Background: 

Reverse shoulder arthroplasty (RSA) is increasingly being utilized for the treatment of primary osteoarthritis. However, limited data are available regarding the outcomes of RSA as compared with anatomic total shoulder arthroplasty (TSA) in the setting of osteoarthritis.

Methods: 

We performed a retrospective matched-cohort study of patients who had undergone TSA and RSA for the treatment of primary osteoarthritis and who had a minimum of 2 years of follow-up. Patients were propensity score-matched by age, sex, body mass index (BMI), preoperative American Shoulder and Elbow Surgeons (ASES) score, preoperative active forward elevation, and Walch glenoid morphology. Baseline patient demographics and clinical outcomes, including active range of motion, ASES score, Single Assessment Numerical Evaluation (SANE), and visual analog scale (VAS) for pain, were collected. Clinical and radiographic complications were evaluated.

Results: 

One hundred and thirty-four patients (67 patients per group) were included; the mean duration of follow-up (and standard deviation) was 30 ± 10.7 months. No significant differences were found between the TSA and RSA groups in terms of the baseline or final VAS pain score (p = 0.99 and p = 0.99, respectively), ASES scores (p = 0.99 and p = 0.49, respectively), or SANE scores (p = 0.22 and p = 0.73, respectively). TSA was associated with significantly better postoperative active forward elevation (149° ± 13° versus 142° ± 15°; p = 0.003), external rotation (63° ± 14° versus 57° ± 18°; p = 0.02), and internal rotation (≥L3) (68.7% versus 37.3%; p < 0.001); however, there were only significant baseline-to-postoperative improvements in internal rotation (gain of ≥4 levels in 53.7% versus 31.3%; p = 0.009). The overall complication rate was 4.5% (6 of 134), with no significant difference between TSA and RSA (p = 0.99). Radiolucent lines were observed in association with 14.9% of TSAs, with no gross glenoid loosening. One TSA (1.5%) was revised to RSA for the treatment of a rotator cuff tear. No loosening or revision was encountered in the RSA group.

Conclusions: 

When performed for the treatment of osteoarthritis, TSA and RSA resulted in similar short-term patient-reported outcomes, with better postoperative range of motion after TSA. Longer follow-up is needed to determine the ultimate value of RSA in the setting of osteoarthritis.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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解剖和反向肩关节置换术治疗盂肱骨关节炎后的结果：倾向得分匹配分析

背景： 

反向肩关节置换术 (RSA) 越来越多地用于治疗原发性骨关节炎。然而，与骨关节炎情况下的解剖全肩关节置换术（TSA）相比，RSA 的结局数据有限。

方法： 

我们对接受 TSA 和 RSA 治疗原发性骨关节炎并至少随访 2 年的患者进行了一项回顾性匹配队列研究。根据年龄、性别、体重指数 (BMI)、术前美国肩肘外科医生 (ASES) 评分、术前主动前抬高和 Walch 关节盂形态对患者进行倾向评分匹配。收集基线患者人口统计学和临床​​结果，包括主动活动范围、ASES 评分、单一评估数值评估 (SANE) 和疼痛视觉模拟量表 (VAS)。评估了临床和影像学并发症。

结果： 

包括 134 名患者（每组 67 名患者）；平均随访时间（和标准差）为 30 ± 10.7 个月。TSA 和 RSA 组在基线或最终 VAS 疼痛评分（分别为 p = 0.99 和 p = 0.99）、ASES 评分（分别为 p = 0.99 和 p = 0.49）或 SANE 评分方面没有发现显着差异（分别为 p = 0.22 和 p = 0.73）。TSA 与明显更好的术后主动前仰角（149° ± 13° vs 142° ± 15°；p = 0.003）、外旋（63° ± 14° vs 57° ± 18°；p = 0.02）和内旋相关旋转（≥L3）（68.7% 对 37.3%；p < 0.001）；然而，从基线到术后，内旋只有显着的改善（53.7% 对 31.3% 增加≥4 个水平；p = 0.009）。总体并发症发生率为 4。5%（134 个中的 6 个），TSA 和 RSA 之间没有显着差异（p = 0.99）。在 14.9% 的 TSA 中观察到射线可透线，没有明显的关节盂松动。一项 TSA（1.5%）被修订为 RSA，用于治疗肩袖撕裂。RSA 组没有出现松动或修订。

结论： 

当用于治疗骨关节炎时，TSA 和 RSA 产生了相似的短期患者报告结果，TSA 后具有更好的术后运动范围。需要更长时间的随访来确定 RSA 在骨关节炎中的最终价值。

证据等级： 

治疗三级。有关证据级别的完整描述，请参见作者说明。