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Shoulder Replacement in the Elderly with Anatomic versus Reverse Total Prosthesis? A Prospective 2-Year Follow-Up

Maciej J K Simon1,2, Jennifer A Coghlan1,3, Simon N Bell1,3

  • 1Melbourne Shoulder and Elbow Centre, 1/80 Beach Road, Sandringham, Melbourne, VIC 3191, Australia.

Journal of Clinical Medicine
|February 15, 2022
PubMed
Summary

For older patients (≥75 years) with an intact rotator cuff, anatomic total shoulder replacement (aTSR) offers better clinical outcomes and fewer complications than reverse total shoulder replacement (rTSR). This finding aids surgical decisions for shoulder arthroplasty in this demographic.

Keywords:
Lazarus scoreSirveaux scoreanatomic total shoulder replacementclinical scoresolder patientsreverse total shoulder replacement

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Area of Science:

  • Orthopedic surgery
  • Geriatric medicine
  • Biomedical engineering

Background:

  • Uncertainty exists regarding the optimal total shoulder replacement (TSR) type for older patients (≥75 years) with an intact rotator cuff.
  • Anatomic TSR (aTSR) and reverse TSR (rTSR) are surgical options, necessitating comparative outcome analysis.

Purpose of the Study:

  • To compare the clinical and radiological outcomes of aTSR versus rTSR in patients aged 75 years and older.
  • To assess patient-reported outcome measures (PROMs) and complication rates between the two surgical approaches.

Main Methods:

  • Prospective cohort study of 44 patients receiving aTSR and 51 patients receiving rTSR.
  • Clinical outcomes assessed using ASES, Constant, SPADI, and DASH scores, alongside range of motion (ROM), pain, and satisfaction at 2-year follow-up.
  • Radiological assessment for glenoid and humeral component osteolysis and notching.

Main Results:

  • Both aTSR and rTSR groups showed postoperative improvements in ROM and clinical scores.
  • The aTSR group reported significantly better PROMs compared to the rTSR group (p < 0.001).
  • Complications included scapular stress fractures in the rTSR group (n=11) and acromioclavicular joint pain in both groups; no revisions were required.

Conclusions:

  • Anatomic TSR (aTSR) leads to superior clinical outcomes and fewer early complications in older patients (≥75 years) with intact rotator cuffs compared to reverse TSR (rTSR).
  • aTSR is a favorable option for this specific patient population undergoing total shoulder replacement.