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Anatomical and Reverse Shoulder Prostheses for the treatment of primary and secondary osteoarthritis, or for the outcomes of fractures

Anatomical and reverse shoulder replacements offer effective solutions for osteoarthritis and non-repairable rotator cuff tears.

Recent surgical techniques, such as sparing the subscapularis, improve outcomes.

Systematic reviews show good clinical outcomes and low complication rates.

Gabriele February

6 min. Feb 15, 2025

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Anatomical and Reverse Shoulder Prostheses for the Treatment of Primary and Secondary Osteoarthritis and Shoulder Fractures

TL:DR:

  • Anatomical and reverse shoulder replacements offer effective solutions for osteoarthritis and non-repairable rotator cuff tears.
  • Recent surgical techniques, such as sparing the subscapularis, improve outcomes.
  • Systematic reviews show good clinical outcomes and low complication rates.

The "revolution" in shoulder surgery for 20 years

In recent years, shoulder surgery has seen significant advances, especially in the treatment of primary and secondary osteoarthritis, as well as fracture outcomes. Anatomical and reverse shoulder replacements have become essential treatment options, thanks to their promising clinical results and ability to improve patients' quality of life.

Anatomical and Reverse Shoulder Prostheses: A Comparison

Anatomical Prostheses

Anatomical shoulder prostheses are designed to restore the natural anatomy of the shoulder, using components that replicate the shape and function of the original joint. These prostheses are particularly suitable for patients with primary osteoarthritis and those with an intact rotator cuff. The primary goal is to improve mobility and reduce pain, allowing patients to resume normal daily activities.

Reverse Prostheses

Reverse shoulder replacements, on the other hand, were developed to address situations where the rotator cuff is compromised, such as arthritis caused by a torn rotator cuff. These replacements reverse the anatomical relationship between the glenoid and the humerus, shifting the center of rotation and increasing the effectiveness of the deltoid muscle. This approach has been shown to significantly improve shoulder function in patients with irreparable rotator cuff tears.

Reverse Prosthesis in Case of Fracture

Reverse prostheses are particularly useful in the treatment of complex proximal humerus fractures, especially in the elderly. Recent literature, as highlighted by studies such as that of Minarro and Sánchez-Sotelo (2024), has demonstrated that the use of reverse prostheses for proximal humerus fractures leads to satisfactory clinical outcomes, with significant improvements in mobility and quality of life. Furthermore, the systematic review by Austin et al. (2019) showed that reverse prostheses offer better outcomes than hemiarthroplasty, reducing the rate of reoperations and improving functional scores.

Advantages of Recent Surgical Techniques

Subscapularis Sparing

One of the most significant innovations in shoulder surgery is the subscapularis-sparing approach. This technique allows the subscapularis tendon to be preserved during surgery, reducing trauma to surrounding tissue and improving recovery times. The advantages of this technique include:

  • Less post-operative pain: Preservation of the subscapularis reduces soft tissue damage, leading to less postoperative pain.
  • Faster recovery: Patients who undergo subscapularis-sparing surgery tend to recover more quickly, with a quicker return to normal daily activities.
  • Better functional results: Recent studies have shown that patients undergoing this technique show superior functional results compared to those treated with traditional approaches.

Recent Scientific Evidence

Over the past five years, numerous systematic studies and meta-analyses have examined the effectiveness of anatomical and reverse shoulder replacements. These studies have provided valuable data on clinical outcomes, complications, and surgical techniques.

Clinical Results

A systematic review by Jensen et al. (2021) found that elderly patients with primary glenohumeral osteoarthritis and an intact rotator cuff showed excellent clinical and radiographic outcomes after anatomical cuff replacement. Implant survival rates were high, and the incidence of secondary rotator cuff tears was low.

In another meta-analysis, Wilcox et al. (2022) compared the clinical outcomes of reverse hip replacements in patients with severe osteoarthritis and intact rotator cuffs, demonstrating that patients treated with reverse hip replacements had significant improvements in functional scores and mobility.

Complications

Complications associated with shoulder arthroplasty have been studied in several studies. A systematic review by Ravi et al. (2021) reported that reverse shoulder arthroplasty revisions have relatively low complication rates, with satisfactory improvement in patient-reported outcome scores. Furthermore, a review by Welch et al. (2024) showed that reverse shoulder arthroplasty revisions after anatomical prosthesis failure resulted in excellent functional outcomes and improved joint mobility.

Final Considerations

Anatomical and reverse shoulder replacements represent a significant advance in the treatment of primary and secondary osteoarthritis, as well as fracture outcomes. Modern surgical techniques, particularly those that spare the subscapularis, offer significant advantages in terms of postoperative pain, recovery time, and functional outcomes. Recent scientific evidence supports the use of these prostheses, demonstrating promising clinical results and low complication rates.

For patients experiencing shoulder problems, it is essential to consult an experienced orthopedic surgeon who can provide a personalized, evidence-based approach. Choosing the right prosthesis and surgical technique can make a significant difference in quality of life and post-operative recovery.

Useful Resources

Bibliography

  1. Ranieri R., Anzillotti G., Rose G., Borroni M., Garofalo R., Castagna A. "Anatomical total shoulder arthroplasty revision to reverse shoulder arthroplasty using convertible glenoid: a systematic review of clinical and radiological outcomes." International Orthopaedics, 2024-04-24.
  2. Welch J.M., Bethell M.A., Meyer A.M., Hurley E., Levin J.M., Péan C.A., Anakwenze O., Klifto C.S. "Outcomes and Complications of Revision Reverse Shoulder Arthroplasty Following Failed Primary Anatomical Shoulder Arthroplasty or Hemiarthroplasty: A Systematic Review." Journal of shoulder and elbow surgery, 2024-05-01.
  3. Wilcox B., Dean R., Naylor A.J., Otte R.S., Sumner-Parilla S.A., Romeo A., Nicholson G. "Comparative Clinical Outcomes of Reverse Total Shoulder Arthroplasty for Primary Cuff Tear Arthropathy Versus Severe Glenohumeral Osteoarthritis With Intact Rotator Cuff: A Matched-Cohort Analysis." The Journal of the American Academy of Orthopaedic Surgeons, 2020-04-27.
  4. Ravi V., Murphy R., Moverley R., Derias M., Phadnis J. "Outcome and complications following revision shoulder arthroplasty." Bone & Joint Open, 2021-08-01.
  5. Jensen A.R., Tangtiphaiboontana J., Marigi E.M., Mallett K., Sperling J., Sánchez-Sotelo J. "Anatomic Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis is Associated with Excellent Outcomes and Low Revision Rates in the Elderly." Journal of shoulder and elbow surgery, 2021-01-20.
  6. Minarro J.C., Sánchez-Sotelo J. "Reverse Shoulder Arthroplasty for Proximal Humerus Fractures: A Review of Current Evidence." Current Reviews in Musculoskeletal Medicine, 2024-07-27.
  7. Austin D., Torchia M., Cozzolino N.H., Jacobowitz L.E., Bell J.E. "Decreased Reoperations and Improved Outcomes With Reverse Total Shoulder Arthroplasty in Comparison to Hemiarthroplasty for Geriatric Proximal Humerus Fractures: A Systematic Review and Meta-Analysis." Journal of Orthopaedic Trauma, 2019-01-01.
  8. Larose G., Virk M. "The Evolution of Reverse Total Shoulder Arthroplasty and Its Current Use in the Treatment of Proximal Humerus Fractures in the Older Population." Journal of Clinical Medicine, 2022-09-30.