Variation in reverse shoulder replacement surgery: A survey of UK shoulder surgeons

Background: Despite reverse shoulder replacement (RSR) being the predominant form of shoulder arthroplasty in the United Kingdom, substantial variation exists in implant selection and surgical technique. This study aims to capture current RSR practice among members of the British Elbow and Shoulder Society (BESS). Methods: A 24-question online survey was sent to BESS surgeon members in December 2024, assessing routine practice in both trauma and elective RSR. Descriptive statistical analysis was performed. Results: In total, 127 surgeons responded. Over half performed at least 20 RSRs annually (54.3%). The most common glenosphere sizes were 42 mm and 36 mm for male and female patients, respectively. Glenoid onlay components were used by 87.9% of respondents, and humeral inlay components by 55.6%. Most surgeons used symmetric liners (69.2%), a standard (50.0%) or short (48.4%) humeral stem, 10°-20° of humeral version (56.7%), and 135° (45.4%) or 145° neck-shaft angles (36.1%). Intraoperatively, 79.5% of surgeons routinely repaired the subscapularis, and metallic augments (70.9%) were the most used method of building offset. Preoperative planning was used by 67.7% of surgeons, while 7.9% used computer navigation. Discussion: This survey highlights variation in implant selection, operative technique, and technology use among UK surgeons, underscoring the need for evidence-based standardisation.