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Reverse versus anatomic total shoulder arthroplasty: A large matched cohort analysis.

Dang-Huy Do1, Anubhav Thapaliya2, Senthil Sambandam1

  • 1Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX, 75390, USA.

Journal of Orthopaedics
|July 23, 2024
PubMed
Summary

Reverse total shoulder arthroplasty (RTSA) increases odds of medical complications like acute renal failure and anemia. Anatomic total shoulder arthroplasty (ATSA) showed fewer mechanical complications but similar infection rates. RTSA also led to longer hospital stays and higher costs.

Keywords:
AnatomicComplicationsCostMatchedReverseShoulder

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty Research
  • Health Services Research

Background:

  • Utilization of reverse total shoulder arthroplasty (RTSA) and anatomic total shoulder arthroplasty (ATSA) has significantly increased.
  • Expanded indications for RTSA necessitate a comparative analysis of outcomes with ATSA.
  • Previous studies often lacked large, nationally-representative samples or matched cohort designs.

Purpose of the Study:

  • To compare medical and surgical complications, length of stay, and hospital charges between RTSA and ATSA.
  • To conduct a large-scale, matched-cohort analysis of shoulder arthroplasty outcomes.
  • To evaluate the safety and economic implications of RTSA versus ATSA.

Main Methods:

  • Utilized the National Inpatient Sample database (2016-2019) for patient identification.
  • Employed propensity-matching to create comparable cohorts based on demographics and comorbidities.
  • Compared complication rates, length of stay, and total hospital charges using statistical tests and odds ratios.

Main Results:

  • The RTSA group exhibited higher odds of acute renal failure, blood loss anemia, and pneumonia.
  • No significant differences were observed in rates of myocardial infarction, pulmonary embolism, deep venous thrombosis, mortality, periprosthetic fracture, or dislocation.
  • RTSA was associated with increased odds of periprosthetic mechanical complications but lower odds of periprosthetic joint infection, longer hospital stays, and higher total charges.

Conclusions:

  • Patients undergoing RTSA face elevated risks of inpatient medical complications, such as acute renal failure and anemia.
  • RTSA is linked to a higher incidence of short-term periprosthetic mechanical complications compared to ATSA.
  • The findings highlight important differences in complication profiles and resource utilization between RTSA and ATSA.