Subscapularis-Sparing Total Shoulder Arthroplasty: A Prospective, Double-Blinded, Randomized Clinical Trial.

Abstract

Although total shoulder arthroplasty (TSA) is generally associated with good to excellent outcomes in most patients, the integrity and function of the subscapularis tendon (SSC) is of paramount importance because SSC rupture after TSA can lead to inferior outcomes. Therefore, the efficacy of a SSC-sparing TSA procedure was evaluated through a prospective, double-blinded, randomized study. Patients with end-stage osteoarthritis of the shoulder were randomized into 2 groups. Group 1 patients were treated with TSA in which the prosthesis was inserted entirely through the rotator interval without violating the SSC tendon (SPARING). Group 2 patients were treated with TSA using the SSC tenotomy approach (STANDARD). Both the patients and the evaluators remained blinded to the surgical approach throughout the study. Outcome data collected included the visual analog scale score for pain and the American Shoulder and Elbow Surgeons outcome score. Complete 2-year outcome data were collected from 32 SPARING and 38 STANDARD patients at a mean follow-up of 31.1 and 33.4 months, respectively. The American Shoulder and Elbow Surgeons and visual analog scale scores improved significantly for both groups. Differences between groups did not reach statistical significance. Complication profiles were similar for the 2 groups, with 3 patients in the SPARING group and 2 patients in the STANDARD group requiring revision surgery during the study. At short-term follow-up, the outcome of TSA using the SSC-sparing surgical approach was similar to the outcome of TSA using the standard approach. Studies with longer follow-up are required to document the potential benefits of this surgical technique. [Orthopedics. 2019; 42(1):e61-e67.].