Reverse total shoulder: better outcomes by selecting healthy patients with uncomplicated osteoarthritis

 Predictors of poor and excellent outcomes after reverse total shoulder arthroplasty

These authors reviewed 338 patients with a mean age of 71.5 year having revere total shoulder arthroplasty by an individual surgeon. The average preoperative ASES score was 35.3 which improved to 82.4 postoperatively.

Worse outcomes were associated with 

diagnoses other than primary osteoarthritis, 

insurance other than private coverage, 

lower preoperative ASES scores, 

workers’ compensation status, 

depression, 

a preoperative diagnosis of rotator cuff tear arthropathy, 

preoperative opioid use, 

a higher number of allergies, and 

prior ipsilateral shoulder surgery.

Comment: This study demonstrates what one might expect: patients who can afford private insurance, those with good preoperative shoulder function, those who have primary arthritis, those who are mentally healthy, those without prior surgery on the shoulder, and those not taking narcotics have the best outcomes after reverse total shoulder..

It would seem that this same group of patients would also do well with an anatomic shoulder arthroplasty. See the articles below:

Value Analysis of Anatomic and Reverse Shoulder Arthroplasty for Glenohumeral Osteoarthritis with an Intact Rotator Cuff

"TSA and RSA demonstrated similar outcomes and value when used to manage glenohumeral osteoarthritis with an intact rotator cuff."

Comparison of Clinical Outcomes after Anatomic Total Shoulder Arthroplasty and Reverse Shoulder Arthroplasty in Patients 70 years and Older with Glenohumeral Osteoarthritis and an Intact Rotator Cuff.

"There was no significant difference in complication rate or revision surgery rate between patients undergoing TSA and RSA. There were no differences in patient-reported outcome measures between the two groups."

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link)

Shoulder arthritis - x-ray appearance (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).