There is interest in comparing outcomes of anatomic and reverse total shoulders.

Two such papers have been published recently.

In Can The Reverse Total Shoulder Arthroplasty Provide As Good Of An Outcome As An Anatomic Shoulder Arthroplasty the authors conducted a retrospective review of patients who underwent TSA or RTSA between 2015 and 2019 who were enrolled in prospective multicenter registry among more than 10 sites. Inclusion criteria were: (1) primary RTSA or TSA, (2) minimum of 2 year follow-up, (3) a minimum of 130° of postoperative forward flexion and (4) minimum postoperative ASES score of 70. Exclusion criteria were: (1) fracture diagnosis, (2) revision arthroplasty, (3) patients who had a concomitant latissimus transfer at the time of surgery and (4) incomplete follow-up.

During the study period, 401 TSAs were performed, of which 318 (79%) had two-year follow-up data. Of these, 155 (49%) met criteria for a “good” outcome. Among RTSAs, 545 were available during the study period, of which 428 (79%) had two-year follow-up data. Of these, 154 (36%) met criteria for a “good” outcome. Overall 20% of these patients were lost to followup by two years.

The authors concluded that patients do well following both TSA and RTSA. In patients who have a good outcome following either TSA and RTSA, those patients who underwent TSA have superior outcomes compared to patients following RTSA. However, the change in outcome scores from pre to post surgery is often more significant with RTSA as they often start out with worse motion and clinical scores.

It is important to note that the preoperative characteristics of the two groups were different, so this is not a comparison of the two types of arthroplasty in similar patients.

In Anatomic Versus Reverse Shoulder Arthroplasty for Glenohumeral Osteoarthritis with

Intact Rotator Cuff: A Retrospective Comparison of Patient-Reported Outcomes Using

the Systems Outcomes Database with up to 5-Year Follow-Up the authors conducted a retrospective study on data prospectively collected in a shoulder arthroplasty database between 2012 and 2021. Inclusion criteria consisted of adult patients who underwent either RSA or TSA for the treatment of primary GHOA with an intact rotator cuff. Follow-up data was available for 70.6% of patients at 1 year, 65.3% at 2 years, and 50.7% at 5 years postoperatively. In other words, one third of these patients were lost to followup by two years.

The authors concluded that RSA as a treatment for GHOA with an intact rotator cuff seems to yield patient reported outcomes that are largely clinically equivalent to TSA extending to 5 years postoperatively. "The observed statistical significance favoring TSA appears to be of marginal clinical benefit based on established minimal clinically important differences and may be a result of the large sample size."

It is important to note that the preoperative characteristics of the two groups were different, so this is not a comparison of the two types of arthroplasty in similar patients. Furthermore, comparison data on the glenoid types and the degree of glenoid retroversion are not provided for the ATSA and RTSA groups.

Comment: In these two studies it is evident that the characteristics of patients and shoulders differed substantially between those indicated for anatomic and reverse total shoulder arthroplasties.

To understand the differences in clinical outcomes for these two procedures - including the rates and types of complications - we need robust clinical research that controls for patient demographics, preoperative pathoanatomy, preoperative comfort and function, and patients lost to followup.

It is important to recall that the value of these procedures is calculated as the benefit to the patient divided by the cost.

Orthopaedic Network News provides some data on the recent average selling prices (ASP) of different implants. Note the substantial variation.