Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty.

Abstract

BACKGROUND:

Anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are increasingly common procedures employed to treat arthritic conditions. Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff, concerns about RTSA persist because of variable complication rates and outcomes.

METHODS:

This is a prospective, case-control study comparing outcomes and complications after TSA and RTSA. The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy. Average clinical follow-up was more than 2 years in both groups. Major complications included infection, periprosthetic fracture, instability, glenoid loosening, and need for revision surgery. Patient outcome measures included the American Shoulder and Elbow Surgeons score, pain visual analog scale score, and goniometer-measured range of motion. Plain radiographs were reviewed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA.

RESULTS:

At 2 years, there were no differences in rate of major complications (TSA, 15%; RTSA, 13%; P = .808) or revision surgeries (TSA, 11%; RTSA, 9%). Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups. TSA patients had greater external rotation than RTSA patients did (53° vs 38°; P = .001). Otherwise, forward flexion, abduction, and internal rotation were comparable in range of motion.

CONCLUSIONS:

TSA and RTSA have similar complication rates, need for revision, patient-reported outcomes, and range of motion at 2 years of follow-up. The use of side-by-side cohorts in this study allows standardized comparison between these 2 shoulder arthroplasty procedures.

• Authors: Tuyen K Kiet, Brian T Feeley, Micah Naimark, Tatiana Gajiu, Sarah L Hall, Teddy T Chung, C Benjamin Ma
• Journal: Journal of shoulder and elbow surgery (J Shoulder Elbow Surg) Vol. 24 Issue 2 Pg. 179-85 (Feb 2015) ISSN: 1532-6500 [Electronic] United States
• PMID: 25213827 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Topics

• Arthritis (surgery)
• Arthroplasty, Replacement (adverse effects, methods)
• Case-Control Studies
• Follow-Up Studies
• Glenoid Cavity (diagnostic imaging)
• Humans
• Pain Measurement
• Periprosthetic Fractures (etiology)
• Prospective Studies
• Prosthesis Failure (etiology)
• Prosthesis-Related Infections (etiology)
• Radiography
• Range of Motion, Articular
• Reoperation
• Rotator Cuff (surgery)
• Rotator Cuff Injuries
• Shoulder Joint (diagnostic imaging, physiopathology, surgery)
• Treatment Outcome