ORIGINAL PAPER Reverse versus anatomical shoulder arthroplasty in patients with intact rotator cuff Emil-George Haritinian 1 & Vincent Belgaid 2 & Tiago Lino 2 & Laurent Nové-Josserand 2 Received: 15 February 2020 /Accepted: 24 July 2020 # SICOT aisbl 2020 Abstract Purpose The study objective was to compare the clinical results of reverse total shoulder arthroplasty (rTSA) and anatomical total shoulder arthroplasty (aTSA) in patients with osteoarthritis and intact rotator cuff. We hypothesised that the clinical results using rTSA would be comparable with those obtained with aTSA in this group of patients. Methods The study included 51 patients with shoulder osteoarthritis and intact rotator cuff who underwent rTSA or aTSA. The range of motion, Constant–Murley score and strength in external rotation were recorded pre-operatively and at the two year follow-up. Subjective post-operative results were measured using the subjective shoulder value (SSV) score and a satisfaction questionnaire. Results The post-operative improvement was significant in both groups, subjectively and concerning all parameters of the Constant–Murley score. Post-operatively, no significant difference was noted between the two groups for active anterior eleva- tion (AAE), active external rotation (ER), internal rotation (IR) or Constant–Murley score (67 ± 12 in the rTSA group vs 71 ± 11 in the aTSA group). An exception was the Constant–Murley range of motion sub-score, which was better in the aTSA group (p = 0.028). No significant complications necessitating revision surgery were encountered. Discussion Our findings are consistent with previous studies showing good results of rTSA with shoulder osteoarthritis and intact rotator cuff with a good restoration of the IR, similar to that obtained with aTSA. Conclusion The rTSA is a valid option for shoulder osteoarthritis and intact rotator cuff in older adult patients. Keywords Shoulder prosthesis . Reverse . Anatomical . Clinical outcome . Rotator cuff Introduction Shoulder arthroplasty has shown good results in patients with chronic and degenerative shoulder pathology. Total anatomi- cal shoulder arthroplasty (aTSA) has demonstrated better clin- ical results in the treatment of shoulder primary osteoarthritis than hemiarthroplasty [1]. The glenoid component represents the weak link of the total anatomic prosthesis, and the rate of loosening increases significantly with time, especially from ten years post-operatively [2, 3]. Additionally, any situation compromising the fixation of the glenoid implant, such as an irreparable rupture of the rotator cuff or significant wear of the bony glenoid, represents a contraindication to the use of the anatomical prosthesis. Reverse total shoulder arthroplasty (rTSA) addresses prob- lems unsolvable with the anatomic prosthesis, such as cuff tear arthropathy and osteoarthritis associated with massive cuff tear [4]. Given the encouraging results of the first reverse prosthesis, the indications have extended to other complex shoulder pathology such as irreparable rotator cuff tear with- out glenohumeral arthritis (pseudoparalysis) [5, 6], rheuma- toid arthritis, osteoarthritis secondary to glenohumeral insta- bility [7], and revision surgery [8]. The rTSA has thus been proposed when the bony glenoid did not allow implantation of an anatomic glenoid in the best condition, either due to a severe asymmetric bone defect requiring a bone graft (Walch B2 glenoid) [9] or a surgical difficulty increasing the risk of instability [10]. Following the positive results of rTSA * Emil-George Haritinian haritinian@gmail.com 1 Carol Davila University of Medicine and Pharmacy, Foișor Orthopaedic Hospital, 35–37 Ferdinand I, 021382 Bucharest, Romania 2 Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France International Orthopaedics https://doi.org/10.1007/s00264-020-04754-z