e we getting better over time? Clinical and patient-reported outcomes for reverse shoulder arthroplasty: a National Joint Registry cohort study.

OBJECTIVES: This study aims to review whether both clinical and Patient Reported Outcome Measures (PROMs) of Reverse Shoulder Arthroplasty have improved over time using the National Joint Registry (NJR). DESIGN: This study is a population-based cohort study using the NJR and Hospital Episode Statistics for England. SETTING: Publicly funded hospitals and procedures in England from 1 January 2013 to 31 December 2021. PARTICIPANTS: All patients that received a reverse shoulder arthroplasty (RSA) in the specified time period. Patients were excluded if they had less than 1 year of follow-up. MAIN OUTCOME MEASURES: Primary outcome was revision at one year. Secondary outcomes were non-revision re-operation and mortality at one year, length of stay (LOS) and mean change in Oxford Shoulder Score (OSS) from pre-operatively to 6 months post-operatively. RESULTS: There were 24 411 RSA cases available for analysis. There was no significant improvement in revision rates over time; however, there was a significant reduction in non-revision re-operations (OR 0.93 (0.86-0.99) p=0.03) and mortality (0.96 (0.92-1.00) p=0.04). LOS over time improved with an average reduction of 0.24 days per year, ranging from a mean of 3.94 days in 2013 to 2.44 days in 2021 (p<0.001). There was also a significant improvement in OSS preoperatively to 6 months as time progressed (p<0.001) with an average improvement of 0.51 points per year with a mean improvement in 2013 of 15.84 improving to 20.29 in 2021. CONCLUSION: Over the 9-year period recorded in the NJR, revision rates were low and remained similar. There has, however, been an improvement in other clinical outcomes such as non-revision reoperation and mortality as well as functional outcomes and reduced LOS, which demonstrates progress in the quality of care provided to shoulder replacement patients and is suggestive of advancements in surgical techniques, perioperative management and rehabilitation strategies.