Clinical Review

Reverse Total Shoulder Arthroplasty: Indications and Techniques Across the World

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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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