Reverse total shoulder outcomes in female patients, are they worse than for male patients? Fractures in 26%

A recent post, What is the outcome of shoulder joint replacement arthroplasty? - need to consider all three dimensions  emphasized the importance of understanding the three different dimensions of measuring the outcome of shoulder arthroplasty: the final scores for comfort and function, the improvement in the comfort and function scores, and the patient satisfaction. In that post, it was pointed out that these three dimensions often yielded different impressions of the surgical outcome.

This point is demonstrated by a recent series of 693 patients receiving an Anatomical Shoulder Inverse/Reverse prosthesis (Zimmer-Biomet).

The authors of Why is female gender associated with poorer clinical outcome after reverse total shoulder arthroplasty? reported the absolute Constant scores (aCS), relative Constant scores (rCS) and Subjective Shoulder Values (SSV) for 422 female patients and 271 male patients. The results are shown below:

final score for comfort and function scores (better in males)

females: aCS  63.5, rCS 77.7, SSV 78.4%

males:    aCS  67.6, rCS 81.4, SSV 79.1%

the improvement in the comfort and function scores (better in females)

females: ΔaCS 31.9, ΔrCS 38.3, ΔSSV 47.8%

males:    ΔaCS 29.6, ΔrCS 33.8, ΔSSV 46.8% 

patient satisfaction (no difference between males and females)

"the subjective satisfaction after RTSA is on average the same in men and women. The two groups also do not differ significantly in terms of postoperative pain and limitations in terms of activities of daily living"

Yet another dimension was revealed by the observation that one out of four (111 out of 422) female patients sustained an intraoperative or postoperative fracture, where as the fracture rate was half that for males.

Comment: The results of this study exemplify the three dimensions of outcome assessment. Women were equally satisfied after RTSA, they improved by a greater amount than males, but had lower final scores. 

The high fracture rate in this study is a concern. The report does not clarify if the fracture rate is related to implant design, implant size, surgical technique or to patient characteristics, such as bone mineral density.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).