Rate of Improvement in Outcomes Measures After Reverse Total Shoulder Arthroplasty: A Longitudinal Study With 2-Year Follow-up

Background Few studies report rate of improvement following reverse total shoulder arthroplasty (RTSA) in a single cohort. The purpose of this study was to compare functional scores following RTSA across postoperative time points in patients who have follow-up scores available at all selected time points. Methods A prospective database was retrospectively queried for patients with functional outcome data from preoperatively and after RTSA at 3 to 6 months, 1 year, and 2 years, excluding any patients with data missing at these points. All patients included had measures from every time point. Collected outcomes included American Shoulder and Elbow Surgeons (ASES), visual analog scale pain, subjective shoulder value (SSV), and range of motion. Results Outcomes from 173 shoulders were analyzed. Average age was 68 ± 9 years, 68% were females, and 15% were revision cases. The average preoperative ASES score (33 ± 17) improved to 73 ± 18 at 3 to 6 months, 80 ± 19 at 1 year, and 81 ± 19 at 2 years after RTSA. Only outcomes at 1 and 2 years were not significantly different ( P = 1.0). SSV scores and forward elevation followed this pattern, with large improvements in the first 3 to 6 months, then reaching a plateau at 1 year. External and internal rotations did not improve by 3 to 6 months, but did significantly improve by 1 year, and remained stable through 2 years. Pain scores improved from 6.8 points before surgery to roughly 1.3 points at all subsequent time points. Conclusions Patients undergoing RTSA can expect significant reductions in pain and the majority of their functional gains to occur in the first 6 months after surgery. At 12 months after RTSA, the average patient will achieve maximal improvement.

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Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-022-00625-y ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Hyojune Kim ◽

Chul-Ho Kim ◽

Minsoo Kim ◽

Wonsun Lee ◽

In-Ho Jeon ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Revision Rate ◽

Meta Analysis ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Functional Scores ◽

Reverse Total Shoulder ◽

Glenoid Loosening

Abstract Purpose We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. Materials and methods The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. Results Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = − 10.28, 95% CI: − 16.69 to − 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06–0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73–65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07–1.57, P = 0.16). Conclusion A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. Level of evidence: Level IV, Meta-analysis.

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Stemless reverse total shoulder arthroplasty: a systematic review of short- and mid-term results

Shoulder & Elbow ◽

10.1177/17585732211013356 ◽

2021 ◽

pp. 175857322110133

Author(s):

Eva Y Liu ◽

Dorsa Kord ◽

Nicholas J Yee ◽

Nolan S Horner ◽

Latifah Al Mana ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Constant Score ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Weighted Mean ◽

Surgical Time ◽

Functional Scores ◽

Reverse Total Shoulder ◽

Mid Term Results

Introduction Stemless reverse total shoulder arthroplasty is used to treat rotator cuff deficient arthropathies, rheumatoid arthritis, and osteoarthritis. It has several advantages over the stemmed implant including preservation of bone stock, reduced surgical time, and easier revision. Methods A systematic search was conducted in MEDLINE, EMBASE, PubMed, and CENTRAL to retrieve all relevant studies evaluating stemless reverse total shoulder arthroplasty. Results The literature search identified 1993 studies out of which 7 studies were included in this review; 324 patients underwent stemless reverse total shoulder arthroplasty with a weighted mean age of 74.1 (SD = 8.6, range = 38 to 93) years and a weighted mean follow-up time of 44 (SD = 6.6, range = 3 to 95) months. The included studies reported significant improvements in range of motion and functional scores comparable to stemmed reverse total shoulder arthroplasty. The weight mean flexion and abduction was (135 ± 12)° and (131 ± 12)° post-operatively, respectively. The weighted mean constant score increased from (26.7 ± 5.2) Patients (pts) to (63.0 ± 8.0) pts post-operatively. Overall complication and revision rate were 12.3% and 5.2%. Conclusion Early and mid-term results indicate stemless reverse total shoulder arthroplasty has similar clinical outcomes to stemmed reverse total shoulder arthroplasty. There was no radiological evidence of humeral loosening at the latest follow-up.

