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 (odds ratio [OR], 2.251; P<0.001) and musculoskeletal infections (OR, 2.908; P<0.001) 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 (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.