Clinical outcomes and complications of cementless reverse total shoulder arthroplasty during the early learning curve period

Sungwook Choi,Jong-Hwan Bae,Yong Suk Kwon,Hyunseong Kang

doi:10.1186/s13018-019-1077-1

Abstract

BackgroundReverse total shoulder arthroplasty (RTSA) is a treatment option for patients with severe osteoarthritis, rotator cuff arthropathy, or massive rotator cuff tear with pseudoparalysis. We are to deduce not only the early functional outcomes and complications of cementless RTSA during the learning curve period but also complication-based, and operation time-based learning curve of RTSA.MethodsBetween March 2010 and February 2014, we retrospectively evaluated 38 shoulders (6 male, 32 female). The average age of the patients was 73.0 years (range, 63 to 83 years), and the average follow-up was at 24 months (range, 12–53 months). The visual analog scale (VAS), University of California Los Angeles (UCLA) score and constant score were used to evaluate the clinical outcomes. We evaluated patients radiographically at 2 weeks, 3 months, 6 months, 1 year, and then annually thereafter for any evidence of complications.ResultsThe VAS score improved from 4.0 to 2.8 (p = 0.013). The UCLA score improved from 16.0 to 27.9 (p = 0.002), and the constant score improved from 41.4 to 78.9 (p < 0.001), which were statistically significant. While active forward flexion, abduction, and internal rotation improved (p value = 0.001, < 0.01, 0.15), external rotation did not show significant improvement (p = 0.764). Postoperative complications included acromion fracture (one case), glenoid fracture (one case), peripristhetic humeral fracture (one case), axillary nerve injury (one case), infection (one case), and arterial injury (one case). Our study presented an intraoperative complication-based learning curve of 20 shoulders, and operation time-based learning curve of 15 shoulders.ConclusionsThe clinical outcomes of RTSA were satisfactory with overall complication rates of 15.7%. An orthopedic surgeon within the learning curve period for the operation of RTSA should be cautious when selecting the patients and performing RTSA.Trial registrationRetrospectively registered.

Highlights

Reverse total shoulder arthroplasty (RTSA) was introduced first by Grammont et al in 1987 as a treatment for patients with cuff tear arthropathy
The indications for reverse total shoulder arthroplasty were the following: rotator cuff tear arthropathy, massive irreparable rotator cuff tear with chronic loss of elevation that failed to respond to physical treatment, posttraumatic glenohumeral arthritis, and primary osteoarthritis of the shoulder with a massive irreparable cuff tear (Table 1) [12]
Functional and clinical outcomes The average visual analog scale (VAS) score improved from 4.0 points before surgery to 2.8 points (p = 0.013) at the time of follow-up

Summary

Introduction

Reverse total shoulder arthroplasty (RTSA) was introduced first by Grammont et al in 1987 as a treatment for patients with cuff tear arthropathy. The advantage of the design of RTSA was based on the concept of reversing the shoulder joint by fixing a metal ball to the glenoid and introducing a spherical socket into the proximal part of the humerus [3, 4]. Michael et al reported cementless fixation of a porous-coated RTSA humeral stem clinical and radiographic outcomes equivalent to those of cemented stems at minimum 2-years follow-up and mentioned several advantages of cementless fixation: (1) no risk of cement-related complications, (2) decreased operative time, (3) simplified operative technique, and (4) greater ease of revision [10]. We are to deduce the early functional outcomes and complications of cementless RTSA during the learning curve period and complication-based, and operation time-based learning curve of RTSA

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Conclusion