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Predictive factors of intraoperative conversion to reverse total shoulder arthroplasty in patients with anatomic total shoulder arthroplasty
Journal article   Open access   Peer reviewed

Predictive factors of intraoperative conversion to reverse total shoulder arthroplasty in patients with anatomic total shoulder arthroplasty

Garrett V. Christensen, Maria F. Bozoghlian, Arman C. Hlas, Joseph M. Rund, Joseph W. Galvin and Brendan M. Patterson
JSES international, Vol.9(2), pp.431-435
03/2025
DOI: 10.1016/j.jseint.2024.09.026
PMCID: PMC11962541
PMID: 40182276
url
https://doi.org/10.1016/j.jseint.2024.09.026View
Published (Version of record) Open Access

Abstract

Many factors play a role in decision-making for arthroplasty type in patients with glenohumeral osteoarthritis (GHOA). The purpose of this study was to evaluate preoperative and intraoperative factors that might predict the need for Reverse Total Shoulder Arthroplasty (rTSA) versus Anatomic Total Shoulder Arthroplasty (aTSA) for patients with primary GHOA. Secondarily, American Shoulder and Elbow Surgeons (ASES) were compared. Patients with primary GHOA indicated for aTSA versus rTSA were identified. Preoperative records were reviewed for demographics, range of motion, rotator cuff strength, and glenoid morphology. Operative reports were assessed to identify intraoperatively rotator cuff pathology and glenoid deficiency. ASES scores at 2-years postoperative were collected. 111 patients were included from 2018-2021. 94 patients underwent aTSA, while 17 were intraoperatively converted to rTSA. There were no significant differences in age, BMI, or preoperative Walch classification between cohorts. rTSA patients had significantly decreased preoperative external rotation (p=0.006). External rotation ≤30 degrees was the only preoperative predictive factor for performing rTSA versus aTSA (p=0.0004). The most common reason for intraoperative transition to rTSA was rotator cuff deficiency. At 2-year follow-up, median ASES scores were 94.2 (IQR 85-96.7) and 88.3 (IQR 73.3-94.5) for aTSA and rTSA, respectively (p=0.097). Many patients with primary GHOA are well-served with aTSA. However, there are patients with primary GHOA in which rTSA may be ideal given rotator cuff deficiency or glenoid defects felt to limit aTSA glenoid component placement. This study highlights the need for preoperative external rotation and intraoperative evaluation of rotator cuff integrity and glenoid bone stock.
 Glenohumeral arthritis intraoperative decision preoperative factors reverse rotator cuff shoulder arthroplasty

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