A comparative analysis of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty for posterior...

Reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA) are well-known methods of treating glenohumeral arthritis, which often leads to posterior wear of the glenoid. This study compared minimum two-year outcome measures in patients treated with RSA and TSA for Walch B2 and B3 glenoids.

Thirty-eight shoulders underwent TSA and 40 shoulders underwent RSA by two fellowship-trained shoulder surgeons at a tertiary referral center.

The mean time for follow-up was 25.9 months and 25.5 months for RSA and TSA groups, respectively (P = 0.47). The RSA group consisted of 27 males and 13 females; whereas the TSA group had 37 males and 1 female (P = <0.001). The mean age for RSA was 71 years old, 61 years for TSA (P = <0.001). TSA patients demonstrated superior average active external rotation (47° vs 40°; P = 0.003) and internal rotation (60° vs 52°; P = 0.002). Active forward elevation did not significantly differ. The TSA group had 7 (18.4 %) postoperative complications, the RSA group had 3 (7.5 %) (P = 0.27). The most common complication was cephalic vein thrombosis. No complication required revision.

Patients with shoulder osteoarthritis and posterior glenoid wear patterns with an intact rotator cuff who underwent TSA had similar outcomes as RSA. While the TSA group had superior active external rotation and internal rotation at 2 years postoperative compared with RSA, the 2-year active forward elevation was equivalent. Both groups had similar 2-year outcomes for strength in all planes and in all three clinical-outcome scoring systems. The TSA group demonstrated a higher incidence of postoperative complications. Neither group required reoperations. These results indicate that TSA and RSA can be safely utilized in posterior glenoid wear patterns with good clinical outcomes.

Level III; Retrospective cohort study.