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Figure B
8%
120/1547
Figure C
63%
977/1547
Figure D
13%
194/1547
Figure E
14%
220/1547
Figure F
2%
24/1547
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Various studies quote a decrease in surgeon specific complications after performing between 18 to 45 reverse total shoulder arthroplasties (RSA). Only Figure C shows a number in this range. RSA is a type of shoulder arthroplasty that uses a convex glenoid (hemispheric ball) and a concave humerus (articulating cup) to reconstruct the glenohumeral joint. Complications associated with the procedure include scapular notching, glenoid malposition, acromial fractures, and neurovascular injuries. Various studies have shown that there is a learning curve associated with performing the RSA. The number of RSAs that need to be performed by a surgeon appears to be between 18 and 45 cases before early complications decrease. Riedel et al. performed a retrospective review of 62 patients having undergone an RSA to quantify the surgical learning curve for RSA. Using data from consecutive cases, surgical time was plotted against patient case order and the number of cases needed to arrive at the flat slope of the curve was defined as the proficiency point. The authors noted a learning curve of approximately 18 cases in this series based on the technical aspects of performing RSA. Kempton et al. determined the types and rates of early complications in RSA in 200 consecutive RSAs performed by a single surgeon to determine the number of cases needed for complications to decrease. The local complication rate was higher in the first 40 shoulders (23.1%) versus the last 160 shoulders (6.5%). The authors concluded that the early complication-based learning curve for RSA is approximately 40 cases. They also noted there was a trend toward more complications in revision versus primary RSAs and more neuropathies in revisions. Figure A reveals a right shoulder that has undergone a RSA. Figures B-F all show a decrease in surgeon-specific complication rate over time at various procedure numbers. Incorrect Answers: Answers B, D, E, and F: Studies quote a decrease in complication rate after performing between 18 to 45 RSAs. Only Figure C shows a number within this range.
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