Reverse Total Shoulder Arthroplasty: Long-Term Clinical, Subjective Outcomes
More than half of the cohort experienced ≥1 complication.
Reverse total shoulder arthroplasty (RTSA) in patients with irreparable rotator cuff tear may lead to long-term improvements in range of motion and pain levels, but may be associated with high rates of complications, according to a study published in the Journal of Shoulder and Elbow Surgery.
In this small case series, investigators evaluated clinical and subjective outcomes at 2- to 5-year intervals in 22 patients (68% women; mean age at surgery, 68 years) who had undergone RTSA, with a mean fcollow-up of 16.1 years (range, 15-19 years). Fifteen of the patients who received RTSA had a history of ≥1 prior shoulder joint-preserving procedure.
The main clinical outcomes assessed were the Constant score (CS) and age- and sex-matched CS or relative CS (rCS) used to evaluate passive and active shoulder ranges of motion. Subjective outcomes were also assessed postoperatively with the Subjective Shoulder Value (SSV) and patient level of satisfaction.
At the latest follow-up, improvements were recorded in shoulder absolute CS (35-point gain; P <.001), SSV (51-point gain; P =.001), range of motion (active anterior elevation, P =.001; abduction, P =.005), pain (P =.001), and patient satisfaction, compared with preoperative levels. Mean active abduction was reduced during the follow-up period (absolute loss, 34⁰; P =.018).
More than half of the cohort (n=13, 59%) experienced ≥1 complication (including infection, n=6; humeral component loosening, n=2; early dislocation, n=2), and 27% (n=6) had failed RTSA. The presence of a complication managed with RTSA retention did not affect the absolute Constant and Murley score or the rCS, compared with absence of complications (P =.09 for both).
The retrospective design and small number of participants undergoing RTSA represent 2 of the primary limitations of this study.
It may be important for physicians to inform patients “about realistic expectations regarding RTSA in the long-term, emphasizing a substantial but controllable complication rate and reduced overhead function over time.”
Gerber C, Canonica S, Catanzaro S, Ernstbrunner L. Longitudinal observational study of reverse total shoulder arthroplasty for irreparable rotator cuff dysfunction: results after 15 years [published online January 3, 2018]. J Shoulder Elbow Surg. doi: 10.1016/j.jse.2017.10.037