Factors Associated with Functional Improvement After Reverse Shoulder Arthroplasty: A Comprehensive Systematic Review and Meta-analysis
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Updated: Nov 7, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Ruitong Xiong1, Wengtai Li1, Songci Wang1
1Department of Sports Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China; Capital Medical University, Beijing, China.
Background:
Reverse total shoulder arthroplasty (rTSA) is now widely used across diverse indications. Existing meta-analyses usually evaluate single factors and rely solely on postoperative functional scores, without accounting for baseline status. A comprehensive quantitative synthesis of determinants of functional improvement, using change in validated scores from pre- to postoperative, is therefore needed.
Objective:
This study aims to systematically evaluate patient- and surgery-related determinants of functional enhancement after rTSA, based on changes in ASES score and Constant-Murley score, through a systematic review and meta-analysis, and provide an evidence-based reference for clinical decision-making.
Methods:
PubMed, EMBASE and Cochrane Library were searched from inception to November 2025. Randomized controlled trials, cohort studies, and case-control studies of reverse shoulder arthroplasty reporting relevant ASES or Constant outcomes by patient- or surgery-related exposures were included, with analyses primarily focused on preoperative-to-postoperative changes. Effect sizes were extracted and pooled using Review Manager 5.3, applying fixed- or random-effects models according to heterogeneity, with publication bias evaluation, and study quality assessment.
Results:
Sixty-five studies were included, with overall methodological quality judged to be high. Meta-analyses showed that prior shoulder surgery was the only consistent patient determinant of smaller gains in ASES and Constant scores, whereas age and obesity had no meaningful impact, and lower socioeconomic status predicted worse postoperative ASES. Among surgical factors, humeral cemented fixation and subscapularis repair were associated with greater functional improvement. Funnel plots supported the robustness of these findings.
Conclusion:
This meta-analysis is the first to prioritize pre- to postoperative change in function after rTSA. Prior shoulder surgery was associated with less improvement in ASES and Constant scores, whereas cemented humeral fixation was associated with greater improvement in Constant scores and subscapularis repair with greater improvement in ASES scores.
Level Of Evidence:
Level IV, systematic review and meta-analysis.