Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older

Background We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. Methods Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant–Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. Results RTSA were older than TSA patients ( p = 0.006), had lower pre-operative AAE ( p < 0.001), ALE ( p < 0.001), IR ( p = 0.002), pain ( p = 0.008) and CS ( p < 0.001), and greater supraspinatus FI ( p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA ( p = 0.006); and AAE and ALE delta scores were higher in RTSA ( p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate ( p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA ( p = 0.001). Conclusion RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.