Reverse Total Shoulder Replacement alternative option for end-stage shoulder arthritis: Study
Researchers found that for patients aged 60 years or older with osteoarthritis and intact rotator cuff tendons, reverse total shoulder replacement (RTSR) is comparable to anatomical total shoulder replacement (TSR). Both procedures showed similar outcomes in terms of revision surgery, adverse events, reoperations, prolonged hospital stay, and lifetime healthcare costs. This study was published in the BMJ journal by Valsamis E. M. and colleagues.
National research priorities led to a study comparing the risk-benefit and costs associated with RTSR and TSR in patients undergoing elective primary shoulder replacement for osteoarthritis. Utilizing data from the National Joint Registry and Hospital Episode Statistics for England from 2012 to 2020, this population-based cohort study aimed to address the need for evidence-based guidance in selecting the appropriate surgical intervention for patients with osteoarthritis.
The key findings of the study were as follows:
• The study included 7124 RTSR or TSR procedures, with 126 revisions in the propensity score matched population and 12,968 procedures, with 294 revisions in the inverse probability of treatment weighted population.
• RTSR showed a reduced hazard ratio of revision in the first three years and a reduced relative risk of reoperations at 12 months compared to TSR.
• However, no statistically significant and clinically important differences were found in terms of long-term revision surgery, serious adverse events, reoperations, prolonged hospital stay, or lifetime healthcare costs between RTSR and TSR.
The study utilized propensity score matching and inverse probability of treatment weighting to balance the study groups. Despite a significant difference in the risk profiles of revision surgery over time, outcomes such as serious adverse events, reoperations, prolonged hospital stay, and lifetime healthcare costs were similar between RTSR and TSR. The findings remained consistent after weighting, indicating that RTSR is an acceptable alternative to TSR for patients aged 60 years or older with osteoarthritis and intact rotator cuff tendons.
In conclusion, this study's results provide reassurance that RTSR is a viable option for patients undergoing elective primary shoulder replacement for osteoarthritis. Despite differences in the risk of revision surgery over time, both RTSR and TSR offer comparable long-term outcomes in terms of adverse events, reoperations, hospital stay, and healthcare costs. These findings support the consideration of RTSR as an alternative to TSR in eligible patients, providing valuable insights for clinical decision-making in the management of osteoarthritis-related shoulder conditions.
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