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Review
. 2023 Oct 6:7:24715492231206685.
doi: 10.1177/24715492231206685. eCollection 2023.

Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis

Christos G Dragonas  1 , Georgios Mamarelis  2 , Cameron Dott  2 , Saima Waseem  1 , Abhijit Bajracharya  1 , Dimitra Leivadiotou  1   3
Affiliations
Review

Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis

Christos G Dragonas et al. J Shoulder Elb Arthroplast. .

Abstract

Introduction: This systematic review and meta-analysis compared the revision rates, complications, and outcomes in anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) performed for primary glenohumeral osteoarthritis in patients aged over 70 years without a full-thickness rotator cuff tear.

Materials and methods: We performed a systematic literature search identifying comparative studies meeting the above patient criteria and published from January 2010 to May 2022 from 3 databases: MEDLINE, EMBASE, and Cochrane Library. We performed the systematic review in accordance with PRISMA guidelines and the study was prospectively registered on PROSPERO.

Results: From the 1798 studies identified from the initial literature search, 4 met our inclusion criteria. Two thousand seven hundred thirty-one shoulder arthroplasties (1472 aTSA and 1259 rTSA) were evaluated with a minimum follow up of 2 years. A statistically significant lower revision rate was observed in rTSA compared to aTSA (odds ratio [OR] 0.50, 95% confidence interval [CI]: 0.30, 0.84, p < .05). No significant difference was noted between aTSA and rTSA in overall complication rate (OR 0.98, 95% CI 0.34, 2.86, p = .97) while aTSA displayed a statistically significant improved postoperative Constant-Murley score [aTSA: 80(75; 82), rTSA: 68(66; 76.5), p < .001].

Conclusion: Higher revision rates were identified following aTSA in our study population, although admittedly this is within retrospective studies. aTSA displayed equal functional results and postoperative complications compared to rTSA in patients over 70 without a full-thickness rotator cuff tear. Given these similar results a shoulder surgeon must carefully consider each patient individually prior to deciding the optimal form of arthroplasty to offer.

Keywords: anatomic total shoulder arthroplasty; elderly; full-thickness rotator cuff tear; glenohumeral osteoarthritis; intact rotator cuff; reverse total shoulder arthroplasty; revision rate; shoulder replacement.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram.
Figure 2.
Figure 2.
Forest plot displaying the odds ratios of revision rate due to reverse total shoulder arthroplasty and anatomic total shoulder arthroplasty.
Figure 3.
Figure 3.
Forest plot displaying the odds ratios of complication rate due to reverse total shoulder arthroplasty and anatomic total shoulder arthroplasty.
See this image and copyright information in PMC

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