Summary

This study of older patients (>75 years) demonstrated that an aTSR for a judiciously selected patient with good rotator cuff muscles can lead to a better clinical outcome and less early complications than a rTSR.

Abstract

Purpose

In older patients, with an intact rotator cuff, requiring a total shoulder replacement (TSR) there is, at present, uncertainty whether an anatomic TSR (aTSR) or a reverse TSR (rTSR) is best for the patient. This comparison study of same age patients aims to assess clinical and radiological outcomes of older patients (> 75 years) who received either an aTSR or a rTSA.

Methods

Consecutive patients with a minimum age of 75 years who received an aTSR (n=44) or rTSR (n=51) were prospectively studied. Pre- and postoperative clinical evaluations included the ASES score, Constant score, SPADI score, DASH score, range of motion (ROM) and pain and patient satisfaction for a follow-up of 2 years. Radiological assessment identified glenoid and humeral component osteolysis, including notching with a rTSR.

Results

Postoperative improvement for ROM and all clinical assessment scores for both groups was found. Patient reported outcome scores (PROMs) were significantly better in the aTSR group compared with the rTSR patients (p<0.001). Both groups had only minor osteolysis on radiographs. No revisions were required in either group. The main complications were scapular stress fractures for the rTSR patients and acromioclavicular joint pain for both groups.

Conclusions

This study of older patients (>75 years) demonstrated that an aTSR for a judiciously selected patient with good rotator cuff muscles can lead to a better clinical outcome and less early complications than a rTSR.