Reverse shoulder arthroplasty: trends in the incidence, indications and complications as reported by ABOS part II oral examination candidates from 2005 through 2017

Background: The experience of early-career orthopedic surgeons performing reverse shoulder arthroplasty (RSA) has not been previously reported. The aims of this study were to evaluate (1) the temporal trends in the incidence of and indications for RSA procedures performed among board-eligible orthopedic surgeons, (2) the temporal trends in the incidence of reported complications after RSA, and (3) the patient-related and surgeon-related variables that affected the reported complication rate. Methods: A query of the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination database for all cases of RSA from 2003 through 2017 was performed. The data over this time period was analyzed for incidence, indications, and complications. Risk factors for complication including patient demographic factors and shoulder fellowship training were also evaluated. Results: From 2003 to 2017, a total of 2,633 RSA procedures were reported. There was an increased incidence of RSA (23-fold) and increased proportion of candidates performing RSA (19-fold) (P-trend < .001). While there was an increasing trend seen in the proportion of primary (P-trend = .009) and trauma cases (P-trend < .001), declining trend was seen in the proportion of revision cases (P-trend < .001). An increasing trend was seen in the proportion of RSA cases for off-label indications (P-trend < .001). Shoulder fellowship-training was reported by 27% of the candidates, and these candidates performed 42% of all RSA procedures. The complication rate over this time period was 34% and the incidence of medical, surgical and anesthesia complications was 18%, 15%, and 1.2%, respectively. The incidence of complications increased over the study period (P-trend < .001). Mortality, reoperation, and readmission rates were 0.6%, 3.2%, and 6.4%, respectively. Risk factors for medical complications were age and trauma cases, whereas revision RSA was a risk factor for surgical complications. Shoulder fellowship-training experience was not associated with a decrease in any of the complications. Conclusion: There was a dramatic increase in the use of RSA among board eligible orthopedic surgeons in the United States. The early complication rates for ABOS candidates performing RSA are above others reported in the literature and showed an increasing trend over the study period. Despite the improvements in the literature, and shoulder fellowship training, there has been no decrease in the incidence of surgical complications over the decade represented in this study. Level of evidence: Level III; Cross-Sectional Design; Treatment Study