Total Open total shoulder arthroplasty (TSA)—including both anatomic total shoulder replacement and reverse total shoulder arthroplasty (RTSA)—there has been a lot of innovation recently. The biggest changes are not necessarily making the incision smaller; they are making the planning, implant positioning, bone reconstruction, and implant design much more individualized.
Here are some of the most important advances as of 2026:
1. 3-D CT planning and patient-specific surgery
Instead of relying primarily on 2-D X-rays and intraoperative measurements, surgeons can use a 3-D CT reconstruction of the patient’s scapula and humerus to plan:
- Exact glenoid component position
- Correction of glenoid version and inclination
- Implant size and orientation
- Screw trajectories
- Amount of bone to remove
- Optimal humeral component position
The plan can essentially be rehearsed virtually before the operation.
This is particularly valuable when the glenoid is severely worn or deformed.
2. Computer navigation during the operation
One of the most significant developments is intraoperative computer navigation.
The surgeon can see real-time information showing where the instruments and implants are relative to the patient’s anatomy. Rather than estimating the glenoid angle by eye, navigation can help reproduce the preoperative 3-D plan.
Recent evidence shows navigation improves accuracy of glenoid version and inclination, and can help optimize screw placement in reverse shoulder replacement.
The important caveat: better positioning does not automatically mean better long-term patient outcomes. Long-term evidence on implant survival and functional improvement is still developing.
3. Patient-specific instrumentation (PSI)
PSI is another major advancement.
A custom guide is produced from the patient’s CT scan and fits onto their particular anatomy. It guides the surgeon where to:
- Drill
- Ream
- Place the glenoid baseplate/component
- Direct fixation screws
A 2026 systematic review found PSI and navigation both improved glenoid positioning compared with conventional instrumentation, with PSI showing particularly strong accuracy in several measurements.
4. Augmented reality (AR) during shoulder replacement
This is one of the more futuristic developments.
The surgeon can potentially wear an AR headset and see virtual information overlaid on the patient’s actual anatomy—for example, the planned glenoid component orientation or drilling trajectory.
A 2025 systematic review found AR/immersive technologies generally improved accuracy in experimental and early clinical RTSA studies, although the clinical evidence remains much less mature than the evidence for conventional navigation.
Interestingly, a June 2026 clinical study reported early outcomes using AR-assisted navigation for reverse shoulder arthroplasty, showing that this technology is moving beyond laboratory/cadaver work.
5. Robotic-assisted shoulder replacement
Robotics are beginning to enter shoulder arthroplasty, although they’re not yet as established as robotic systems in knee replacement.
The concept is similar:
CT → 3-D plan → robotic/computer guidance → highly controlled bone preparation → implant placement.
The potential advantages are extremely precise execution and reproducibility, particularly in difficult anatomy. The limitations currently include cost, complexity, learning curve, and limited long-term clinical evidence.
6. Custom 3-D printed implants for severe bone loss
This is particularly exciting for complex revision shoulder surgery.
If someone has already had a shoulder replacement and has lost substantial glenoid bone, a conventional implant may not have enough healthy bone to attach to.
Modern CT-based design and 3-D/additive manufacturing can produce patient-specific implants designed around the individual’s remaining bone.
These can incorporate customized fixation points and screw trajectories. This is becoming an important option for otherwise extremely difficult revision cases.
7. Better reverse shoulder replacements
Reverse shoulder replacement itself has been one of the biggest advances in shoulder surgery.
Modern systems are increasingly:
- Modular
- Convertible
- Customizable
- Designed to optimize shoulder biomechanics
- Available in multiple glenosphere/baseplate configurations
- Designed to improve fixation and reduce complications
This allows surgeons to tailor the reconstruction to the patient’s anatomy rather than using a single standardized geometry.
8. Improved glenoid fixation
The glenoid side is one of the biggest technical challenges in shoulder replacement.
Newer reverse-shoulder designs and navigation systems are focusing heavily on:
- Larger/optimized central fixation
- Improved screw trajectories
- Longer screw purchase
- Better baseplate contact
- Bone-preserving designs
- Augmented components for asymmetric bone loss
Navigation can actually help the surgeon identify better screw trajectories and maximize available bone.
9. Augmented glenoid implants
Instead of removing large amounts of bone to make a severely deformed glenoid flat, surgeons can increasingly use augmented components.
Think of it as:
old approach: remove more bone to make the implant fit
newer approach: preserve more bone and make the implant fit the patient’s anatomy.
This can be particularly useful for patients with substantial posterior or superior glenoid wear.
10. Better humeral implants and convertible systems
Modern humeral components are becoming more flexible and bone-preserving.
Some systems allow the surgeon to change from anatomic to reverse configuration without completely replacing the humeral component. This is particularly valuable in revision surgery.
There is also increasing emphasis on preserving bone for a potential future revision.
