Anatomic or reverse total shoulder for cuff-intact arthritis in patients >70 years of age - which provides the best value?

 The outcomes of shoulder arthroplasty in those over 70 years with glenohumeral arthritis: A New Zealand Joint Registry Study.

These authors used data from New Zealand Joint Registry to compare the outcomes of a primary anatomic Total Shoulder Arthroplasty (aTSA) and a primary reverse (RTSA) performed for arthritic shoulders with an intact rotator cuff in patients >70 years old. They sought to determine if there is clear evidence to support a primary RSA in those >70 years of age instead of a primary TSA.

A total of 3449 primary TSA, 4681 primary RTSA and 104 revision RTSA’s were identified. 

The mean Oxford Shoulder Score (OSS) at 6 months for 

a primary aTSA was 39.5± 9.0

a primary RTSA was 35.5± 9.4

a revision RTSA was 32.5± 9.7.

Primary aTSA yielded significantly higher scores than primary RSTA (p <0.001)

The mean OSS at 5 years for 

a primary aTSA was 42.1± 7.5 

a primary RTSA was 39.8± 8.4 (p <0.001).

The revision rates for 

a primary TSA was 0.53/100 component-years

a primaryRTSA was 0.51/100 component years (p=0.193)

The authors listed the indications for the patients having a primary aTSA revised to a RTSA: rotator cuff disorder, dislocation, component loosening, instability, and infection.

They did not provide similar data for the indications for the patients having a primary RTSA having a revision for RTSA failure. 

These authors concluded that anatomic TSA remains the gold-standard for primary shoulder arthroplasty. For those individuals >70 years of age with OA as their primary diagnosis, a primary TSA was associated with a higher OSS score and similar revision rates to a primary RTSA.

Comment: The average selling price for a RTSA implant is about 50% higher than that of an aTSA (see data below from Orthopaedic Network News).

 If value is defined as benefit to the patient divided by cost, the patient-realized outcomes for a RTSA would have to be about 50% better to achieve the same value as that for an aTSA.

Follow on twitter: https://twitter.com/shoulderarth

Follow on facebook: https://www.facebook.com/frederick.matsen

Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/

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)

The smooth and move for irreparable cuff tears (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).

This is a non-commercial site, the purpose of which is education, consistent with "Fair Use" as defined in Title 17 of the U.S. Code.          

Note that author has no financial relationships with any orthopaedic companies.