Comparing the use of reverse total shoulder arthroplasty for glenohumeral osteoarthritis, irreparable rotator cuff tears, and rotator cuff tears with arthritis: a 2-year clinical outcome analysis using the Enovis AltiVate reverse

Abstract

Background The purpose of this study was to compare outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) for rotator cuff tears with arthritis, irreparable rotator cuff tears without arthritis, and primary glenohumeral osteoarthritis. Methods A retrospective review of prospectively collected data was performed of patients undergoing primary rTSA using the AltiVate Reverse (Enovis; Austin, TX) by a single surgeon from 2021 to 2023. Patients were categorized as irreparable rotator cuff tear without arthritis, rotator cuff tear with arthritis, or primary glenohumeral osteoarthritis. Outcomes included American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) pain score, and range of motion, collected pre-operatively and through 2-year follow-up. Statistical analysis included Kruskal-Wallis, Chi-square, Mann-Whitney U, and Fisher exact tests (P < .05). Results A total of 219 patients (221 shoulders) were included. All groups demonstrated significant improvements in ASES, SST, VAS, and range of motion at final follow-up (P < .05). Post-operative VAS, ASES, and SST scores were comparable between groups (all P > .05). External rotation at 2 years was greater in the osteoarthritis cohort compared with rotator cuff tear with arthritis (65° vs. 50°, P = .014). Overall complication rates were low and similar between groups (P = .686). Subscapularis repair was associated with a higher complication rate compared with no repair (22.7% vs. 11.8%, P = .043). Conclusion rTSA provides comparable clinical outcomes across indications of irreparable rotator cuff tear, rotator cuff tear arthropathy, and primary osteoarthritis at 2 years, supporting its broad applicability.