Mid- to long-term outcomes of reverse total shoulder arthroplasty: a systematic review

Background

The reverse total shoulder arthroplasty (rTSA) is increasingly gaining popularity in treating various traumatic and degenerative glenohumeral diseases as well as rotator cuff-deficient shoulders. An investigation of midterm outcomes of rTSA is warranted as this is a relatively new procedure when compared to other forms of arthroplasty. This systematic literature review evaluates midterm outcomes of rTSA at a minimum of five-year follow-up.

Methods

A literature search was performed for studies reporting long-term outcomes of rTSA in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Papers were included if they described long-term outcomes of rTSA at a minimum of 5-year follow-up. Data were collected on patient demographics, including age, gender, and body mass index. Follow-up duration, indication for surgery, patient-reported outcome measures, and range of motion (ROM) were also recorded. Complication rates and device survivorship were also collected.

Results

There were a total of 4127 patients from 34 included studies. The overall study population was 74% female, and the average age was 72.6 years (23-95). The most common diagnosis was cuff tear arthropathy [35.2%], followed by proximal humerus fracture [19.5%], and rotator cuff tears [14.9%]. Patient-reported outcome measures improved significantly when comparing preoperative and postoperative values. ROM, including forward elevation, abduction, and external rotation, also improved significantly postoperatively. The overall complication rate was 14.7% (n = 981). The most common complications were implant loosening (3.3%, n = 219) and instability or dislocation (3.3%, n = 218). The overall revision rate was 5.5% (n = 310). The device survivorship rate at a minimum of 5 years was 94%.

Conclusion

This systematic review demonstrated that outcomes of rTSA performed for a variety of shoulder pathologies demonstrate significant improvement in nearly all patient-reported outcome scores as well as significant improvement in ROM at long-term follow-up. The overall complication rate of 14.7% is relatively low, and the device survivorship is good at 94% at a minimum of 5 years.