Evolution of Reverse Shoulder Arthroplasty: Two Decades of Evidence from the Journal of Shoulder and Elbow Surgery.

BACKGROUND: Reverse shoulder arthroplasty (rTSA) has evolved from a salvage procedure to a widely adopted reconstructive solution. This study performed a descriptive bibliometric and content-trend analysis of rTSA publications in the Journal of Shoulder and Elbow Surgery (JSES) from 2004-2025.

METHODS: A systematic review identified 506 clinical rTSA studies published in JSES between 2004 and 2025. Extracted variables included publication year, level of evidence, authorship, institution, geographic origin, research topic, demographics, indications, complications, and implant characteristics. Temporal trends were tested using Mann-Kendall trend test and segmented regression; the relationship between implant design representation and complication reporting was evaluated with Spearman rank correlation.

RESULTS: Annual publications increased significantly (BH-adjusted P < .001), peaking at 51 studies in 2023. Mean level of evidence improved (BH-adjusted P < .001), from 4.0 (2006) to 2.86 (2023). Early authorship centered on foundational surgeons (Frankle, Boileau, Walch) and European institutions, later diffusing globally. Mean age rose modestly, though this did not remain significant after correction for multiple comparisons (BH-adjusted P = .077), stabilizing near 70-72 years after 2012. Research focus shifted from complications/technique toward outcomes after 2013, then toward instrumentation, rehabilitation, and cost. Osteoarthritis indications increased (BH-adjusted P = .005) while revision surgery declined (BH-adjusted P = .002). Implant design shifted from medialized to lateralized/non-Grammont configurations (both BH-adjusted P < .001). No individual complication subtype showed a significant temporal trend.

CONCLUSION: RTSA publication trends in JSES reflect the field's evolution from complication-focused study to evidence-driven refinement. Implant design, evidence level, and indications changed significantly, alongside, but not statistically linked to, complication reporting, informing future shoulder reconstruction research directions.

LEVEL OF EVIDENCE: Literature Review, Bibliometric Analysis.