Patients 75 years or older with primary glenohumeral arthritis and an intact rotator cuff show similar clinical improvement after reverse or anatomic total shoulder arthroplasty

Abstract

BackgroundThe optimal management of primary glenohumeral arthritis (GHOA) in the elderly is an ongoing topic of debate. The purpose of this study was to compare functional outcomes and complications in patients aged 75 years or older treated with anatomic total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) for primary GHOA with an intact rotator cuff. MethodsA retrospective study was performed on a prospectively maintained database which was queried for patients 75 years of age or older who underwent TSA or RSA for primary GHOA with an intact rotator cuff at a single institution between 2012 and 2021 with minimum 2-year follow-up. Patient-reported outcomes (PROs), including Visual Analog Scale for pain (VAS), American Shoulder and Elbow Surgeons (ASES), and Subjective Shoulder Value (SSV), as well as active range of motion including forward flexion (FF), external rotation (ER), internal rotation (IR), were collected pre- and postoperatively. Complications, reoperations, and satisfaction were also recorded. The percentage of patients achieving clinically significant improvement was evaluated with the minimally clinical important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for each PRO. ResultsOne-hundred and four patients were available for analysis, including 67 TSA patients and 37 RSAs with a mean follow-up of 39.4 months. Preoperative baseline characteristics, PROs, and ROM were similar between groups. RSA was more commonly performed for eccentric glenoid wear (Walch B2/B3, 62% vs 22%; p < 0.001). While clinical outcomes improved comparably in both groups, the TSA cohort showed significantly greater improvement in ER (36° vs 26°; p=0.013). Both cohorts had low revision (3% for TSA vs 0% for RSA) and complication (7% for TSA vs 5% for RSA; p=0.677) rates. Satisfaction was similar in both groups (93% for TSA vs 92% for RSA; p=0.900). Clinically significant improvement was comparable between groups based on the ASES score (MCID, 93% for TSA vs 100% for RSA; SCB, 82% vs 95%; PASS, 67% vs 78%; p > 0.05). ConclusionIn this retrospective small sample size comparison study, TSA and RSA provide similar short-term clinical outcomes for patients 75 years and older with primary GHOA and an intact rotator cuff. Complication and revision rates are comparably low at short-term follow-up. Our data suggests that advanced age alone should not be used as a decision-making tool for TSA versus RSA in the setting of primary GHOA with an intact rotator cuff.