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. 2022 Jan 21;11(3):540.
doi: 10.3390/jcm11030540.

Shoulder Replacement in the Elderly with Anatomic versus Reverse Total Prosthesis? A Prospective 2-Year Follow-Up Study

Maciej J K Simon  1   2 , Jennifer A Coghlan  1   3 , Simon N Bell  1   3
Affiliations

Shoulder Replacement in the Elderly with Anatomic versus Reverse Total Prosthesis? A Prospective 2-Year Follow-Up Study

Maciej J K Simon et al. J Clin Med. .

Abstract

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

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 post-operative 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 an rTSR.

Results: We found postoperative improvement for ROM and all clinical assessment scores for both groups. There were significantly better patient reported outcome scores (PROMs) 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 (n = 11) patients and acromioclavicular joint pain for both groups (aTSR = 2; rTSR = 6).

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

Level of evidence: Level II-prospective cohort study.

Keywords: Lazarus score; Sirveaux score; anatomic total shoulder replacement; clinical scores; older patients; reverse total shoulder replacement.

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Conflict of interest statement

Maciej Simon: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Jennifer Coghlan: Receives funds for data collection, entry and storage through her Department of Monash University from Mathys Bettlach, Switzerland, Mathys Australia and Wright Medical, Australia. Simon Bell: Has a consultancy agreement with Mathys Ltd. Bettlach, Switzerland, and Wright Medical, Australia.

Figures

Figure 1
Figure 1
The CONSORT flowchart of the study. Pre- and post-operative assessment of range of motion (ROM), ASES, DASH, SPADI and Constant scores, and radiologic assessments.
See this image and copyright information in PMC

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