Comparison of Clinical Outcomes After Anatomic Total Shoulder Arthroplasty and Reverse Shoulder Arthroplasty in Patients 70 Years and Older With Glenohumeral Osteoarthritis and an Intact Rotator Cuff.

INTRODUCTION: As the indications for reverse shoulder arthroplasty (RSA) expand beyond traditional cuff tear arthropathy, the role of RSA in elderly patients with glenohumeral arthritis and an intact rotator cuff remains unclear.
METHODS: This retrospective cohort study included 135 patients who underwent RSA or total shoulder arthroplasty (TSA) at a single tertiary orthopedic center between 2005 and 2015 and were 70 years of age or older at the time of surgery. All patients had preoperative advanced imaging confirming an intact rotator cuff but active forward elevation less than 90°. Complications, reoperations, and patient survival were recorded from the medical record. Patient-reported outcomes (Pain visual analog scale, Satisfaction Score, American Shoulder and Elbow Surgeons [ASES], and Western Ontario Osteoarthritis of the Shoulder [WOOS]) and patient-reported range of motion were collected at a minimum of 2 years after procedure.
RESULTS: There was no significant difference in complication rate or revision surgery rate between patients undergoing TSA and RSA (complications 13.7% versus 12.1%, P = 0.810; reoperations 6.9% vs 3.0%, P = 0.418). There were no differences in patient-reported outcome measures between the two groups. Mean pain visual analog scale scores were low in both groups (0.72, SD 1.93 for TSA and 0.31, SD 0.72 for RSA). Satisfaction scores were high (86.1, SD 23.3 for TSA and 91.8, SD 9.0 for RSA, P = 0.286). Mean ASES and WOOS scores were also high in both groups (86 [SD 15.6] for TSA and 83 [SD 12.6] for RSA for ASES [P = 0.400] and 86 [SD 18.3] for TSA and 89 [SD 10.2] for RSA for WOOS [P = 0.400]). One hundred percent of subjects following RSA and 98% of subjects following TSA rated their forward elevation as full or nearly full (>135°) (P = 0.516). DISCUSSION: Given the good clinical outcomes after both TSA and RSA, there may be an increased role for RSA in this elderly cohort to provide effective treatment of glenohumeral osteoarthritis. LEVEL OF EVIDENCE: Level III, retrospective comparative study.