Outcomes Of Reverse Shoulder Arthroplasty Research Articles

Short term Functional Outcomes of Reverse Shoulder Arthroplasty Following Three-Dimensional Planning is Similar Whether Placed with a Standard Guide or Patient Specific Instrumentation (PSI).

Preoperative assessment of the glenoid and surgical placement of the initial guide wire are important in implant positioning during reverse total shoulder arthroplasty (rTSA). Three-dimensional (3D) computed tomography (CT) and patient specific instrumentation (PSI) have improved the placement of the glenoid component, but the impact on clinical outcomes remains unclear. The purpose of this study was to compare short term clinical outcomes after rTSA based on intraoperative technique for central guidewire placement in a cohort of patients that had preoperative 3D planning. A retrospective matched analysis was performed from a multicenter prospective cohort of patients who underwent rTSA with preoperative 3D planning and a minimum of 2-year clinical follow-up. Patients were divided into 2 cohorts based on the technique utilized for glenoid guide pin placement: 1) Standard manufacture guide (SG) that was not customized or 2) PSI. Patient reported outcomes (PROs), active range of motion (ROM), and strength measures were compared between the groups. The ASES score was used to assess the minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS). One hundred seventy patients met the study criteria, including 56 performed with SGs and 122 with PSI. There was no difference in PROs between cohorts. There were no significant differences in the percentage of patients that achieved an ASES MCID, SCB, or PASS. Improvement in internal rotation to the nearest spinal level (p < .001) and at 90° (p = .002) were higher in the SG group and, but likely explained by differences in glenoid lateralization utilized. Improvement in abduction strength (p < .001) and external rotation strength (p = .010) were higher in the PSI group. rTSA performed following preoperative 3D planning leads to similar improvement in PROs regardless of whether a SG or PSI are utilized intraoperatively for central glenoid wire placement. Greater improvement in postoperative strength was observed with the use of PSI, but the clinical significance of this finding is unclear.

Lateralization and distalization shoulder angles do not predict outcomes in reverse shoulder arthroplasty for cuff tear arthropathy

In reverse shoulder arthroplasty (RSA), there is a plethora of measurements regarding implant lateralization and distalization to optimize the center of rotation. Two specific measurements known as the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) have been the recent focus of studies to assess their association with RSA and postoperative function. The aim of this study was to evaluate the prognostic clinical value of the LSA and DSA in a large cohort of patients with cuff tear arthropathy (CTA) who were treated with different RSA systems. Two local shoulder arthroplasty registries were reviewed for all RSA patients documented with a radiological assessment and complete 2-year follow-up examination. The main inclusion criterion was primary RSA for patients with CTA. Any patients with either a complete teres minor tear, os acromiale or acromial stress fractures reported between the time of surgery and the 24-month follow-up were excluded. Five different RSA implant systems with four different neck-shaft angles were assessed. The Constant Score (CS), Subjective Shoulder Value (SSV) and range of motion (ROM) at two years were correlated with both LSA and DSA assessed on 6-month anteroposterior radiographs. Linear and parabolic univariable regressions were calculated for both shoulder angles, for each prosthesis system and for the entire patient cohort. Between May 2006 and November 2019, there were a total of 630 CTA patients who had undergone primary RSA. Of this large cohort, 270 were treated with the Promos Reverse (neck-shaft angle [NSA], 155°), 44 with the Aequalis Reversed II (NSA, 155°), 62 with the Lima SMR Reverse (150°), 25 with the Aequalis Ascend Flex (145°) and 229 with the Univers Revers (135°) prosthesis systems. The mean (standard deviation [SD]) LSA was 78° (10; range, 6-107) and the mean DSA was 51° (10; range, 7-91). The average CS at 24 months follow-up was 68.1 (SD: 13; 13-96) points. Neither the linear nor parabolic regression calculations for LSA or DSA revealed significant associations with any of the clinical outcomes. Different patients may achieve different clinical outcomes despite having identical LSA and DSA values. There is no association between angular radiographic measurements and 2-year functional outcome.

Narrative review of influence of prosthesis lateralization on clinical outcomes in reverse shoulder arthroplasty: glenoid vs. humerus vs. combined.

