These authors asked the question, "how do the clinical outcomes of patients who underwent reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff compare with those who underwent reverse total shoulder arthroplasty for rotator cuff tear arthropathy (CTA)"?
They conducted a retrospective review of patients who underwent primary reverse total shoulder arthroplasty for GHOA or CTA with a minimum of 2-year follow-up.
In comparison to patients with cuff tear arthropathy, patients with a diagnosis of GHOA had an average of 12 degrees more postoperative active forward elevation, 11 degrees more external rotation as well as greater internal rotation. Patients with GHOA demonstrated better postoperative ASES, Single Assessment Numerical Evaluation, and visual analog scale scores. Minimal clinically important difference for ASES score was achieved by 97.5% of patients with GHOA compared with 86.7% of patients with CTA.
The complications within the first two years for patients having reverse total shoulder for GHOA are shown below.
Comment: It is not surprising that that reverse total shoulder for the less severe glenohumeral pathology (GHOA) would yield somewhat better outcomes than reverse total shoulder for more severe glenohumeral pathology (CTA). Of course neither the surgeon nor the patient can change the diagnosis, so this is not a modifiable risk factor.
Because the choice of procedure for GHOA is modifiable, a more important question to ask is "how do the outcomes of reverse total shoulder for GHOA compare with those of anatomic total shoulder arthroplasty for the same diagnosis?".
A comparison of the outcomes in this report of reverse total shoulder for GHOA to those from a recent large international series of patients having anatomic total shoulder for GHOA (see this link) is enlightening.
For these two similar series of two year outcomes, the comparison failed to indicate an advantage of the reverse total shoulder over anatomic total shoulder for patients with glenohumeral arthritis and an intact rotator cuff.
So the questions to be answered in future studies include
*does reverse total shoulder offer an advantage over anatomic arthroplasty to patients with primary glenohumeral arthritis and an intact rotator cuff?
*how durable are the results for each procedure?
*how do the type, rate and severity of adverse events compare in the short term as well as at 5 and 10 years?
*is there a benefit of the reverse total shoulder that merits its increased cost?
*what patient and shoulder characteristics should guide the choice between these procedures?
*is the "reverse for everything" the appropriate approach to shoulder arthroplasty?
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Here are some videos that are of shoulder interest
