Disclosures A prospective comparison between reverse and anatomic total shoulder arthroplasty Tuyen Kiet Micah Naimark, MD Brian T. Feeley, MD Teddy T. Chung Tatiana Gajiu Sarah L. Hall, MA C. Benjamin Ma, MD Kiet, Naimark, Chung, Hall, Gajiu, Feeley Nothing to disclose Ma Educational Consultant of Zimmer Research support from Zimmer, Histogenics, Moximed Total shoulder Total shoulder replacement (TSA) was developed in 1970s to primarily treat glenohumeral arthritis success depends on preserved function of rotator cuff Reverse total shoulder Reverse total shoulder arthroplasty (Reverse TSA) has gained popularity in the U.S. Used to treat rotator cuff-deficient pathologies approved by FDA in 2004 Boileau et al. JBJS 2005 Frankle et al. JBJS 2005 Groh. JSES 2014 Guery et al. JBJS 2006 1
Prior studies Purpose Concerns about greater complication rates in Reverse TSA vs. TSA complications ranged from 0-75%, 4x complication rate of TSA possible sources of variation in complication rates indication for surgery different classification of complications difference in surgeon experience Improvement in surgical techniques compare side-by-side cohorts for the two procedures with regards to: complications patient-reported functional outcome range of motion radiographic follow-up Kim et al. JBJS 2011 Scarlat. Int Ortho 2013 Wierks et al. Cin Ortho 2009 Wall et al. JBJS 2007 Methods Prospective data collection TSA for glenohumeral arthritis, Reverse TSA for rotator cuff arthropathy Study period: 2008-2011, minimum two year follow-up Outcomes: American Shoulder and Elbow Surgeons (ASES) scoring, visual analog scale (VAS) for pain, and range of motion (ROM) Methods Need for revision surgeries Major complications include infection dislocation glenoid component loosening Rotator cuff tears fractures Radiographs: scapular notching in Reverse TSA and glenoid lucency in TSA 2
Study population Study population Study cohort from 2008-2011 238 shoulder replacements performed 99 TSA and 139 Reverse TSA 77 TSA performed for osteoarthritis 75 Reverse TSA performed for cuff tear arthropathy Reverse TSA 75 Patients 10 Lost to follow-up 2 deaths 1 Year 63 Patients 5 complications 3 revisions 9 Lost to follow-up 1 Death 2 Year 53 Patients 7 Complications 5 Revisions TSA 77 Patients 14 Lost to follow-up 1 death 1 Year 62 patients 3 complications 2 revisions 15 Lost to follow-up 2 Year 47 Patients 7 Complications 5 Revisions - Complications - - Functional outcomes - Reverse TSA TSA P Reverse TSA TSA Total a 13% (7/53) 14% (7/47) Infection 2 1 Dislocation 1 0 Fracture 4 0 Cuff tear 0 4 Glenoid loosening 0 2 Revision surgeries 5 5 a. P=0.93 Mean SD Mean SD Pain rate (VAS) 1.3 2.1 1.8 2.8 0.28 Pain Score (ASES) 44 10.4 41 13.9 0.30 Function Score (ASES) 34 12.0 39 10.7 0.08 ASES Total Score 77 19.0 80 21.2 0.71 Forward elevation 136 30.9 144 23.5 0.37 Abduction 129 33.5 136 28.5 0.48 External rotation 38 22.7 53 16.5 0.001 Internal rotation (spinous process) L2 3.9 L2 3.4 0.87 3
- Functional outcomes - Radiolucency TSA Reverse TSA TSA P Mean SD Mean SD Pain rate (VAS) 1.3 2.1 1.8 2.8 0.28 Pain Score (ASES) 44 10.4 41 13.9 0.30 Function Score (ASES) 34 12.0 39 10.7 0.08 ASES Total Score 77 19.0 80 21.2 0.71 Forward elevation 136 30.9 144 23.5 0.37 Abduction 129 33.5 136 28.5 0.48 External rotation 38 22.7 53 16.5 0.001 Internal rotation (spinous process) L2 3.9 L2 3.4 0.87 Boileau et al. JSES 2005 Lazarus et al. JBJS 2002 - TSA Glenoid lucency - Scapular Notching Reverse TSA Grade Finding 0 No radiolucency 1 incomplete lucency 1-2 pegs 2 complete lucency ( 2 mm wide) 1 peg 3 complete lucency ( 2 mm) 2+ pegs 4 complete lucency 2+ pegs 5 gross loosening Lazarus et al. JBJS 2002 4
- Rev TSA Scapular notching - Conclusions Grade Finding Recent practice of RTSA in the US has much lower rates of complications and revisions Evolution of implant design and techniques, performed by experienced surgeons, RTSA and TSA have similar clinical outcomes at two-year follow-up Further research is needed to compare medium and long-term outcomes between RTSA and TSA 0 absence of bone erosion 1 defect limited to inferior pillar 2 defect contacts lower fixation screw 3 erosion covering lower screw 4 bony erosion under base plate Sirveaux et al. JBJS 2004 Clark et al. JSES 2012 Kempton et al. Clin Ortho 2011 Acknowledgement C. Benjamin Ma, MD Brian T. Feeley, MD Micah Naimark, MD Tatiana Gajiu Sarah L. Hall, MA Teddy T. Chung 5