Rotator cuff preserving reverse shoulder arthroplasty vs. eccentrically reamed anatomic total shoulder arthroplasty for glenohumeral osteoarthritis and an intact rotator cuff with B2 glenoid deformity

Abstract

BackgroundAnatomic total shoulder arthroplasty (TSA) is a common treatment choice for patients with advanced glenohumeral osteoarthritis and an intact rotator cuff. In the setting of B2 glenoid deformity, eccentric glenoid reaming with a TSA is a viable option; however, an increasing trend is to perform a reverse shoulder arthroplasty (RSA). The ideal implant choice for these patients is still uncertain. MethodsA retrospective review of an eccentrically reamed TSA (ER-TSA) cohort vs. a rotator cuff–preserving RSA (RCP-RSA) cohort performed from 2013 to 2021 was completed. Any patient with evidence of a B2 glenoid verified by preoperative computed tomography or magnetic resonance imaging was considered for inclusion. A retrospective review of patients’ last clinical follow-up was performed and radiographic review of postoperative complications. All patients were then contacted by phone to determine if they underwent any revision surgery and to obtain American Shoulder and Elbow Surgeons (ASES) scores. ResultsIn the ER-TSA cohort, 18 patients were identified and contacted for follow-up ASES questionnaire. The average age was 72. The average follow-up was 4.7 years, with an average clinic follow-up period of 15 months. The delta range of motion (ROM) for forward flexion was +35° improvement, for abduction was +17°, and for external rotation was +23°. The average ASES score was 87. For the RCP-RSA cohort, 17 patients were identified and contacted for ASES questionnaire with 19 total shoulders. The average age was 75. The average follow-up was 2.5 years, with an average clinic follow-up period of 18 months. The delta ROM for forward flexion was +53° improvement, for abduction was +61°, and for external rotation was +23°. The average ASES score was 93. ConclusionIn the present cohorts of ER-TSA vs. RCP-RSA for glenohumeral osteoarthritis with an intact rotator cuff and B2 glenoid deformity in patients 65+ years old, there were no revisions, and overall patients reported an ASES score of 87 for ER-TSA and 93 for RCP-RSA. This study demonstrates that both ER-TSA and RCP-RSA remain a viable option, however it also shows that RCP-RSA has better early to midterm patient-reported outcome measures, the ability to account for worse posterior glenoid deformity, and has greater overall improvement in ROM in such a commonly encountered patient population.