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Anatomic versus reverse total shoulder arthroplasty outcomes after prior contralateral anatomic total shoulder arthroplasty in patients with bilateral primary osteoarthritis with an intact rotator cuff

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Abstract

Purpose

We aimed to compare outcomes in patients that underwent bilateral anatomic total shoulder arthroplasty (aTSA) vs. aTSA/ reverse total shoulder arthroplasty (rTSA) for rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA) to further elucidate the role of rTSA in this patient population.

Methods

A single-institution prospectively collected shoulder arthroplasty database was reviewed for patients undergoing bilateral total shoulder arthroplasty (TSA) for RCI-GHOA with a primary aTSA and subsequent contralateral aTSA or rTSA. Outcome scores (SPADI, SST, ASES, UCLA, Constant) and active range of motion (abduction, forward elevation [FE], external and internal rotation [ER and IR]) were evaluated. Clinically relevant benchmarks (minimal clinically important difference [MCID], substantial clinical benefit [SCB], and patient acceptable symptomatic state [PASS]) were evaluated against values in prior literature. Incidence of surgical complications and revision rates were examined in qualifying patients as well as those without <two year follow-up.

Results

Of the 55 bilateral TSA patients with an intact rotator cuff, 46 underwent aTSA/aTSA and 9 underwent aTSA/rTSA. At the time of the second TSA, patients undergoing aTSA/rTSA were older (71 ± 4 vs. 67 ± 7, P = .032) and more commonly had inflammatory arthritis (44% vs. 11%, P = .031). Mean time to the second TSA was shorter for aTSA/aTSA (2.3 ± 2.8 vs. 4.4 ± 3.6 years, P < .001). Postoperative outcomes were similar after the first aTSAs between groups with similar proportions achieving the MCID, SCB, and PASS (all P > .05). The 2nd TSAs between groups were similar preoperatively, but aTSA/rTSA had superior outcome scores, overhead motion, and active abduction compared to patients that underwent aTSA/aTSA. There were no differences in active ER and IR scores or complication rates between groups.

Conclusion

Patients with RCI-GHOA have excellent clinical outcomes after either aTSA/aTSA or aTSA/rTSA.

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Data Availability

The data set generated during the current study will be available from the corresponding author upon reasonable request.

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Acknowledgements

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sports Medicine, Orthopaedics and Sports Medicine Institute, 3450 Hull Road, University of Florida, Gainesville, FL, 32611, USA

    Lacie M. Turnbull, Jonathan O. Wright, Thomas W. Wright, Kevin W. Farmer, Terrie Vasilopoulos, Aimee M. Struk & Joseph J. King

  2. College of Medicine, University of Florida, Gainesville, FL, USA

    Kevin A. Hao & Victoria E. Bindi

  3. Department of Anesthesiology, University of Florida, Gainesville, FL, USA

    Terrie Vasilopoulos

  4. Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA

    Bradley S. Schoch

Authors
  1. Lacie M. Turnbull
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr. LMT, KAH, and Dr. JJK. The first draft of the manuscript was written by Dr. LMT and VEB, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Joseph J. King.

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Ethics approval

The University of Florida Institutional Review Board (IRB) has approved this study as exempt (IRB#: 202201657).

Competing interests

Mr. Hao is a paid consultant for LinkBio Corp. Dr. Schoch receives royalties from Exactech, Innomed and Responsive Arthroscopy. Dr. King is a paid consultant for Exactech, Inc. and LinkBio Corp. Dr. Farmer is a paid consultant for Exactech, Inc. and Arthrex. Dr. Wright is a paid consultant and receives royalties from Exactech, Inc. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Turnbull, L.M., Hao, K.A., Bindi, V.E. et al. Anatomic versus reverse total shoulder arthroplasty outcomes after prior contralateral anatomic total shoulder arthroplasty in patients with bilateral primary osteoarthritis with an intact rotator cuff. International Orthopaedics (SICOT) 48, 801–807 (2024). https://doi.org/10.1007/s00264-023-06044-w

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