Females experience inferior outcomes and higher rates of revisions and complications compared to males following anatomic total shoulder arthroplasty: a systematic review and meta-analysis

Background

To compare patient-reported outcomes, range of motion, and rates of revision surgery between male and female patients undergoing primary anatomic total shoulder arthroplasty (aTSA).

Methods

A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A literature search was performed on June 1, 2024, using the PubMed, Embase, and Scopus library databases for human clinical studies reporting postoperative outcomes and revision rates following aTSA between male and female patients. Preoperative and postoperative outcome scores and revision rates were stratified by patient sex and quantitatively compared. The quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria.

Results

Six studies met the inclusion criteria, totaling 4525 patients. Males (n = 2288) had a mean age of 68.3 years and females (n = 2237) had a mean age of 67.4 years (mean difference, 2.02; P = .43). Males demonstrated significantly greater improvement in postoperative American Shoulder and Elbow Surgeons scores (mean difference 2.18, P < .001) and visual analog scale pain scores (mean difference 0.40, P < .001) compared to females. Females demonstrated higher rates of postoperative complications (10.1% vs. 7.3%, risk ratio 1.43, P < .001) and revision surgeries (6.2% vs. 3.7%, risk ratio 1.87, P = .03).

Conclusion

Males undergoing aTSA demonstrate significantly greater improvements in postoperative American Shoulder and Elbow Surgeons and visual analog scores than females. Females have higher rates of postoperative complications and revision surgery. These findings highlight the necessity for tailored preoperative counseling, perioperative management, and postoperative care strategies. Further investigation is needed to determine the clinical significance of these difference and to identify modifiable biological and social risk factors to improve results in female patients.