Journal of shoulder and elbow surgery · 2026 · 統合分析（依標題推測）
Reverse versus anatomic total shoulder arthroplasty in patients over 70 with a competent rotator cuff and glenohumeral osteoarthritis: a meta-analysis
肩 · 肩關節骨關節炎
中文閱讀摘要
統合分析顯示，70歲以上肩關節骨關節炎且旋轉肌群完整者，aTSA旋轉活動度優於rTSA，但rTSA併發症及翻修率較低。
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原始摘要
Background
Reverse total shoulder arthroplasty (rTSA) is increasingly performed in elderly patients with primary glenohumeral osteoarthritis (GHOA) and preserved rotator cuff function. Once reserved for cuff deficiency, it is now often selected based on age rather than cuff status, driving a rapid rise in its use among older adults. This meta-analysis compares rTSA and anatomic total shoulder arthroplasty (aTSA) in patients aged ≥70 years with a competent cuff, focusing on range of motion, functional outcomes, and risks of complications, revisions, and reoperations.
Methods
Following PRISMA 2020 guidelines, we systematically searched 5 databases from inception to March 2025 for comparative studies reporting on aTSA and rTSA in patients aged ≥70 years with primary GHOA and a competent rotator cuff. Inclusion was restricted to studies with ≥2 years' follow-up and validated outcome reporting. Continuous outcomes were pooled using inverse variance random-effects models, and dichotomous outcomes were assessed via Mantel-Haenszel risk ratios. Risk of bias was evaluated using ROBINS-I, and evidence certainty was appraised via GRADE.
Results
Eight studies encompassing 1716 patients met inclusion. Compared with rTSA, aTSA demonstrated significantly greater postoperative external rotation and internal rotation. There were no significant differences in forward elevation, abduction, and patient-reported outcomes (ASES, Constant, SST) between the groups. aTSA was associated with a nearly fourfold higher risk of revision and a higher overall complication rate while reoperation rates were comparable. Heterogeneity was low to moderate across most analyses, and no evidence of publication bias was detected.
Conclusion
In patients aged ≥70 years with primary GHOA and a competent rotator cuff, aTSA provides superior rotational mobility, exceeding the MCID and potentially supporting improvements in daily activities such as dressing or toileting. rTSA offers superior implant survivorship and lower complication rates without compromising patient-reported outcomes, though at the expense of reduced rotational range of motion. aTSA remains preferable in select active patients prioritizing rotation-dependent tasks, provided cuff integrity is preserved. These findings support a patient-tailored approach to implant selection.
至 Europe PMC 閱讀完整來源 ↗ · 擷取日期 2026-10-19
書目、來源與全文狀態
- DOI
- 10.1016/j.jse.2025.10.015
- PMID／PMCID
- 41276069
- 作者
- Gupta MS, Krishan A, Rashid A, Lee MH
- 首次發表日期
- 2025-11-21Europe PMC 提供，部分日期可能依年份或月份推定。
- 卷／期／頁碼或文章編號
- 35 ／ 5 ／ 1370-1386
- 書目來源與查核日期
- Europe PMC · 2026-10-19僅核對書目欄位與來源連結；不代表已評讀研究品質。
- 全文與授權
- 來源尚未確認免費全文。 來源授權標示：cc by。
可回溯引用
Gupta MS, Krishan A, Rashid A, Lee MH. Reverse versus anatomic total shoulder arthroplasty in patients over 70 with a competent rotator cuff and glenohumeral osteoarthritis: a meta-analysis. Journal of shoulder and elbow surgery. 2026;35(5):1370-1386. PMID: 41276069. doi:10.1016/j.jse.2025.10.015
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