Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta‐Analysis
ABSTRACT Background It is still unclear whether reverse total shoulder arthroplasty (RTSA) has advantages over traditional hemiarthroplasty (HA) and anatomic total shoulder arthroplasty (ATSA) in the treatment of complex shoulder joint diseases. Therefore, this study aims to evaluate the clinical ef...
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| Format: | Article |
| Language: | English |
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Wiley
2025-02-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.14311 |
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| author | Huankun Li Hangsheng Bao Zhidong Yang Baijun Hu Yaocheng Pan Yi Wang Jiayi Chen Hongjun Chen Bisheng Shen Yonggen Zou |
| author_facet | Huankun Li Hangsheng Bao Zhidong Yang Baijun Hu Yaocheng Pan Yi Wang Jiayi Chen Hongjun Chen Bisheng Shen Yonggen Zou |
| author_sort | Huankun Li |
| collection | DOAJ |
| description | ABSTRACT Background It is still unclear whether reverse total shoulder arthroplasty (RTSA) has advantages over traditional hemiarthroplasty (HA) and anatomic total shoulder arthroplasty (ATSA) in the treatment of complex shoulder joint diseases. Therefore, this study aims to evaluate the clinical effectiveness of RTSA in the treatment of complex shoulder joint diseases and further determine whether it is necessary to expand the indications of RTSA. Method We conducted a systematic search of studies published between January 1, 2012 and May 31, 2023 in PubMed, Embase, and Cochrane databases. The experimental group included patients who underwent primary reverse total shoulder arthroplasty (RTSA), while the control group consisted of patients who underwent primary hemiarthroplasty (HA) or anatomic total shoulder arthroplasty (ATSA). The minimum follow‐up period was 1 year, and a random‐effects model was utilized for data synthesis. Results A total of 45 studies were included in the meta‐analysis. Compare to HA, RTSA showed significant advantages in postoperative ASES scores (p = 0.004), forward flexion (p < 0.0001), and abduction (p < 0.0001). Compare to ATSA, RTSA showed significantly lower postoperative Constant scores (p = 0.004), ASES scores (p = 0.001), SST scores (p < 0.0001), forward flexion (p < 0.0001), abduction (p = 0.011), internal rotation (p < 0.0001), and external rotation (p < 0.0001). Further meta regression analysis was conducted, considering factors such as region, age, gender ratio, and follow‐up time, excluding the influence of relevant factors. Overall, RTSA did not demonstrate advantages in postoperative functional scores and range of motion. In terms of complication and revision rates, RTSA had lower rates compared to HA and ATSA, except for the complication rate, where there was no significant difference between RTSA and ATSA (p = 0.521), but statistically significant differences were observed in other measures. Conclusion RTSA demonstrates better clinical efficacy compared to HA but is inferior to ATSA. It can be considered for expanding treatment options for elderly patients with 3 or 4‐part proximal humeral fractures, but it is not suitable for treating end‐stage shoulder arthritis and humeral head necrosis. Overall, the decision to use RTSA should be carefully evaluated based on the extent of the patient's rotator cuff injury. |
| format | Article |
| id | doaj-art-91a2a1b7c8f646b49e0fc012e324dbc2 |
| institution | Kabale University |
| issn | 1757-7853 1757-7861 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj-art-91a2a1b7c8f646b49e0fc012e324dbc22025-02-03T03:10:59ZengWileyOrthopaedic Surgery1757-78531757-78612025-02-0117231333210.1111/os.14311Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta‐AnalysisHuankun Li0Hangsheng Bao1Zhidong Yang2Baijun Hu3Yaocheng Pan4Yi Wang5Jiayi Chen6Hongjun Chen7Bisheng Shen8Yonggen Zou9The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine Foshan ChinaThe Eighth Clinical Medical College of Guangzhou University of Chinese Medicine Foshan ChinaThe Eighth Clinical Medical College of Guangzhou University of Chinese Medicine Foshan ChinaZhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine Zhongshan ChinaThe