Anatomic and reverse total shoulder arthroplasty for osteoarthritis: outcomes in patients 80 years old and older

There has been an increase in both primary anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) over the last decade, with rates peaking for patients aged 75 years and older. Despite aTSA being the mainstay of treatment for patients with glenohumeral arthritis in the absence of rotator cuff insufficiency, there has been an upward trend of rTSA utilization in the elderly due to concerns about rotator cuff integrity, regardless of deformity. The purpose of this study is to evaluate outcomes including pain, function, range of motion, satisfaction, and complications in patients 80 years or older following primary aTSA and rTSA for osteoarthritis without full thickness rotator cuff tears.

A retrospective query of our institution's shoulder and elbow surgery repository identified patients treated with aTSA or rTSA between November 2006 and February 2022. Patients ≥80 year old with minimum 2-year follow-up who underwent surgery for a primary indication of osteoarthritis without a full thickness rotator cuff tear were included. Patient-reported outcome measures (PROMs; American Shoulder and Elbow Surgeons, Simple Shoulder Test, Single Assessment Numeric Evaluation, Visual Analog Score Function, and Visual Analog Score Pain scores), range of motion, and strength were evaluated at the visit immediately before surgery and at most recent follow-up. Patient satisfaction was also evaluated at most recent follow-up. Complications and revisions were reported.

A total of 130 patients (77 aTSA and 53 rTSA) met inclusion criteria. There were no significant differences in demographics between cohorts. At most recent follow-up, there were no significant differences in PROMs between cohorts. aTSA patients achieved greater postoperative motion in external rotation (50° vs. 40°; P = .003) and internal rotation (8 vs. 5; P = .001), with no difference in forward elevation. There were 6 complications amongst aTSA patients (7.8%): 4 with subscapularis insufficiency, one humeral shaft periprosthetic fracture treated with open reduction and internal fixation, and one with prosthetic joint infection revised to a functional composite spacer. Three rTSA patients (5.6%) sustained complications - all acromion/scapular spine fractures (2 type 2; 1 type 3) which were treated nonoperatively. There was no significant difference in the rate of complications or revisions between groups.

Both aTSA and rTSA for osteoarthritis yield similarly high patient satisfaction, good functional outcomes, and low complication rates in patients over the age of 80 years.