Anatomic or reverse total shoulder for primary glenohumeral osteoarthritis? What do 10 recent articles say?

These authors compared the minimum two year outcomes between TSA and RSA in matched patients under the age of 80 years with primary glenohumeral arthritis and limited preoperative active forward flexion (≤90 degrees). The average preoperative active forward flexion was 68±20 for the TSA and 64±19 for the RSA  groups. The post operative ranges of active flexion were 141±22 and 139±21.

They also examined a subset of matched patients having TSA and RSA with severely limited preoperative forward flexion (≤70 degrees). They found no significant differences in postoperative forward flexion, external rotation, strength, ASES score, VAS, Constant score, SANE score or revision rates between the the TSA and RSA groups. The limited active forward flexion TSA group achieved significantly improved internal rotation compared to the RSA group. 

Here is a brief review of the articles.
Comparison between Anatomic Total Shoulder Arthroplasty and Reverse Shoulder Arthroplasty for Older Adults with Osteoarthritis without Rotator Cuff Tears (Kim 2024) compared the clinical outcomes of anatomic TSA and reverse shoulder arthroplasty (RSA) in patients aged over 70 years with primary glenohumeral osteoarthritis without rotator cuff tears. Of the 67 patients included in this study, TSA was performed in 41 patients, and RSA was performed in 26 patients. The two groups had no clinical differences in the patients’ preoperative demographic and radiographic data. At final follow-up, both groups showed improved pain, ROM, and functional outcomes. The TSA group demonstrated significantly better postoperative ASES and Constant-Murley scores than the RSA group. The TSA group showed significantly better postoperative active forward flexion, external rotation and internal rotations than the RSA group. Patients 75 years or older with primary glenohumeral arthritis and an intact rotator cuff show similar clinical improvement after reverse or anatomic total shoulder arthroplasty (Ardebol 2023) studied patients 75 years of age or older who underwent TSA (n=67) or RSA (n=37) for primary GHOA with an intact rotator cuff with a minimum 2-year follow-up.  The TSA cohort showed significantly greater improvement in external rotation; however both TSA and RSA provided similar clinical outcomes otherwise. Clinical outcomes of anatomic vs. reverse total shoulder arthroplasty in primary osteoarthritis with preoperative rotational stiffness and an intact rotator cuff: a case control study (Hao 2023) compared stiff patients(ER ≤ 0 degrees) having RSAs to matched stiff patients having TSAs.  Postoperative outcome scores were similar across all matched cohort comparisons. Preoperative limitations in passive ER did not appear to be a limitation to utilizing TSA.Clinical outcomes of anatomic vs. reverse total shoulder arthroplasty in primary osteoarthritis with preoperative external rotation weakness and an intact rotator cuff: a case-control study (Hones 2024) analyzed the two year minimum outcomes for 333 TSAs and 155 RSAs performed for primary cuff-intact osteoarthritis and having ER weakness (strength <3.3 kilograms (7.2 pounds)). When comparing weak TSA vs.weak RSA, no differences were found in postoperative outcome measures, rate of complications or rate of revision surgery.