Timing and Reported Indications for Revision After Anatomic Versus Reverse Total Shoulder Replacement: A National Joint Registry Study

Background/Objectives: Although reverse total shoulder replacement (RTSR) is now the predominant shoulder replacement procedure in England and Wales, RTSR and anatomic total shoulder replacement (anatomic TSR) serve mainly different indications and are seldom compared in terms of when and why they are revised. We aimed to describe the timing and reported indications for the first revision of each construct and quantify the between-construct comparison that the National Joint Registry (NJR) describes only qualitatively. Methods: We conducted a secondary analysis of published aggregate data from the NJR’s 22nd Annual Report for elective primary anatomic TSR (n = 21,180) and RTSR (n = 39,408) performed in England and Wales between 2012 and 2024. We used NJR’s published Kaplan–Meier and prosthesis-time incidence rate (PTIR) estimates to derive the unadjusted between-construct difference (anatomic TSR minus RTSR) in cumulative revision at each time point, with approximate 95% confidence intervals (CIs), and rate ratios for each reported revision indication. Results: In these unadjusted estimates, the between-construct difference was −0.66 percentage points at 1 year (95% CI [−0.85, −0.47]), close to 0 at 3 years, and 3.52 percentage points at 12 years (95% CI [2.19, 4.85]). Revision for infection (rate ratio, 2.43), periprosthetic fracture (1.75) and instability (1.26) was more common after RTSR, whereas cuff insufficiency was markedly less frequent (PTIR 0.01 vs. 0.34 per 100 prosthesis years). Conclusions: The constructs differ in revision timing and reported indications. Because they are used for different indications in patients of different ages, these unadjusted data are descriptive and cannot establish comparative superiority or guide construct selection alone.