Eighth Clinical Medical College of Guangzhou University of Chinese Medicine Foshan ChinaThe Eighth Clinical Medical College of Guangzhou University of Chinese Medicine Foshan ChinaZhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine Zhongshan ChinaZhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine Zhongshan ChinaThe Eighth Clinical Medical College of Guangzhou University of Chinese Medicine Foshan ChinaThe Eighth Clinical Medical College of Guangzhou University of Chinese Medicine Foshan ChinaABSTRACT Background It is still unclear whether reverse total shoulder arthroplasty (RTSA) has advantages over traditional hemiarthroplasty (HA) and anatomic total shoulder arthroplasty (ATSA) in the treatment of complex shoulder joint diseases. Therefore, this study aims to evaluate the clinical effectiveness of RTSA in the treatment of complex shoulder joint diseases and further determine whether it is necessary to expand the indications of RTSA. Method We conducted a systematic search of studies published between January 1, 2012 and May 31, 2023 in PubMed, Embase, and Cochrane databases. The experimental group included patients who underwent primary reverse total shoulder arthroplasty (RTSA), while the control group consisted of patients who underwent primary hemiarthroplasty (HA) or anatomic total shoulder arthroplasty (ATSA). The minimum follow‐up period was 1 year, and a random‐effects model was utilized for data synthesis. Results A total of 45 studies were included in the meta‐analysis. Compare to HA, RTSA showed significant advantages in postoperative ASES scores (p = 0.004), forward flexion (p < 0.0001), and abduction (p < 0.0001). Compare to ATSA, RTSA showed significantly lower postoperative Constant scores (p = 0.004), ASES scores (p = 0.001), SST scores (p < 0.0001), forward flexion (p < 0.0001), abduction (p = 0.011), internal rotation (p < 0.0001), and external rotation (p < 0.0001). Further meta regression analysis was conducted, considering factors such as region, age, gender ratio, and follow‐up time, excluding the influence of relevant factors. Overall, RTSA did not demonstrate advantages in postoperative functional scores and range of motion. In terms of complication and revision rates, RTSA had lower rates compared to HA and ATSA, except for the complication rate, where there was no significant difference between RTSA and ATSA (p = 0.521), but statistically significant differences were observed in other measures. Conclusion RTSA demonstrates better clinical efficacy compared to HA but is inferior to ATSA. It can be considered for expanding treatment options for elderly patients with 3 or 4‐part proximal humeral fractures, but it is not suitable for treating end‐stage shoulder arthritis and humeral head necrosis. Overall, the decision to use RTSA should be carefully evaluated based on the extent of the patient's rotator cuff injury.https://doi.org/10.1111/os.14311anatomical total shoulder arthroplastyhemi‐arthroplastyindicationsmeta‐analysisreverse shoulder arthroplasty |
| spellingShingle | Huankun Li Hangsheng Bao Zhidong Yang Baijun Hu Yaocheng Pan Yi Wang Jiayi Chen Hongjun Chen Bisheng Shen Yonggen Zou Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta‐Analysis Orthopaedic Surgery anatomical total shoulder arthroplasty hemi‐arthroplasty indications meta‐analysis reverse shoulder arthroplasty |
| title | Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta‐Analysis |
| title_full | Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta‐Analysis |
| title_fullStr | Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta‐Analysis |
| title_full_unstemmed | Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta‐Analysis |
| title_short | Whether the Indications for Reverse Shoulder Arthroplasty Should Continue to Be Expanded? A Systematic Review and Meta‐Analysis |
| title_sort | whether the indications for reverse shoulder arthroplasty should continue to be expanded a systematic review and meta analysis |
| topic | anatomical total shoulder arthroplasty hemi‐arthroplasty indications meta‐analysis reverse shoulder arthroplasty |
| url | https://doi.org/10.1111/os.14311 |
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