Influence of design features and brand of reverse shoulder arthroplasties on survivorship and reasons for revision surgery: results of 5,494 arthroplasties with up to 15 years’ follow-up reported to the Norwegian Arthroplasty Register 2007–2022

Abstract

Background and purpose: We aimed to report the survival of different reverse shoulder arthroplasty (RSA) designs and brands, and factors associated with revision. The secondary aim was to evaluate the reasons for revision. Methods: We included 4,696 inlay and 798 onlay RSAs reported to the Norwegian Arthroplasty Register (NAR) 2007–2022. Kaplan–Meier estimates of survivorship and Cox models adjusted for age, sex, diagnosis, implant design, humeral fixation, and previous surgery were investigated to assess revision risks. The reasons for revision were compared using competing risk analysis. Results: Overall, the 10-year survival rate was 94% (confidence interval [CI] 93–95). At 5 years all brands exceeded 90%. Compared with Delta Xtend (n = 3,865), Aequalis Ascend Flex (HR 2.8, CI 1.7–4.6), Aequalis Reversed II (HR 2.2, CI 1.2–4.2), SMR (HR 2.5, CI 1.3–4.7), and Promos (HR 2.2, CI 1.0–4.9) had increased risk of revision. Onlay and inlay RSAs had similar risk of revision (HR 1.2, CI 0.8–1.8). Instability and deep infection were the most frequent revision causes. Male sex (HR 2.3, CI 1.7–3.1), fracture sequelae (HR 3.1, CI 2.1–5.0), and fractures operated on with uncemented humeral stems had increased risk of revision (HR 3.5, CI 1.6–7.3). Conclusion: We found similar risk of revision with inlay and onlay designs. Some prosthesis brands had a higher rate of revision than the most common implant, but numbers were low.

Keywords

• Arthroplasty
• Arthroplasty registry
• Implant survival
• Reverse shoulder arthroplasty
• Shoulder