These authors analyzed the Australian Joint Replacement Registry to compare revision rates of 3795 primary anatomic (aTSAs) using cemented all polyethylene glenoids and 8878 reverse total shoulder (rTSA) in the treatment of shoulder osteoarthritis (OA).
The characteristics of the two groups are shown below.
Overall, the authors found no differences in the 4-year cumulative percent revision rates between the groups.
The results for women are shown below
Comment: This is a valuable population-based study from a database that includes almost all of the arthroplasties performed in Australia. It is of surprise and interest that in this report there were over twice as many rTSAs as aTSAs. The data from this study of revision rates do not appear to justify the more expensive procedure (rTSAs) for this diagnosis.
There are a number of key considerations regarding this study.
(1) Patients having the two procedures differed in a number of important ways (see table above).
(2) The tipping point for having an aTSA is different from that for a rTSA (see this link).
(3) The tipping point for revising an aTSA is likely to be different from that for a rTSA.
(4) Older patients and patients with high ASA scores may be less inclined to undergo another procedure even if the outcome of the index arthroplasty was not satisfactory.
(5) The study did not compare functional outcomes of the two procedures.
Thus we agree with the conclusion of the authors that this study, "supports the continued use of aTSA with all-polyethylene glenoids for OA, despite national trends. If there is no survivorship difference between aTSA with all-polyethylene glenoids and rTSA for OA, future research should pursue other avenues such as differences in economic cost, patient-reported satisfaction, or function."
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