a Grammont type of prosthesis, instability was less when the subscapularis tendon was reattached than when it was not [23]. This finding might be prosthesis design-dependent because a prosthesis with a lateral offset and a higher head neck angle has a lower rate of instability than the Grammont prosthesis [24].