A 10-year experience with reverse shoulder arthroplasty: are we operating earlier?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Clinical Practice

Background:

• Surgeons' increasing confidence in reverse shoulder arthroplasty (RSA) may lead to earlier surgical intervention for glenohumeral joint disease.
• Evaluating the "tipping point" for primary RSA over time is crucial to understand practice evolution.

Purpose of the Study:

• To assess changes in the criteria for undergoing primary reverse shoulder arthroplasty (RSA) over a 10-year period.
• To analyze shifts in preoperative range of motion (ROM) and patient-reported outcome measures (PROMs) influencing RSA decisions.

Main Methods:

• Retrospective review of 3536 primary RSAs from a multi-institutional database over 10 years.
• Inclusion criteria: osteoarthritis with rotator cuff deficiency, irreparable rotator cuff tear, and rotator cuff tear arthropathy.
• Calculation of yearly tipping points for ROM and PROMs to identify trends.

Main Results:

• Patient-reported outcome measures (PROMs) and Constant scores remained stable, with a slight increase in tipping points.
• Preoperative range of motion (ROM) measures (forward elevation, abduction, external rotation) showed small increases over time.
• Patients undergoing RSA in later years demonstrated better preoperative ROM.

Conclusions:

• The "tipping point" for ROM in patients electing RSA has increased, indicating greater preoperative motion.
• The "tipping point" for patient-reported outcomes has remained stable, suggesting consistent perceived disability.
• Surgical practice and patient selection for RSA have evolved, with increased ROM but similar perceived morbidity.