Published online Jan 18, 2026. doi: 10.5312/wjo.v17.i1.110188
Revised: June 15, 2025
Accepted: November 21, 2025
Published online: January 18, 2026
Processing time: 224 Days and 0.7 Hours
The optimal surgical approach for patients with primary glenohumeral osteo
To systematically compare the outcomes of RTSA and TSA in this specific patient population.
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included. Key outcomes assessed included complication and reoperation rates, patient-reported outcome measures (PROMs), and range of motion. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.
Twelve studies encompassing 1608 patients (580 RTSA, 1028 TSA) met inclusion criteria. RTSA was associated with a lower reoperation rate compared to TSA [odds ratio = 0.37; 95% confidence interval (CI): 0.14-0.94; P value = 0.04], while no significant difference in overall complication rates was observed (odds ratio = 0.47; 95%CI: 0.19-1.16; P value = 0.10). RTSA patients showed superior outcomes in University of California Los Angeles, Simple Shoulder Test, and Shoulder Pain and Disability Index scores; however, the differences did not exceed the minimal clinically important difference. TSA patients had significantly better external rotation (mean difference= -9.0°; 95%CI: -13.21 to -5.02; P value < 0.0001). No significant differences were found in other range of motion measures or satisfaction scores. The overall methodological quality of included studies was moderate to serious.
In patients with GHOA and an intact rotator cuff, RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles. Functional outcomes favour RTSA in certain patient-reported outcome measures, while TSA retains an advantage in external rotation. Surgical decision-making should remain individualized based on patient characteristics and functional demands.
Core Tip: This systematic review and meta-analysis compares reverse total shoulder arthroplasty (RTSA) and total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis and an intact rotator cuff. Analyzing 1608 patients across 12 studies, we found RTSA was associated with lower reoperation rates and similar complication profiles compared to TSA. While TSA demonstrated better external rotation, RTSA showed favourable patient-reported outcomes, though most did not exceed clinical relevance thresholds. These findings support RTSA as a viable alternative in select patients, challenging traditional treatment paradigms and guiding individualized surgical decision-making.