Early complications and risk factors following reverse versus anatomic total shoulder arthroplasty for osteoarthritis: a nationwide registry study.

Background: Reverse shoulder arthroplasty (RSA) is an alternative to anatomic total shoulder arthroplasty (TSA) for treating glenohumeral osteoarthritis (OA), particularly in elderly patients. This study evaluates 90-day postoperative complication rates and identifies risk factors for adverse outcomes in RSA and TSA patients.

Methods: A retrospective cohort study was conducted using the TriNetX Research NLP Network to identify patients aged 65-90 years who underwent RSA or TSA for OA from 2006 to 2024. 1:1 propensity score matching controlled for demographics and comorbidities. Orthopedic and infectious complications were compared using multivariate logistic regression.

Results: The final matched cohort included 4,117 RSA and TSA patients. RSA was associated with significantly higher odds of orthopedic complications compared to TSA. Significant risk factors for orthopedic complications in RSA included nicotine dependence (OR, 1.592; P=0.001) and hypertension (OR, 1.545; P=0.001). In TSA, risk factors included male sex (OR, 0.702; P=0.005), chronic obstructive pulmonary disease (OR, 1.650; P=0.016), and obesity (OR, 1.776; P<0.001). For infections, RSA risk factors were male sex (odds ratio [OR], 1.698; P=0.005), heart failure (OR, 2.396; P<0.001), and diabetes (OR, 1.525; P=0.039). Diabetes was the only significant risk factor in TSA (OR, 2.453; P=0.003).

Conclusions: RSA carries a higher risk of orthopedic complications and infection than TSA within 90 days. Distinct risk factors for each procedure highlight the need for patient-specific risk stratification to optimize preoperative assessment and surgical decision-making. Level of evidence: III.