Anatomical versus reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis with an intact rotator cuff

Aims

Anatomical total shoulder arthroplasty (aTSA) has been the traditional treatment for glenohumeral osteoarthritis (OA) with an intact rotator cuff. However, reverse total shoulder arthroplasty (rTSA) is now being more frequently performed, with its utility in consistent fixation and severe bony deformity. This study systematically reviews available literature comparing aTSA and rTSA in patients with OA with an intact rotator cuff.

Methods

A literature review was conducted to identify studies comparing aTSA and rTSA in patients with glenohumeral OA and intact rotator cuffs. Primary postoperative outcomes were analyzed, including range of motion, patient-reported outcomes, complications, revisions, cost, radiological changes, and satisfaction.

Results

In all, 18 articles met the inclusion criteria. aTSA demonstrated better range of motion with no difference in American Shoulder and Elbow Surgeons scores and pain outcomes. While complication and revision reasons varied slightly, there was no difference in overall complication and revision rates. Of four studies reporting patient satisfaction, two favoured aTSA.

Conclusion

In our population, aTSA and rTSA yield comparable postoperative outcomes. While aTSA may offer a superior range of motion, its clinical value remains uncertain. These findings support the growing consideration of rTSA as a viable alternative to aTSA in this population, although longer follow-up time is required.

Cite this article: Bone Jt Open  2026;7(8):1056–1063.