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

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.