Reverse Total Shoulder Arthroplasty: Indications and Techniques Across the World

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Clinical Research Methodology

Background:

• Reverse total shoulder arthroplasty (RTSA) is a prevalent surgical procedure for rotator cuff tear arthropathy.
• Global variations in RTSA patient selection and treatment protocols are suspected but not well-documented.

Purpose of the Study:

• To systematically review and compare patient demographics, indications, and outcomes of RTSA across different continents.
• To assess the quality and trends in RTSA research literature globally.

Main Methods:

• Systematic review of Level I-IV evidence studies on RTSA outcomes, registered with PROSPERO and adhering to PRISMA guidelines.
• Analysis of 103 studies (8973 patients) comparing demographics, surgical techniques, and outcomes between continents using statistical tests.
• Evaluation of study quality using the Modified Coleman Methodology Score (MCMS).

Main Results:

• Indications for RTSA varied by continent, with rotator cuff arthropathy being the most common (60.8%).
• North American studies reported significantly better postoperative external rotation and greater flexion changes compared to European studies.
• RTSA research quantity is increasing annually, but study quality (MCMS) is decreasing.

Conclusions:

• Global practices in RTSA patient selection and outcome reporting are inconsistent.
• While RTSA research is expanding, there is a concerning trend of declining study quality.
• Further standardization of RTSA protocols and outcome reporting is needed globally.