title: Is there evidence that the outcomes of primary anatomic and reverse shoulder arthroplasty are getting better?
abstract: Have the results of shoulder arthroplasty got better over the last two decades? To answer this question, we sought published evidence that the patient-reported outcomes and re-operation rates have improved in reports of more recently performed anatomic (TSA) and reverse (RSA) total shoulder arthroplasties.
  
  
  
  We analyzed the arthroplasty results among studies published from 1990 to 2015, adjusting for the fact that the different publications presented patient groups with different combinations of diagnoses, used various outcome scales, and had different lengths of follow-up.
  
  
  
  The adjusted clinical outcomes (p = 0.048), but not the revision rates (p = 0.3), were significantly better for articles reporting more recent TSA procedures. Neither the clinical outcomes (p = 0.9) nor the revision rates (p = 0.4) were significantly better in articles reporting more recent RSA surgeries.
  
  
  
  Better evidence from reports with greater detail will be necessary to show that patients are realizing progressively better outcomes from shoulder arthroplasty.
  
  
  
  Level IV.
authors.affiliation: The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Somerson
authors.affiliation: The Mountain-Whisper-Light Statistics, 1827 23rd Avenue East, Seattle, WA, 98112, USA.
authors.forename: Moni B
authors.initials: MB
authors.lastname: Neradilek
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Hsu
authors.affiliation: Orthopaedic Surgery and Sports Medicine, Orlando Health, 1222 S. Orange Ave., 5th floor, Orlando, FL, 32806, USA.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Service
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
authors.forename: Albert O
authors.initials: AO
authors.lastname: Gee
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA. matsen@uw.edu.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Matsen
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome
keywords: Effect of surgical date; Published evidence; Revision rates; Shoulder arthroplasty outcomes