These authors compared the two year outcome measures between anatomic total shoulder (TSA) and reverse total shoulder (RTSA) for patients with shoulder arthritis. Patients with a diagnosis of inflammatory arthritis, infection, proximal humerus fracture, or revision TSA were excluded.
A total of 659 TSA and 172 RTSA patients were included. Total shoulder arthroplasty had a larger improvement in ASES scores compared with RTSA.
Comment: The value of a procedure to the patient is commonly defined as the amount of improvement divided by the cost. It is recognized that a major component of arthroplasty cost is the the expense of the implant. As shown in the data from Orthopaedic Network News below, the average selling price for a reverse total shoulder implant is about $7,700 in comparison to the average selling price for an anatomic arthroplasty implant of $4,500.
Using these data, the implant costs per unit improvement in the ASES score were about $93 for the anatomic shoulders and over twice as much (about $200 per unit improvement in the ASES score) for the reverse total shoulders.
This analysis indicates that both the patient reported improvement and the implant costs are important components of determining the value of different types of implants in the management of glenohumeral arthritis.
The results of this study need to be viewed with caution, however, because the diagnoses in the two groups were not the same. Of patients who underwent TSA, the majority had a preoperative diagnosis of OA (96.2%; 634 of 659), and of the patients who underwent RTSA, the majority had a preoperative diagnosis of cuff tear arthropathy ( CTA) (66.3%; 114 of 172). 26.2% (45 of these 172) had a preoperative diagnosis of rotator cuff deficiency in the setting of OA or notable glenoid deformity.
A study comparing the value of TSA vs RSA needs to be sure that the patients in each group are comparable with respect to diagnosis, age and overall health.
How you can support research in shoulder surgery Click on this link.
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The total shoulder arthroplasty (see this link).
The ream and run technique is shown in this link.
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
Shoulder rehabilitation exercises (see this link).
Follow on twitter: Frederick Matsen (@shoulderarth)
Average selling price (ASP) data from Orthopaedic Network News
Reverse:
Anatomic
