Incidence of anatomic total shoulder arthroplasty vs. reverse total shoulder arthroplasty in cuff intact osteoarthritis in males vs. females 70 years or older

Background

While there has been increased attention to the use of reverse total shoulder arthroplasty (RTSA) to treat rotator cuff intact glenohumeral osteoarthritis (RCIOA) for older age groups, there has not been as precise an assessment of the differences in utilization for female vs. male patients or in specific age groups. Our purpose was to determine if differences existed in the utilization of shoulder arthroplasty to treat RCIOA based on gender and age in North America.

Methods

Anatomic total shoulder arthroplasty (ATSA) and RTSA cases were queried from the American Academy of Orthopaedic Surgeons Shoulder and Elbow Registry between January 2015 and December 2021. Cases were included if they had a diagnosis of RCIOA, defined by the International Classification of Diseases-10 codes M19.011, M19.012, and M19.019. Cases were stratified by procedure, age, gender, and year of surgery. Chi-square and Fisher’s exact tests were calculated to assess the associations between procedure type and patient demographics.

Results

There were 2748 (48.06%) ATSA and 2970 (51.94%) RTSA procedures reported to the American Academy of Orthopaedic Surgeons Shoulder and Elbow Registry. There was a significant relationship between procedure type and age group (P < .001) in that ATSA was utilized more frequently than RTSA for patients ages <70 years old, and this relationship reversed for ages ≥ 70 years old. Female patients were more likely to receive RTSA (P < .001). When looking at the relationship between procedure type and gender by age group, both genders were more likely to receive ATSA compared to RTSA for age groups 50-59 and 60-69 (P = .0097 and P = .0005, respectively) but not for other age groups. For patients ≥ 70 years old, both females and males were more likely to receive RTSA, but this relationship did not reach statistical significance (P = .1094). For both genders and ages ≥ 70 years old, there was a significant relationship between year and procedure type (P < .0001) in that RTSA was more commonly utilized in 2017 and onward.

Discussion and Conclusion

When assessing patients with RCIOA, the use of ATSA and RTSA was similar, but for patients 50 to 69 years old, for both genders, the use of ATSA was greater. Although RTSA was more commonly used for both genders in the ≥ 70 years old population, this difference was not significant. Interestingly, for both genders, ages ≥ 70 years old, RTSA was significantly more utilized from 2017 onward. This analysis highlights the influence of age and gender in use of ATSA and RTSA.