Kirsch, J Bone Joint Surg Am 2022 - Outcomes after Anatomic and Reverse Shoulder Arthroplasty for the Treatment of Glenohumeral Osteoarthritis: A Propensity Score-Matched Analysis
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Outcomes after Anatomic and Reverse Shoulder Arthroplasty for the Treatment of Glenohumeral Osteoarthritis: A Propensity Score-Matched Analysis
Kirsch, Jawa, et al.·J Bone Joint Surg Am·2022·79 citations
Kirsch and colleagues compared outcomes and complications of anatomic and reverse arthroplasty for primary osteoarthritis with an intact cuff, in propensity‑matched groups.
Single‑surgeon retrospective review of a prospectively maintained database, 2015 to 2018: 134 patients (67 per group) followed a mean of 30 months.
Patient‑reported outcomes would be similar between groups, with better motion after anatomic TSA.
Key Findings
Patient‑reported outcomes did not differ: median final ASES 95 after TSA vs 93.3 after RSA (p = 0.49), and change from baseline in ASES, SANE and VAS pain was similar.
Final forward elevation (149° vs 142°, p = 0.003) and external rotation (63° vs 57°, p = 0.02) were better after TSA. Gains from baseline did not differ significantly.
Internal rotation reached L3 or higher in 68.7% after TSA vs 37.3% after RSA (p < 0.001), and gained 4 or more levels in 53.7% vs 31.3% (p = 0.009).
Complications occurred in 3 patients per group (6 of 134, 4.5%, p = 0.99), including transient nerve palsy in 1 per group.
Ten TSAs (14.9%) had glenoid radiolucent lines in at least 1 zone, none with gross loosening. One TSA (1 of 67) was revised to RSA for a cuff tear, vs no RSA revisions.
All operations were by one surgeon whose practice was shifting toward RSA for osteoarthritis, which the authors note may have introduced confirmation bias. Follow‑up was longer for TSA (p < 0.001).
Authors' conclusion
When performed for the treatment of osteoarthritis, TSA and RSA resulted in similar short-term patient-reported outcomes, with better postoperative range of motion after TSA. Longer follow-up is needed to determine the ultimate value of RSA in the setting of osteoarthritis.
Kirsch and colleagues compared outcomes and complications of anatomic and reverse arthroplasty for primary osteoarthritis with an intact cuff, in propensity‑matched groups.
Single‑surgeon retrospective review of a prospectively maintained database, 2015 to 2018: 134 patients (67 per group) followed a mean of 30 months.
Patient‑reported outcomes would be similar between groups, with better motion after anatomic TSA.
Key Findings
Patient‑reported outcomes did not differ: median final ASES 95 after TSA vs 93.3 after RSA (p = 0.49), and change from baseline in ASES, SANE and VAS pain was similar.
Final forward elevation (149° vs 142°, p = 0.003) and external rotation (63° vs 57°, p = 0.02) were better after TSA. Gains from baseline did not differ significantly.
Internal rotation reached L3 or higher in 68.7% after TSA vs 37.3% after RSA (p < 0.001), and gained 4 or more levels in 53.7% vs 31.3% (p = 0.009).
Complications occurred in 3 patients per group (6 of 134, 4.5%, p = 0.99), including transient nerve palsy in 1 per group.
Ten TSAs (14.9%) had glenoid radiolucent lines in at least 1 zone, none with gross loosening. One TSA (1 of 67) was revised to RSA for a cuff tear, vs no RSA revisions.
All operations were by one surgeon whose practice was shifting toward RSA for osteoarthritis, which the authors note may have introduced confirmation bias. Follow‑up was longer for TSA (p < 0.001).
Authors' conclusion
When performed for the treatment of osteoarthritis, TSA and RSA resulted in similar short-term patient-reported outcomes, with better postoperative range of motion after TSA. Longer follow-up is needed to determine the ultimate value of RSA in the setting of osteoarthritis.