Reverse Total Shoulder Arthroplasty: Indications and Techniques Across the World
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).
Continue to: Rotator cuff tear arthropathy...
