Journal of Orthopaedics and Traumatology · IF 3.5 · September 28, 2026 · LoE III
Complications and revisions of inlay versus onlay design for reverse shoulder arthroplasty: a meta analysis and systematic review
Xingyao He, Wenhao Lu, Shide Jiang, Ke Wang, Shiyao Chu, Pavel Volotovsky, GERASIMENKO MIKHAIL, Andrey Bespalchuk, Wenfeng Xiao, Yusheng Li, Licheng Wei — Central South University
This meta-analysis pooled 13 mostly retrospective cohort studies (including large national registries) comparing inlay and onlay humeral components in reverse shoulder arthroplasty. Inlay stems had more scapular notching (77/434, 17.7% vs 37/393, 9.4%; risk ratio 1.83) while onlay stems had more infections (1.67% vs 0.87%), with no significant differences in revision (3.48% inlay vs 3.94% onlay; RR 0.85, p = 0.17), loosening, fracture, dislocation, ASES or VAS. Neck-shaft angle and registry confounding were not adjusted for.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersInlay versus onlay humeral design is a common implant choice in reverse shoulder arthroplasty, and notching is a frequently tested RTSA complication tied to implant geometry.
Conclusion strengthConfirms prior evidence
The conclusions are not supported by the reported results.
Presenting this at rounds? Start here
- ?Should a patient with diabetes or prior shoulder surgery be steered toward an inlay humeral component given the observed infection difference, or do patient factors outweigh implant design?
- ?How would you counsel a patient about scapular notching risk when choosing between a lateralized onlay and a Grammont-style inlay reverse shoulder, given that notching did not translate into a revision difference here?