EVIDENCE-BASED REVIEW & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: REVERSE VERSUS ANATOMIC TOTAL ARTHROPLASTY FOR THE TREATMENT OF PRIMARY GLENOHUMERAL OSTEOARTHRITIS WITH AN INTACT ROTATOR CUFF IN PATIENTS AGED 70 YEARS OR OLDER

Abstract

ABSTRACT Introduction: Anatomic total shoulder arthroplasty (ATSA) has long been indicated for the treatment of degenerative joint diseases in patients with an intact rotator cuff. However, age-related rotator cuff degeneration may negatively impact outcomes. Reverse total shoulder arthroplasty (RTSA), initially indicated for cuff tear arthropathy, has progressively expanded its indications, including elderly patients with an intact rotator cuff. Methods: A systematic review of the literature was conducted in the PubMed, Embase, Cochrane Library, and Virtual Health Library databases up to November 2025, with the aim of comparing ATSA and RTSA regarding functional outcomes, complication rates, and the need for reoperation in patients aged 70 years or older with primary shoulder osteoarthritis and an intact rotator cuff. Results: Only one systematic review met the inclusion criteria, encompassing four observational studies, with a total of 2.731 arthroplasties. RTSA showed a lower reoperation rate compared with ATSA. Functional outcomes favored ATSA, although based on limited data. No statistically significant differences were observed between the techniques regarding complication rates. The overall quality of evidence was classified as very low. Conclusions: In patients aged 70 years or older with primary glenohumeral osteoarthritis and an intact rotator cuff, RTSA is associated with a lower revision rate, whereas ATSA demonstrates superior functional outcomes, with similar complication rates between the two techniques. Level of evidence II; Systematic review.