Reverse versus anatomic total shoulder arthroplasty for glenohumeral osteoarthritis with intact cuff: a meta-analysis of clinical outcomes.

Background: Anatomic and reverse total shoulder arthroplasty (RSA) (total shoulder arthroplasty [TSA]) have surged in popularity in recent years. While RSA is Food and Drug Administration approved for cases of rotator cuff tear arthropathy, indications have expanded to include, among others, primary glenohumeral osteoarthritis (GHOA).

Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through November 2023. Inclusion criteria consisted of studies that compared the utility of TSA to that of RSA for the treatment of GHOA with intact rotator cuff with respect to adverse events, patient-reported outcomes, and range of motion (ROM). The Risk Of Bias In Non-randomised Studies - of Interventions tool was used to assess the risk of bias in the included nonrandomized studies, and Review Manager 5.4 was used for statistical analysis. P values <.05 were deemed significant.

Results: Fourteen studies met the above inclusion criteria. Twelve studies reported adverse outcomes, with the RSA group having a lower rate of complications (odds ratio = 0.54, P = .004) and reoperations (odds ratio = 0.31, P < .001) relative to TSA at an average follow-up of 3.4 years. Four studies reported Shoulder Pain and Disability Index and University of California Los Angeles scores, while 5 reported Simple Shoulder Test scores. These studies showed superior Shoulder Pain and Disability Index (P = .040), University of California Los Angeles (P = .006), and Simple Shoulder Test (P = .040) scores among the RSA group. No significant differences were seen with regards to other patient-reported outcomes. Ten studies reported on ROM, and the RSA group had a significantly lower external rotation relative to the TSA group (P < .001) while other ROM parameters did not show statistically significant differences.

Conclusion: The present study provides support for RSA as a reasonable surgical option for patients with GHOA and an intact rotator cuff, with lower rates of adverse events and better outcomes relative to TSA, although at the expense of decreased external rotation. Patient education and counseling is key in order to decide optimal treatment as part of a shared decision-making process, as well as setting appropriate expectations.