Reverse total shoulder replacement versus anatomical total shoulder replacement for osteoarthritis: population based cohort study using data from the National Joint Registry and Hospital Episode Statistics for England

Epaminondas Markos Valsamis*, Albert Prats-Uribe, Ian Koblbauer, Sophie Cole, Adrian E Sayers, Michael R Whitehouse, Gillian Coward, Gary S. Collins, Rafael Pinedo-Villanueva, Daniel Prieto-Alhambra, Jonathan L Rees

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

Abstract

Objectives:
To answer a national research priority by comparing the risk-benefit and costs associated with reverse total shoulder replacement (RTSR) and anatomical total shoulder replacement (TSR) in patients having elective primary shoulder replacement for osteoarthritis.

Design:
Population-based prospective cohort study employing propensity score matching and inverse probability of treatment weighting.

Setting:
Public and private hospitals in England, 2012-20.

Participants:
Adults aged 60 years or older who underwent RTSR or TSR for osteoarthritis with intact rotator cuff tendons. These patients were identified in the National Joint Registry and linked to Hospital Episode Statistics and Civil Registration Mortality data.

Main outcome measures:
The main outcome measure was revision surgery. Secondary outcome measures included serious adverse events (SAE) within 90 days, other reoperations within 12 months, prolonged hospital stay (>3 nights), 6-month postoperative Oxford Shoulder Score (OSS), and lifetime costs to the healthcare service.

Results:
The propensity score matched population comprised 7,124 patients receiving RTSR or TSR, and the inverse probability of treatment weighted population comprised 12,966 patients with a maximum follow-up of 8.75 years. RTSR had a reduced hazard ratio (HR) of revision in the first 3 years (HR local minimum 0.31 [95% CI 0.17 to 0.56]) with no significant difference in revision-free restricted mean survival time, and a reduced relative risk of 12-month reoperations (OR 0.47 [95% CI 0.25 to 0.87]) with an absolute risk difference of -0.48% [95% CI -0.85 to -0.10]. SAEs, prolonged hospital stay risks, OSS, and modelled mean lifetime costs were similar. Outcomes remained consistent after weighting.

Conclusions:
This study’s findings provide reassurance that RTSR is an acceptable alternative to TSR for patients aged 60 years or older with osteoarthritis and intact rotator cuff tendons. Despite a significant difference in the risk profiles of revision surgery over time, we found no statistically significant or clinically important differences between RTSR and TSR in terms of long-term revision surgery, SAEs, reoperations, prolonged hospital stays, or lifetime healthcare costs.
Original languageEnglish
JournalBMJ
Publication statusAccepted/In press - 7 Mar 2024

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