Influence of preoperative diagnosis on outcomes after reverse total shoulder arthroplasty: a systematic review

Background

Reverse total shoulder arthroplasty (rTSA) is currently used to treat a variety of preoperative diagnoses. Patient outcomes after rTSA may be affected by the indication in which it is used to treat.

Methods

A literature search of the PubMed and MEDLINE databases was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies were included if they reported patient-reported outcome measures (PROMs) following rTSA for the following preoperative indications: glenohumeral osteoarthritis, acute proximal humerus fracture (PHF), chronic PHF sequelae, inflammatory arthritis, revision arthroplasty, humeral head avascular necrosis, massive rotator cuff tear without arthritis, and rotator cuff tear arthropathy. The most used PROMs among the studies were the American Shoulder and Elbow Surgeons shoulder score and the Single Assessment Numeric Evaluation or the Subjective Shoulder Value. Forward elevation and external rotation were also evaluated.

Results

There were 30 studies from the literature review that met inclusion criteria with a total of 3,463 patients. The average age of included patients ranged from 60 to 84 years. All studies reported improved American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation or Subjective Shoulder Value scores as well as improved range of motion following rTSA. Patients who underwent rTSA for acute or chronic PHF or failed primary arthroplasty reported lower PROMs when compared to patients undergoing rTSA for other conditions of the glenohumeral joint.

Conclusion

Understanding the influence of preoperative diagnosis on rTSA outcomes can assist clinicians with preoperative risk stratification as well as managing patient expectations.