Reverse and Anatomic Total Shoulder Arthroplasty for Glenohumeral Osteoarthritis: A Propensity-Matched Comparison at Early and Midterm Follow-up.

Abstract

Reverse shoulder arthroplasty (rTSA) and anatomic total shoulder arthroplasty (aTSA) treat glenohumeral osteoarthritis (GHOA) with comparable early outcomes. Given increasing utilization of rTSA for GHOA, we sought to evaluate outcomes of rTSA and aTSA for GHOA at early and midterm follow-up. A retrospective propensity-matched cohort study of patients undergoing aTSA and rTSA for GHOA with early and midterm follow-up was performed. Matching included age, sex, body mass index (BMI), preoperative American Shoulder and Elbow Surgeons (ASES) score, preoperative forward elevation, and Walch glenoid morphology. Baseline patient characteristics, range of motion (ROM), ASES, Single Assessment Numerical Evaluation (SANE), visual analog scale (VAS) for pain scores, complications and revision rTSAs/aTSAs were assessed at early and midterm follow-up. 122 patients (61 per group) were included with early and midterm follow-up. Baseline characteristics, comorbidities, preoperative ASES, SANE, VAS pain scores, and ROM were similar (p > 0.05). Both groups showed significant improvements in ASES, SANE, and VAS scores at both time points (p < 0.001); >96% achieved Minimal Clinically Important Difference (MCID) for ASES. While more aTSA patients met Substantial Clinical Benefit (SCB) early (95.1% vs. 80.3%, p = 0.027); there was no statistically significant difference at midterm follow-up (p = 0.074). aTSA patients had better early internal (5.0 vs. 3.3, p < 0.001) and external rotation (63.0° vs. 57.0°, p = 0.036), with no difference at midterm follow-up.Complication rates were similar; however, aTSA had more revisions and radiolucencies. TSA and rTSA yield similar clinical outcomes for GHOA at early and midterm follow-up. Early differences in SCB, internal and external rotation with aTSA diminished by midterm follow-up. Complication rates were similar between the cohorts. One patient in the aTSA group was revised to rTSA and no patients with primary rTSA required revision. While rTSA and aTSA result in excellent clinical outcomes, longer follow-up is needed to determine durability.