Trends in Reverse Total Shoulder Arthroplasty: How the Early Trends in New Innovation Provide Experience in Utilization of Later Designs

Background Recent literature has described an increase in overall rates of shoulder arthroplasty procedures being performed. To date few reports have characterized the yearly trended earliest incidence of introduction of the then innovative reverse total shoulder arthroplasty (RTSA) since FDA approval in 2003. This study aimed to describe the earliest surgical trends in RTSA use performed in the United States over time. We believe this knowledge will help show how early trends in new innovations provide experience to understand later iterative innovation in the same device. Methods Two complementary datasets that recorded RTSA use discretely at the advent of use in America were reviewed to compare the rates of RTSA being performed on national and regional levels over time. The American Board of Orthopaedic Surgery (ABOS) national database was reviewed, to identify all shoulder arthroplasty cases reported by Part II candidates from 2005-2010. RTSA, total shoulder arthroplasty (TSA), and shoulder hemiarthroplasty cases were each identified separately. Additionally, a regional integrated healthcare system implant registry was reviewed to identify all RTSA, TSA, and shoulder hemiarthroplasty cases performed from 2005-2010. Surgical trends in RTSA rates from both datasets were calculated and compared. Results From 2005-2010 the national ABOS database reported 2,674 shoulder arthroplasty cases, of which 425 were RTSA. In 2005, 19 RTSA cases were reported to the ABOS and constituted 5.2% of all shoulder arthroplasty cases reported. In 2010, 108 RTSA cases were reported and constituted 24.5% of all shoulder arthroplasty cases, an increase of 369%. Meanwhile the regional integrated healthcare system implant registry from 2005-2010 reported 1519 shoulder arthroplasty cases of which 174 were RTSA. In 2005, 8 RTSA cases were reported through this registry and constituted 4.1% of all shoulder arthroplasty cases. In 2010, 49 RTSA cases were performed and constituted 14.9% of all shoulder arthroplasty cases, an increase of 173%. Conclusion Rates of RTSA being performed have increased dramatically since FDA approval. Both regional and national rates showed this increase, suggesting a lack of regional bias. The rise of RTSA use has continued since these early documented rates with newer literature supporting increases in indications and volumes. This report serves as a retrospective comparison of the earliest documented RTSA use. The use rates early in the experience of the innovative idea of RTSA may be instructive and educational to surgeons in this time of expanding indications for RTSA and with utilization of newer RTSA designs. Level of Evidence Level III Retrospective Comparative Study