Restoration of internal rotation after reverse shoulder arthroplasty may vary depending on etiology in patients younger than 60 ​years of age: a multicenter retrospective study

Abstract

BackgroundReverse shoulder arthroplasty (RSA) offers promising functional outcomes for young patients, yet challenges persist in restoring internal rotation (IR). This study aimed to assess the restoration of IR after RSA in patients younger than 60 years old and analyze the factors affecting IR recovery. MethodsA retrospective multicenter study was conducted, examining the functional outcome of patients who underwent RSA, with a minimum follow-up period of 2 years. Two subgroups of patients who underwent primary RSA were analyzed separately with respect to active (AIR1): “difficult AIR1” and “easy AIR1.” ResultsThe study included 136 patients (overall series) with a mean age of 51.6 years. The overall series showed statistically significant improvement in active range of motion (RoM), pain, and Constant scores, especially with active IR (p<0.01). According to etiology, statistically significant improvement (p<0.05) in active IR was observed for fracture sequelae, primary osteoarthritis, and rheumatoid arthritis, while no statistically significant improvement in internal rotation was observed for tumor, revision, and cuff tear arthropathy (p>0.05). In subgroup analysis, patients with easy AIR1 displayed a statistically significant lower body mass index and better Constant score mobility, as well as improved motion in forward elevation and active IR (p<0.05). No statistically significant associations were found between improved IR and prosthetic design or subscapularis repair. Scapular notch, lysis of the graft, and teres minor atrophy were significantly associated with better active IR (p<0.05). ConclusionRSA improves active RoM, pain, and functional outcomes in patients under 60. However, the degree of improvement in IR may vary depending on several factors and the underlying etiologies. These insights are crucial for patient selection and counseling, guiding RSA optimization efforts. Level of evidenceIV