Reverse shoulder arthroplasty with preservation of the rotator cuff for primary glenohumeral osteoarthritis has similar outcomes to anatomic total shoulder arthroplasty and reverse shoulder arthroplasty for cuff arthropathy

Introduction: Indications for reverse total shoulder arthroplasty (RSA) have expanded to include individuals with intact rotator cuffs such as patients with severe glenoid deformity or with concern of future rotator cuff insufficiency. The purpose of this study was to compare outcomes of RSA with an intact rotator cuff to RSA for cuff arthropathy and anatomic total shoulder arthroplasty (TSA). We hypothesized that outcomes of RSA with an intact rotator cuff would be comparable to RSA for cuff arthropathy and TSA but with diminished range of motion (ROM) compared with TSA. Materials and Methods: Patients at one institution who underwent RSA and TSA between 2015 and 2020 with minimum 12-month follow-up were identified. RSA with preservation of the rotator cuff (thornrcRSA) was compared to RSA for cuff arthropathy (-rcRSA) and anatomic TSA (TSA). Demographics and glenoid version/ inclination were obtained. Pre- and postoperative ROM; patientreported outcomes including visual analog scale (VAS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores; and complications were obtained. Results: Twenty-four patients underwent thornrcRSA, 69 underwent-rcRSA, and 93 underwent TSA. There were more women in the thornrcRSA cohort (75.8%) than in the-rcRSA (37.7%, P=.001) and TSA (37.6%, P=.001) cohorts. Mean age of the thornrcRSA cohort (71.1) was greater than that of TSA (66.0, P=.021) but similar to that of-rcRSA (72.4, P =.237). Glenoid retroversion was greater in thornrcRSA (18.2 degrees) compared with-rcRSA (10.5 degrees, P =.011) but was similar to TSA (14.7 degrees; P =.244). Postoperatively, there were no differences in VAS or ASES between thornrcRSA vs.-rcRSA and thornrcRSA vs. TSA. SSV was lower in thornrcRSA (83.9) compared with-rcRSA (91.8, P =.021), but was similar to TSA (90.5, P =.073). Similar ROM was achieved in forward flexion, external rotation, and internal rotation at final follow-up between thornrcRSA and-rcRSA, but TSA had greater external rotation (44 degrees vs. 38 degrees, P =.041) and internal rotation (6.5 degrees vs. 5.0 degrees, P =.001) compared with thornrcRSA. There were no differences in complication rates. Discussion: At short-term follow-up, preservation of the rotator cuff in RSA demonstrated similarly excellent outcomes and low complication rates compared with RSA with a deficient rotator cuff and TSA, except for slightly lower internal and external rotation compared with TSA. Although multiple factors deserve consideration when choosing between RSA and TSA, RSA with preservation of the posterosuperior cuff is a viable treatment option for glenohumeral osteoarthritis, particularly in patients with severe glenoid deformity or those at risk for future rotator cuff insufficiency. Level of Evidence: Level III; Retrospective Cohort Comparison; Treatment Study (C) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.