Objectives To answer a national research priority by comparing the risk-benefit and costs associated with reverse total shoulder replacement (RTSR) and anatomical total shoulder replacement (TSR) in patients having elective primary shoulder replacement for osteoarthritis. Design Population based cohort study using data from the National Joint Registry and Hospital Episode Statistics for England. Setting Public hospitals and publicly funded procedures at private hospitals in England, 2012-20. Participants Adults aged 60 years or older who underwent RTSR or TSR for osteoarthritis with intact rotator cuff tendons. Patients were identified from the National Joint Registry and linked to NHS Hospital Episode Statistics and civil registration mortality data. Propensity score matching and inverse probability of treatment weighting were used to balance the study groups. Main outcome measures The main outcome measure was revision surgery. Secondary outcome measures included serious adverse events within 90 days, reoperations within 12 months, prolonged hospital stay (more than three nights), change in Oxford Shoulder Score (preoperative to six month postoperative), and lifetime costs to the healthcare service. Results The propensity score matched population comprised 7124 RTSR or TSR procedures (126 were revised), and the inverse probability of treatment weighted population comprised 12 968 procedures (294 were revised) with a maximum follow-up of 8.75 years. RTSR had a reduced hazard ratio of revision in the first three years (hazard ratio local minimum 0.33, 95% confidence interval 0.18 to 0.59) with no clinically important difference in revision-free restricted mean survival time, and a reduced relative risk of reoperations at 12 months (odds ratio 0.45, 95% confidence interval 0.25 to 0.83) with an absolute risk difference of −0.51% (95% confidence interval −0.89 to −0.13). Serious adverse events and prolonged hospital stay risks, change in Oxford Shoulder Score, and modelled mean lifetime costs were similar. Outcomes remained consistent after weighting. Conclusions This study’s findings provide reassurance that RTSR is an acceptable alternative to TSR for patients aged 60 years or older with osteoarthritis and intact rotator cuff tendons. Despite a significant difference in the risk profiles of revision surgery over time, no statistically significant and clinically important differences between RTSR and TSR were found in terms of long term revision surgery, serious adverse events, reoperations, prolonged hospital stay, or lifetime healthcare costs. Access to the data analysed in this study required permission from the National Joint Registry research subcommittee. Information on research data access requests to the National Joint Registry is available at . No additional data available.

中文翻译：

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反向全肩关节置换术与解剖学全肩关节置换术治疗骨关节炎：基于人群的队列研究，使用英格兰国家联合登记处和医院发病统计数据


目的 通过比较骨关节炎选择性初次肩关节置换术患者的反向全肩关节置换术 (RTSR) 和解剖性全肩关节置换术 (TSR) 相关的风险效益和成本，回答国家研究重点。使用英格兰国家联合登记处和医院发病统计数据设计基于人群的队列研究。 2012-20 年英国公立医院和私立医院公立医院的设置。参与者 60 岁或以上因骨关节炎接受 RTSR 或 TSR 且肩袖肌腱完整的成年人。患者是从国家联合登记处确定的，并与 NHS 医院病例统计和民事登记死亡率数据相关联。使用倾向评分匹配和治疗加权的逆概率来平衡研究组。主要结果指标 主要结果指标是修复手术。次要结局指标包括 90 天内的严重不良事件、12 个月内的再次手术、住院时间延长（超过三晚）、牛津肩评分的变化（术前至术后六个月）以及医疗服务的终生费用。结果 倾向评分匹配人群包括 7124 例 RTSR 或 TSR 手术（其中 126 例进行了修订），治疗加权逆概率人群包括 12 968 例手术（294 例进行了修订），最长随访时间为 8.75 年。 RTSR 的前三年翻修风险比降低（风险比局部最小值 0.33，95% 置信区间 0.18 至 0.59），无翻修限制平均生存时间没有临床上的重要差异，并且再次手术的相对风险降低12 个月（优势比 0.45，95%置信区间为0.25至0.83），绝对风险差异为-0.51%（95%置信区间为-0.89至-0.13）。严重不良事件和长期住院风险、牛津肩评分的变化以及建模平均终生成本相似。加权后结果保持一致。结论 这项研究的结果证明，对于 60 岁或以上患有骨关节炎且肩袖肌腱完整的患者来说，RTSR 是 TSR 的可接受替代方案。尽管随着时间的推移，翻修手术的风险状况存在显着差异，但在长期翻修手术、严重不良事件、再次手术、住院时间延长或终生医疗费用方面，RTSR 和 TSR 之间没有发现统计学上显着的和临床上重要的差异。访问本研究中分析的数据需要获得国家联合登记研究小组委员会的许可。有关向国家联合登记处提出研究数据访问请求的信息，请访问： 。没有其他可用数据。