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Reverse Total Shoulder Arthroplasty: Indications and Techniques Across the World

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TAKE-HOME POINTS

  • RTSA is an effective treatment for rotator cuff tear arthropathy (the most common reason patients undergo RTSA).
  • While there has been a plethora of literature surrounding outcomes of RTSA over the past several years, the methodological quality of this literature has been limited.
  • Similarly, this study found the number of publications surrounding RTSA is increasing each year while the average methodological quality of these studies is decreasing.
  • Females undergo RTSA more commonly than males, and the average age of patients undergoing RTSA is 71 years.
  • Interestingly, patients’ postoperative external rotation was higher in studies out of North America compared to other continents. Further research into this area is needed to understand more about this finding.

RESULTS

There were 103 studies included in the analysis (Figure 1). A total of 8973 patients were included, 62% of whom were female with a mean age of 70.9 ± 6.7 years (Table 1). The average follow-up was 34.3 ± 19.3 months. North America had the overall greatest total number of publications on RTSA, followed by Europe (Figure 2). The total yearly number of publications increased by a mean of 1.95 publications each year (P < .001). There was no association between the mean level of evidence with the year of publication (P = .296) (Figure 3). Overall, the rating of studies was poor for the MCMS (mean 36.9 ± 8.7). The MCMS decreased each year by a mean of 0.76 points (P = .037) (Figure 4).

Table 1. Demographic Data by Continent

North America

Europe

Asia

Australia

Total

P-value

Number of studies

52

43

4

4

103

-

Number of subjects

6158

2609

51

155

8973

-

Level of evidence

0.693

    II

5 (10%)

3 (7%)

0 (0%)

0 (0%)

8 (8%)

    III

10 (19%)

4 (9%)

0 (0%)

1 (25%)

15 (15%)

    IV

37 (71%)

36 (84%)

4 (100%)

3 (75%)

80 (78%)

Mean MCMS

34.6 ± 8.4

40.2 ± 8.0

32.5 12.4

34.5 ± 6.6

36.9 ± 8.7

0.010

Institutional collaboration

1.000

    Multi-center

7 (14%)

6 (14%)

0 (0%)

0 (0%)

13 (13%)

    Single-center

45 (86%)

37 (86%)

4 (100%)

4 (100%)

90 (87%)

Financial conflict of interest

0.005

    Present

28 (54%)

15 (35%)

0 (0%)

0 (0%)

43 (42%)

    Not present

19 (37%)

16 (37%)

4 (100%)

4 (100%)

43 (42%)

    Not reported

5 (10%)

12 (28%)

0 (0%)

0 (0%)

17 (17%)

Sex

N/A

    Male

2157 (38%)

1026 (39%)

13 (25%)

61 (39%)

3257 (38%)

    Female

3520 (62%)

1622 (61%)

38 (75%)

94 (61%)

5274 (62%)

Mean age (years)

71.3 ± 5.6

70.1 ± 7.9

68.1 ± 5.3

76.9 ± 3.0

70.9 ± 6.7

0.191

Minimum age (mean across studies)

56.9 ± 12.8

52.8 ± 15.7

62.8 ± 6.2

68.0 ± 12.1

55.6 ± 14.3

0.160

Maximum age (mean across studies)

82.1 ± 8.6

83.0 ± 5.5

73.0 ± 9.4

85.0 ± 7.9

82.2 ± 7.6

0.079

Mean length of follow-up (months)

26.5 ± 13.7

43.1 ± 21.7

29.4 ± 7.9

34.2 ± 16.6

34.3 ± 19.3

<0.001

Prosthesis type

N/A

    Cemented

988 (89%)

969 (72%)

0 (0%)

8 (16%)

1965 (78%)

    Press fit

120 (11%)

379 (28%)

0 (0%)

41 (84%)

540 (22%)

Abbreviations: MCMS, Modified Coleman Methodology Score; N/A, not available.

In studies that reported press-fit vs cemented prostheses, the highest percentage of press-fit prostheses compared with cemented prostheses was seen in Australia (84% press-fit), whereas the highest percentage of cemented prostheses was seen in North America (89% cemented). A higher percentage of studies from North America had a financial conflict of interest (COI) than did those from other countries (54% had a COI).

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