Abstract
There is a large and growing population of patients with shoulder arthritis that are over 70 years old. Many of these patients live alone and sling immobilization after shoulder arthroplasty is problematic. Other than improved internal rotation, there are limited benefits of anatomic shoulder arthroplasty compared to reverse arthroplasty.
Anatomic arthroplasty is associated with longer OR time, longer recovery with need for assistance to allow the subscapularis to heal, and more challenging glenoid exposure. The reverse arthroplasty is a faster operation without the need for subscapularis healing and the sphere provides a more forgiving implant position. Additional benefits of reverse arthroplasty include better ability to manage glenoid bone loss and joint subluxation.
Data from the Australian Orthopaedic Association National Joint Replacement Registry shows that within the first year of surgery the rate of revision of anatomic shoulder arthroplasty is less than reverse arthroplasty. However, after one year, the overall revision rate of reverse arthroplasty is less than anatomic shoulder arthroplasty.
Therefore, increased technical difficulty of anatomic shoulder arthroplasty together with concerns of subscapularis insufficiency, glenoid loosening, and lack of strong evidence of superiority do not warrant changing from reverse for patients over 70 years old.
