Abstract
Reverse total shoulder arthroplasty (RTSA), initially indicated for cuff tear arthropathy, is increasingly used for elderly patients with primary glenohumeral osteoarthritis (GHOA) and an intact rotator cuff. This is often done to avoid revision surgery in elderly patients for rotator cuff failure with anatomic total shoulder arthroplasty (TSA) despite traditionally good outcomes of TSA. We sought to determine whether there was a difference in outcomes for patients ≥70 years who receive RTSA compared to TSA for GHOA. A retrospective cohort study was conducted using data from a US integrated health care system's Shoulder Arthroplasty Registry. Patients ≥70 years who underwent primary shoulder arthroplasty for GHOA with an intact rotator cuff were included (2012-2021). RTSA was compared to TSA. Multivariable Cox proportional hazard regression was used to evaluate all-cause revision risk during follow-up, while multivariable logistic regression was used to evaluate 90-day emergency department (ED) visit, and 90-day readmission. The final study sample comprised 685 RTSA and 3,106 TSA. Mean age was 75.8 years (standard deviation 4.6) and 43.4% were male. After accounting for confounders, no significant difference in all-cause revision risk was observed for RTSA compared to TSA (hazard ratio=0.79, 95% confidence interval [CI]=0.39-1.58). The most common reason for revision following RTSA was glenoid component loosening (40.0%). Over half (54.0%) of revisions following TSA were for rotator cuff tear. No difference between procedure type was observed in likelihood for 90-day ED visits (odds ratio [OR]=0.94, 95% CI=0.71-1.26) and 90-day readmission (OR=1.32, 95% CI=0.83-2.09). RTSA and TSA for GHOA with an intact rotator cuff in patients ≥70 years had a similar revision risk, as well as likelihood for 90-day ED visits and readmissions. While revision risk was similar, the most common causes for revision were different with rotator cuff tears for TSA and glenoid component loosening for RTSA.
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