ANATOMIC OR REVERSE TOTAL SHOULDER ARTHROPLASTY
In the absence of reliable evidence, it is the opinion of the workgroup that clinicians may use either anatomic total shoulder arthroplasty (TSA) or reverse TSA for the treatment of glenohumeral joint osteoarthritis in select patients with excessive glenoid bone loss and/or rotator cuff dysfunction

Rationale

Despite the increasing use of reverse total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis (GJO), there are limited studies comparing anatomic to reverse total shoulder arthroplasty for the treatment of GJO with an intact rotator cuff. Kiet et al. 2015, Steen et al. 2015, and Wright et al. 2019, all performed comparison studies between anatomic and reverse total shoulder arthroplasty finding no significant difference in patient reported outcomes, complication rates, visual analog pain scores, range of motion, and incidence of revision surgery. All three studies concluded that either method is both safe and effective for the treatment of glenohumeral joint arthritis. Reverse total shoulder arthroplasty can be used for the treatment of glenohumeral joint osteoarthritis with significant associated rotator cuff dysfunction and/or severe glenoid deformity.

 

Strength of Evidence (quality of evidence):

No reliable evidence

 

Benefits & Harms:

Anatomic and reverse total shoulder arthroplasty are safe and effective methods for treatment of glenohumeral joint arthritis.

 

Outcome Importance:

Given the increased utilization of reverse total shoulder arthroplasty it is important to understand the safety, outcomes, and survivorship of these implants as compared to anatomic total shoulder arthroplasty.

 

Cost Effectiveness/Resource Utilization:

Although no difference in short term outcomes have been reported, Steen et al.76 found reverse total shoulder arthroplasty to be approximately $7274 more expensive then anatomic total shoulder arthroplasty at the time of the authors publication (2015). These costs must be weight with the issues associated with anatomic total shoulder arthroplasty such as glenoid loosening and rotator cuff failure neither of which have been an issue with reverse total shoulder arthroplasty.

 

Acceptability:

Both anatomic and reverse total shoulder arthroplasty are being used in clinical practice for the treatment of this patient population.

 

Feasibility:

Anatomic and reverse total shoulder arthroplasty are both commonly used for the treatment of glenohumeral joint arthritis therefore this recommendation does not result a change in clinical practice recommendations.

 

Future Research:

There is a need for future high-quality prospective cohort and/or randomized clinical trials comparing the outcomes, survivorship, and complications associated with anatomic and reverse total shoulder arthroplasty. The results of these investigations will provide evidence-based recommendations as to which patients would be more appropriate for each implant type. 
 

 

Additional References: 

Kiet, T.K.Feeley, B.T.Naimark, M., et. al. Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. J Shoulder Elbow Surg. 2015;24(2):179-85.

Wright, M.A.Keener, J.D.Chamberlain, A.M., 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. J Am Acad Orthop Surg. 2019.


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