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The Clinical and Radiographic Impact of Increasing Medialization of the Bone-Prosthesis Interface in Primary Reverse Total Shoulder Arthroplasty At Short-Term Follow-Up

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.03.060 ◽

2021 ◽

Vol 30 (7) ◽

pp. e441-e442

Author(s):

Jorge Rojas Lievano ◽

Prashant Meshram ◽

Filippo Familiari ◽

Uma Srikumaran ◽

Edward Mcfarland

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Short Term ◽

Reverse Total Shoulder

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Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-1280.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 761-766 ◽

Cited By ~ 25

Author(s):

M. Holschen ◽

M-K. Siemes ◽

K-A. Witt ◽

J. Steinbeck

Keyword(s):

Shoulder Arthroplasty ◽

Proximal Humeral Fracture ◽

Constant Score ◽

Total Shoulder Arthroplasty ◽

Operating Time ◽

Humeral Fracture ◽

Reverse Total Shoulder Arthroplasty ◽

The Mean ◽

Reverse Total Shoulder

Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6.

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Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00087 ◽

2021 ◽

Vol 24 (3) ◽

pp. 125-134

Author(s):

Kirtan Tankshali ◽

Dong-Whan Suh ◽

Jong-Hun Ji ◽

Chang-Yeon Kim

Keyword(s):

Los Angeles ◽

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Intraoperative Complications ◽

Total Shoulder Arthroplasty ◽

Asian Population ◽

Reverse Total Shoulder Arthroplasty ◽

Scapular Notching ◽

Reverse Total Shoulder

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up.Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with a minimum of 2 years of follow-up were enrolled. We evaluated the preoperative and postoperative clinical outcomes, radiological outcomes (notching and loosening), and complications of BIO-RSA at the last follow-up. In addition, we divided these patients into notching and not-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients between the two groups.Results: Visual analog scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Simple Shoulder Test scores improved significantly from preoperative (average: 5, 39.43, 16.22, 3.94) to postoperative (average: 1.71, 78.91, 28.34, 7.8; p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20/38 patients (53%). In the comparison between notching and not-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications were three metaphyseal fractures and one inferior screw malposition. Postoperative complications included one heterotopic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection.Conclusions: BIO-RSA resulted in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantages of glenoid lateralization were observed, we observed higher rates of scapular notching compared to previously reported rates in BIO-RSA studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

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Near-simultaneous bilateral reverse total shoulder arthroplasty for the treatment of bilateral fracture dislocations of the shoulder

BMJ Case Reports ◽

10.1136/bcr-2019-230212 ◽

2019 ◽

Vol 12 (10) ◽

pp. e230212 ◽

Cited By ~ 1

Author(s):

Alexander Wendling ◽

Matthew L Vopat ◽

Shang-You Yang ◽

Bradley Saunders

Keyword(s):

Shoulder Arthroplasty ◽

Treatment Plan ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Left Shoulder ◽

Fracture Dislocations ◽

Bilateral Fracture ◽

Reverse Total Shoulder

A man in his mid-80s presented with bilateral posterior fracture dislocations of the humerus after suffering a seizure. He had Parskinson’s disease and lived with his wife at home. His left shoulder was not felt to be reconstructable. The initial treatment plan was to perform reverse total shoulder arthroplasty (rTSA) on the left and non-operatively reduce his right shoulder. A left rTSA was performed, but his right shoulder was unstable due to a glenoid fracture and soft tissue instability. In order to preserve the patient’s quality of life, a right rTSA was performed 4 days later. In the follow-up period, the patient was able to regain enough pain-free range of motion on activities of daily living. The patient died from complications of Parkinson’s disease 10 months postoperatively.

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