title: Outcome and value of reverse shoulder arthroplasty for treatment of glenohumeral osteoarthritis: a matched cohort.
abstract: BACKGROUND
  Total shoulder arthroplasty (TSA) is commonly used to treat glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. Recently, reverse shoulder arthroplasty (RSA) has been used for GHOA patients who are elderly or have eccentric glenoid wear. We evaluated patients with GHOA scheduled to have TSA but who were changed to RSA because of intraoperative difficulties with the glenoid component or instability and compared them with a cohort that underwent TSA to determine if the groups had similar outcomes.
  
  
  METHODS
  We identified 24 consecutive GHOA patients who underwent RSA and matched them to 96 patients who underwent TSA. Glenoid wear and rotator cuff musculature were assessed with preoperative computed tomography scans. Direct hospital costs of the procedure were collected.
  
  
  RESULTS
  Postoperative American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and range of motion were similar between the 2 groups. Five TSA patients had radiographic glenoid loosening, whereas no RSA patients did. Neither group required a revision. One RSA patient required surgery for treatment of a periprosthetic fracture. RSA was $7274 more costly than TSA, related mainly to implant cost.
  
  
  CONCLUSIONS
  Patients with GHOA who were converted intraoperatively to RSA because of improper seating of the glenoid trial or persistent posterior subluxation had outcomes comparable to those of a similar group of patients in whom TSA was performed. At midterm follow-up, TSA is associated with lower cost than RSA. The higher rate of radiographic loosening in the TSA group warrants longer follow-up to assess revision costs. In cases in which a TSA cannot be performed with confidence, RSA is a reasonable alternative.
authors.affiliation: Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA.
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Steen
authors.affiliation: Foundation for Orthopaedic Research and Education, Phillip Spiegel Orthopaedic Research Laboratory, Tampa, FL, USA.
authors.forename: Andres F
authors.initials: AF
authors.lastname: Cabezas
authors.affiliation: Foundation for Orthopaedic Research and Education, Phillip Spiegel Orthopaedic Research Laboratory, Tampa, FL, USA.
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Santoni
authors.affiliation: Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Hussey
authors.affiliation: Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Cusick
authors.affiliation: Coastal Orthopedics and Sports Medicine, Bradenton, FL, USA.
authors.forename: Avinash G
authors.initials: AG
authors.lastname: Kumar
authors.affiliation: Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frankle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017006:Rotator Cuff; D012540:Scapula; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome
keywords: Reverse shoulder arthroplasty; glenohumeral arthritis; glenoid wear patterns; intact rotator cuff; total shoulder arthroplasty