Male patients experience similar improvement in clinical and functional outcomes despite higher revision rates following reverse shoulder arthroplasty compared to female patients: a systematic review and meta-analysis

Abstract

Background

To compare patient-reported outcomes, range of motion, and rates of revision surgery following primary reverse shoulder arthroplasty (RSA) between male and female patients.

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 January 20, 2024, using the PubMed, Embase, and Scopus library databases for human clinical studies reporting postoperative outcomes and revision rates following RSA between male and female patients. Studies were excluded if patients underwent RSA for proximal humerus fractures. 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

Five studies consisting of 3227 male (mean age, 72.2 years; mean follow-up, 29.4 months) and 5649 female (mean age, 72.7 years; mean follow-up, 29.2 months) patients were included. At final follow-up, male and female patients reported similar improvements in postoperative Constant scores (mean difference, −1.63; P = .17), American Shoulder and Elbow Surgeons scores (mean difference, −1.66; P = .26), external rotation (mean difference, −1.82°; P = .17), forward flexion (mean difference, 0.47°; P = .91), and abduction (mean difference, 0.85°; P = .82) when compared to female patients. Revision rates were significantly higher in males when compared to those in females (5.1% vs. 1.9%, respectively; P < .001).

Conclusion

Males undergoing RSA report similar improvement in postoperative patient-reported outcomes and range of motion values at a mean final follow-up of 29.4 months when compared to females with a mean final follow-up of 29.2 months. However, revision rates were significantly higher in males.