2015 ISAKOS Biennial Congress ePoster #2102
Reverse Total Shoulder Arthroplasty for the Treatment of Osteoarthritis Without Radiographic Rotator Cuff Tear: A Case Control Study
Peter Chalmers, MD, Chicago, IL UNITED STATES
Terrence Feldheim, BA, Chicago UNITED STATES
Chris Mellano, MD, Santa Monica, CA UNITED STATES
Randy Mascarenhas, MD, FRCSC, Houston, TX UNITED STATES
Brian Forsythe, MD, Chicago, IL UNITED STATES
Anthony A. Romeo, MD, Scarsdale, NY UNITED STATES
Gregory P. Nicholson, MD, Chicago, IL UNITED STATES
Rush University Medical Center, Chicago, IL, USA
FDA Status Cleared
Summary: In patients over the age of 70 with glenohumeral OA, TSA and RTSA provide similar improvement in clinical outcomes.
Reverse total shoulder arthroplasty (RTSA) could be considered for the treatment of glenohumeral osteoarthritis in the presence of an intact rotator cuff (GHOA+IRC) in patients over 70 years old due to suspicion of subclinical or impending rotator cuff dysfunction.
Twenty-five elderly (>70 years) patients at least one year status-post RTSA for GHOA+IRC were matched via age, sex, body mass index, smoking status, and whether the procedure involved the dominant extremity with 25 GHOA+IRC patients who received anatomic total shoulder arthroplasty (TSA). Standardized outcome measures, range of motion, and treatment costs were compared between arthroplasty groups. Treatment cost was assessed using implant and physical therapy costs as well as reimbursement.
Patients who received RTSA for GHO+IRC had significantly lower pre-operative active forward elevation (AFE, 69° vs. 98°, p<0.001) and experienced a greater change in AFE (p=0.01), but had equivalent AFE at final follow-up (140° vs. 142°, p=0.71). Outcomes were otherwise equivalent between groups with no differences. In both those patients who underwent TSA and those that underwent RTSA, significant improvements between pre-operative and final follow-up were seen in all standardized outcome measures and in AFE (p<0.001 in all cases). RTSA provided these outcomes at a cost savings of $2,025 in medicare reimbursement due to decreased physical therapy costs.
In patients over the age of 70 with GHOA+IRC, RTSA provides similar improvement in clinical outcomes to TSA at a reduced cost while avoiding issues related to the potential for subclinical or impending rotator cuff dysfunction.