Outcomes After Anatomic and Reverse Shoulder Arthroplasty for the Treatment of Glenohumeral Osteoarthritis

Abstract

Background: Reverse shoulder arthroplasty (RSA) is increasingly being utilized for the treatment of primary osteoarthritis. However, limited data are available regarding the outcomes of RSA as compared with anatomic total shoulder arthroplasty (TSA) in the setting of osteoarthritis. Methods:We performed a retrospective matched-cohort study of patients who had undergone TSA and RSA for the treatment of primary osteoarthritis and who had a minimum of 2 years of follow-up. Patients were propensity scorematched by age, sex, body mass index (BMI), preoperative American Shoulder and Elbow Surgeons (ASES) score, preoperative active forward elevation, and Walch glenoid morphology. Baseline patient demographics and clinical outcomes, including active range of motion, ASES score, Single Assessment Numerical Evaluation (SANE), and visual analog scale (VAS) for pain, were collected. Clinical and radiographic complications were evaluated.Results: One hundred and thirty-four patients (67 patients per group) were included; the mean duration of follow-up (and standard deviation) was 30 ± 10.7 months. No significant differences were found between the TSA and RSA groups in terms of the baseline or final VAS pain score (p = 0.99 and p = 0.99, respectively), ASES scores (p = 0.99 and p = 0.49, respectively), or SANE scores (p = 0.22 and p = 0.73, respectively). TSA was associated with significantly better postoperative active forward elevation (149°± 13°versus 142°± 15°; p = 0.003), external rotation (63°± 14°versus 57°± 18°; p = 0.02), and internal rotation ( ‡L3) (68.7% versus 37.3%; p < 0.001); however, there were only significant baselineto-postoperative improvements in internal rotation (gain of ‡4 levels in 53.7% versus 31.3%; p = 0.009). The overall complication rate was 4.5% (6 of 134), with no significant difference between TSA and RSA (p = 0.99). Radiolucent lines were observed in association with 14.9% of TSAs, with no gross glenoid loosening. One TSA (1.5%) was revised to RSA for the treatment of a rotator cuff tear. No loosening or revision was encountered in the RSA group.Conclusions: When performed for the treatment of osteoarthritis, TSA and RSA resulted in similar short-term patientreported outcomes, with better postoperative range of motion after TSA. Longer follow-up is needed to determine the ultimate value of RSA in the setting of osteoarthritis.

Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis

“…23,24 The majority of papers in the current literature show that there is no difference in overall complication rate between aTSA and rTSA, although the nature of the complication is different. 15,[25][26][27] However, other studies demonstrate that rTSA has a higher complication rate compared to aTSA, as it can increase mechanical complications, blood loss, postoperative pain, and the length of stay. The most common complication found in our study following aTSA is rotator cuff tear.…”

“… 3 , 29 Additionally, other studies report no difference in the functional outcome between aTSA and rTSA. 1 , 11 , 25 , 26 Mowbray et al 18 included 2490 patients for their functional outcomes (OSS), where they reported that for elderly population aged over 70 with osteoarthritis as primary diagnosis and intact rotator cuff, aTSA was associated with an improved OSS compared to primary rTSA. 18 We were unable to include this clinical outcome in our meta-analysis as Mowbray et al 18 was the only study using OSS.…”

Inverse Schulterendoprothetik – aktueller Stand

“…Neben dem beachtlichen Fortschritt im Bereich der inversen Schulterendoprothetik verbleiben weiterhin beachtliche Einschränkungen und Komplikationsmöglichkeiten. ▪ So zeigen sich trotz optimierter biomechanischer Aspekte, variabler Implantatkonfigurationen und einem allgemein erhöhten Erfahrungsschatz im Bereich der inversen Endoprothetik Bewegungseinschränkungen im Vergleich zur anatomischen Situation, die insbesondere im Bereich des rotationsbasierten Bewegungsausmaßes hervorstechen [67]. ▪ Des Weiteren konnten Probleme, etwa das skapuläre Notching, zwar reduziert, bislang aber nicht eliminiert werden, sodass vergleichende Arbeiten weiterhin Notching-Raten von bis zu 14,8 % beschreiben [68].…”

What’s New in Shoulder and Elbow Surgery

“…However, there has been a limited amount of current literature comparing RSA and TSA in the setting of osteoarthritis. Kirsch et al 8 conducted a retrospective propensity-score-matched cohort analysis to compare clinical outcomes between RSA and TSA in 134 patients with primary osteoarthritis. At a mean follow-up of 30 months, no significant differences were observed in patient-reported outcome measures (PROMs) (i.e., ASES, SANE, and VAS pain scores) between RSA and TSA.…”