Clinical outcomes of upper extremity ambulators post-reverse total shoulder arthroplasty

Abstract

BackgroundPatients requiring upper extremity assist devices such as canes, walkers, and wheelchairs have shown an increased incidence of rotator cuff tears (RCTs), distal clavicle osteolysis, and osteoarthritis. The frequent combination of glenohumeral arthritis and rotator cuff arthropathy makes reverse total shoulder arthroplasty (rTSA) an attractive option in treating the shoulder pathology in these patients. The objective of this study is to determine the effectiveness of the rTSA procedure for treatment of shoulder pathology in the upper extremity ambulator population, and what role preoperative functional status plays on outcomes. MethodsThe study involved a retrospective analysis of 30 upper extremity ambulator patients (ages 48-88, average = 72.54 years) who underwent a rTSA procedure performed by the senior author (S.G.) in Milwaukee, WI, USA. Of these 30, 5 patients received bilateral rTSAs, for a total of 35 procedures. Average follow-up for these patients was 32 months, (range 24-84 months). The following preoperative and postoperative characteristics were recorded for each patient: range of motion, Visual Analog Scale scores, American Shoulder and Elbow Surgeons scores, Constant Murley scores, and Simple Shoulder Test scores. Data were analyzed using ANCOVA analysis. ResultsAverage Visual Analog Scale scores improved from 6.40 to 2.08 (gain = 4.362; P< .0001). Average forward flexion improved from 70.32° to 127.74° (gain = 57.42°; P < .0001), while average abduction improved from 41.79° to 110.18° (gain = 68.69°; P = .0002). Average Murley scores improved from 25.68 to 63.32 (gain = 37.64; P = .030). American Shoulder and Elbow Surgeons and Simple Shoulder Test scores were not shown to be statistically significant, though patients showed a trend toward gains in these metrics. A patient's preoperative status was highly correlated with their expected gain in function postoperatively, with lower baseline preoperative function correlating to larger gains postoperatively. Patients showed statistically significant gains in the metrics listed above, regardless of preoperative diabetic status, opioid use, or the type of ambulatory assistive device used. ConclusionThis study shows that rTSA reliably leads to significant postoperative improvements in range of motion, function, and pain relief in the upper extremity ambulator population. Patients with lower preoperative scores showed overall higher gains in both pain and function postoperatively, ultimately leading to similar postoperative outcomes to those who started at a high baseline function. These gains were irrespective of a patient's other preoperative characteristics, including diagnosis of diabetes, preoperative opioid use, and the type of upper extremity assist device used. Level of evidenceLevel III.