LAUSR

BACKGROUND The indications for Reverse total shoulder arthroplasty (rTSA) have expanded to include the treatment of a wide variety of shoulder pathology, and there may be significant differences in patient outcomes based upon preoperative diagnosis. METHODS A systematic review of the orthopedic literature contained in PubMed, Cochrane, and EMBASE was performed on November 14th, 2019. Studies investigating rTSA indicated for seven distinct preoperative diagnoses (massive rotator cuff tear (MCT) without glenohumeral osteoarthritis (GHOA), MCT with GHOA or cuff tear arthropathy, primary GHOA, inflammatory arthritis with a MCT, failed shoulder arthroplasty, proximal humerus fracture (PHF), and sequelae following proximal humerus fracture) were included. Main outcomes of interest included functional outcomes (abduction, external rotation, forward flexion) and patient reported outcome measures (American Shoulder and Elbow Surgeons and Constant). Due to significant variation in measurement and reporting, data on internal rotation was not extracted. Radiographic outcomes and complication rates were also extracted and recorded for each of the included studies. RESULTS 47 studies, comprising 2,280 patients met inclusion criteria. Significant improvements in functional outcomes and PROMs were found across preoperative diagnostic groups. There were no significant differences between diagnostic groups regarding improvement between preoperative and postoperative values for the outcomes of interest, with the exception that the inflammatory arthropathy group had significantly less improvement in Constant score than the primary GHOA and revision arthroplasty groups. While there were few differences in improvement between groups, there were significant differences regarding level of postoperative functional performance which was not as consistent in the context of trauma or revision operations (e.g., complex PHF, fracture sequelae, and revision arthroplasty groups). CONCLUSION rTSA can provide reliable improvement in clinical outcomes, regardless of preoperative diagnosis with few differences across diagnostic groups regarding preoperative to postoperative improvement. Primary GHOA and MCT with or without GHOA demonstrate the most reliable postoperative functional outcomes of the examined diagnostic groups. Postoperative outcomes were not as consistent in the context of trauma or revision operations, and these groups may benefit from a variety of modern advancements in rTSA, though further research into these modalities for these groups is needed. Reverse total shoulder arthroplasty also remains an important treatment option in the context of rheumatoid arthritis, with similar outcomes and complication rates compared to the six other operative indications. LEVEL OF EVIDENCE Level IV; Systematic Review.