Osseointegration in reverse total shoulder arthroplasty: a review of implant biomaterials and surface technology

Implant fixation failure remains a leading cause of revision in reverse total shoulder arthroplasty (rTSA), yet the role of biomaterials in supporting osseointegration has received comparatively less focus than implant geometry or surgical technique. Achieving durable biological fixation requires a careful balance of surface roughness, porosity, and material composition, all factors that have evolved significantly over the past 2 null decades. This review takes a historical approach to the development and progression of biomaterials in rTSA, detailing the transition from smooth machined titanium to advanced porous structures designed to enhance bone integration. Key surface technologies are reviewed chronologically, including grit-blasted titanium, sintered beads, titanium plasma spray, hydroxyapatite coatings, diffusion bonding, trabecular metal, and modern 3D-printed architectures. For each, we outline the manufacturing methods, decision-making rationale, and clinical relevance. By mapping how fixation strategies have changed over time, this review provides a structured understanding of how biomaterials contribute to implant stability and highlights where gaps in evidence remain. As new technologies emerge, the future of rTSA fixation will depend on integrating innovation with material designs that have proven long-term performance. This review offers a framework for understanding current options and guiding material selection in clinical practice.

Duke Scholars

Author Ken Gall Thomas Lord Department of Mechanical Engineering and Materia ...