Outcomes of anatomic versus reverse shoulder arthroplasty for B2 & B3 glenoids with an intact rotator cuff: An updated systematic review and proportional meta-analysis.

Background: It is unclear whether anatomic total shoulder arthroplasty (aTSA) or reverse total shoulder arthroplasty (rTSA) produces better outcomes in patients with Walch type B2 and B3 glenoids. The purpose of this systematic review was to examine the clinical and functional outcomes of anatomic and reverse shoulder arthroplasty in patients with B2 or B3 glenoids and preserved rotator cuff musculature.

Methods: A comprehensive literature search of MEDLINE, EMBASE, and COCHRANE library was performed from the database inception through November 12, 2023.

Results: There were 36 studies included in the final analysis. A total of 1349 shoulders underwent aTSA, while 478 shoulders underwent rTSA. The mean active range of motion improvements for patients undergoing aTSA and rTSA were similar, as were improvements in American Shoulder and Elbow Surgeons, Constant and Visual Analogue Scale scores. The pooled complication rate for aTSA was 7.8% (95% CI, 4.7%-11.4%) and for rTSA was 4.4% (95% CI, 2.8%-6.9%). For revision rates, aTSA had a pooled rate of 5.2% (95% CI, 3.3%-7.1%) whereas rTSA had a revision rate of 1.6% (95%CI, 1.1%-3.8%).

Discussion: Based on the available data, both aTSA and rTSA effectively improved range of motion and patient-reported outcomes in patients with Walch B2 and B3 glenoids. However, aTSA demonstrated a higher complication rate (7.8% vs 4.5%) and a higher revision rate (5.2% versus 1.6%) compared to rTSA. Given the potential for bias in the included studies, these findings should be interpreted with caution.

Level of evidence: III.