Reverse Total Shoulder Arthroplasty and Gait

Background & Significance of Gait in the Aging Adult

Maeda and colleagues recently published their article, “Gait Analysis After Reverse Total Shoulder Arthroplasty” in the Journal of Bone and Joint Surgery Open Access.¹ Many patients who develop glenohumeral osteoarthritis, irreparable rotator cuff tear, rotator cuff arthropathy, and the other primary indications for reverse total shoulder arthroplasty are elderly.² With age, these patients develop multiple comorbidities that affect their gait, including osteoarthritis of the knees and hips, weakness in the core and trunk, loss of sensation within the feet, and loss of proprioception within the joints.³ These changes not only affect gait but also balance. Changes in gait and balance secondarily affect fall risk. Falls are the number one risk for sustaining a fragility fracture.⁴ Among these, the most feared is a hip fracture, which has significant mortality. In one recent analysis, 62.1% of patients who sustained a hip fracture had expired within 1.2 years of follow-up.⁵ As a result, gait is a critical issue in the aging adult.

Study Design & Methodology

While most gait analyses focus on the lower extremities, gait is a whole-body motion and is thus affected by musculoskeletal diseases of the spine and upper extremities. This truth is laid bare within Maeda’s analysis.¹ In this retrospective observational study, 32 elderly Japanese patients (91% women with a mean age of 78) underwent a gait analysis prior to, one week after, one month after, and three months after a reverse total shoulder arthroplasty under both normal walking speed and maximum walking speed. All of the included patients had either glenohumeral osteoarthritis or rotator cuff tear arthropathy. All underwent a deltopectoral approach replacement with an Advita Equinoxe^® Shoulder System implant. Of interest, the gait analysis was performed using a wireless accelerometer affixed to the spinous process of the third lumbar vertebra.

Post-Operative Improvements in Gait Efficiency

The results are dramatic – after surgery the authors observed a decrease in walking time, an increase in stride length, a decrease in walking cycle, and a decrease in trunk acceleration. These results occur quickly, within one month of surgery. These results demonstrate an overall improved gait efficiency, that may allow elderly individuals with diminished reserves to walk greater distances. Walking velocity has been closely associated with life expectancy⁶ and thus an intervention that improves walking velocity could be beneficial for overall patient health.

Gait Symmetry & Clinical Implications

The authors also describe an improvement in gait symmetry. This finding has several implications. First, it demonstrates that these patients had developed compensatory gait patterns pre-operatively to reduce movement in the pathologic shoulder. Certainly, these abnormal, asymmetric compensatory gait patterns can be associated with decreased balance and thus increased fall risk.⁷ They can also be associated with other, more distant injuries as other tissues are abnormally loaded. Thus, normalization of these patterns, as shoulder pain recedes and function normalizes, may reduce both fall risk and risk for injury to tissues elsewhere in the body.

Overall, this study adds to our understanding of the global impact of degenerative shoulder conditions (glenohumeral osteoarthritis and rotator cuff tear arthropathy) and successful surgical treatment (reverse total shoulder arthroplasty) upon our patients. These pathologies, and their treatment, clearly have impact beyond the shoulder, influencing gait efficiency and symmetry, and thus potentially fall risk and mortality. Surgeons should be attentive to these changes pre-operatively, especially in the very common situation in which the patient has associated spine or lower extremity musculoskeletal comorbidities. Discussion of these benefits with patients may alter our thinking about the risks and benefits of surgery. Finally, as suggested by the authors, the changes seen suggest that incorporation of trunk and balance training into rehabilitation protocols should be considered as these are clearly altered post-operatively and could be further optimized to the benefit of the patient.

References:

1. Maeda T, Ikegami H, Yoshizawa S, et al. Gait Analysis After Reverse Total Shoulder Arthroplasty. JBJS Open Access. 2026;11(2):e26.00015. doi:10.2106/jbjs.oa.26.000152.
2. Chalmers PN, Salazar DH, Romeo AA, Keener JD, Yamaguchi K, Chamberlain AM. Comparative Utilization of Reverse and Anatomic Total Shoulder Arthroplasty. J Am Acad Orthop Sur. 2018;26(24):1. doi:10.5435/jaaos-d-17-00075
3. Centner C, Ritzmann R, Marusic U, Hughes L. Variability in spatial and temporal gait dynamics during aging: a narrative review on the role of the neural system. Arch Gerontol Geriatr. 2026;144:106189. doi:10.1016/j.archger.2026.106189
4. Feng J nan, Zhang C gui, Li B hua, Zhan S yan, Wang S feng, Song C li. Global burden of hip fracture: The Global Burden of Disease Study. Osteoporos Int. 2024;35(1):41-52. doi:10.1007/s00198-023-06907-3
5. Liu E, Killington M, Cameron ID, Li R, Kurrle S, Crotty M. Life expectancy of older people living in aged care facilities after a hip fracture. Sci Rep. 2021;11(1):20266. doi:10.1038/s41598-021-99685-z
6. Studenski S, Perera S, Patel K, et al. Gait Speed and Survival in Older Adults. JAMA. 2011;305(1):50-58. doi:10.1001/jama.2010.1923
7. Gillain S, Boutaayamou M, Schwartz C, et al. Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: a 2-year longitudinal study. Aging Clin Exp Res. 2019;31(8):1057-1067. doi:10.1007/s40520-019-01210-w