Reverse shoulder arthroplasty has become a common orthopaedic procedure, with a growing number of cases annually for multiple indications, such as rotator cuff arthropathy, osteoarthritis, or fractures of the proximal humerus, to reduce pain and restore shoulder mobility. Prosthesis design and various recent improvements aim to enhance range of motion (ROM) and stability and to limit component loosening and other potential complications. Many of these well-known issues could theoretically be improved by glenoid, humeral, or combined component lateralization. The objective of this article is to provide an up-to-date literature overview, present available options, and discuss the rationale behind lateralization of certain components, as well as their combined impact on outcomes of reverse shoulder arthroplasty. PubMed and Scopus databases from 2003 to 2023 were searched and screened for studies, including systematic reviews, on the influence of glenoid, humeral, and combined component lateralization that served for narrative review of rationale behind such design. Currently, a number of computer simulations, anatomic studies, and limited clinical references aim to support the rationale behind glenoid augmentation, variable humeral neck-shaft angle (NSA), or humeral tray design. The utility of lateralization has not yet been clinically established. Randomized, long-term clinical outcome studies are still needed to reach a verdict going beyond surgeon preference and case-specific indications.

The use of a large diameter glenosphere in Reverse Shoulder Arthroplasty for proximal humeral fractures in elderly patients undergoing tuberosity removal.

Prosthetic replacement with reverse shoulder arthroplasty (RSA) is commonly indicated for complex proximal humerus fractures (PHFs) in elderly patients. Aim of this study was to evaluate the clinical and radiological outcomes of RSA performed for comminuted PHFs, without periprosthetic reconstruction of the tuberosities. Our hypothesis was that a large diameter glenosphere could ensure satisfactory RSA mobility and stability, regardless of tuberosity removal. We selected 32 patients (4 men, 28 women) with comminuted PHFs who underwent RSA with tuberosity excision and implantation of a 44-mm glenosphere between 2009 and 2015. Active range of motion (ROM), stability, Constant-Murley Score (CMS) (1) and Subjective Shoulder Value (SSV) (2) were assessed one year and four years after surgery. Clinical and radiological information were collected for 23 patients (72%). At one-year follow-up, active anterior elevation (AE) was 96±28 degrees, external rotation with adducted arm (ER1) 9±7 degrees, external rotation with abducted arm (ER2) 14±10 degrees, internal rotation (IR) to L4; CMS was 56±10 and SSV 65±22. Clinical assessment at 4-year follow up showed a decrease in active ROM (AE was 88±20 degrees, ER1 8±2 degrees, ER2 12±10 degrees, IR to L4), CMS (52±9) and SSV (62±8). No RSA dislocation occurred during the study. In 4 patients, grade I glenoid notching without any sign of component loosening was observed 4 years after surgery. A large diameter glenosphere does not ensure results comparable to those achieved after RSA with tuberosity reconstruction. However, the 44-mm glenosphere was effective in preventing RSA instability.

Anterior deltoid muscle reflection using a deltopectoral approach is safe and does not influence outcome of reverse shoulder arthroplasty.

The deltopectoral approach is well accepted for shoulder arthroplasty procedures. The extended deltopectoral approach with detachment of the anterior deltoid from the clavicle allows increased joint exposure and can protect the anterior deltoid from traction injury. The efficacy of this extended approach has been demonstrated in anatomical total shoulder replacement surgery. However, this has not been shown in reverse shoulder arthroplasty (RSA). The primary aim of this study was to evaluate the safety of the extended deltopectoral approach in RSA. The secondary aim was to evaluate the performance of the deltoid reflection approach in terms of complications, surgical, functional and radiological outcomes up to 24 months post-surgery. A prospective non-randomized comparative study was performed between January 2012 and October 2020 including 77 patients in the deltoid reflection group and 73 patients in the comparative group. Decision for inclusion was based on patient and surgeon factors. Complications were recorded. Patients were followed up for at least 24 months to evaluate their shoulder function and ultrasound evaluation. Functional outcome measures included the Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder Elbow Surgeons score (ASES), pain intensity (VAS 0-100), range of motion (forward flexion (FF), abduction (AD), and external rotation (ER)). A regression analysis was performed to evaluate any factors of influence on the VAS. There were no significant differences in the rate of complications between the two groups (14.5% in the deltoid reflection group and 13.8% in the comparative group, p=0.915). Ultrasound evaluation was available in 64 (83.1%) patients, and no proximal detachment was observed. In addition, there were no significant differences in functional outcome measures both preoperatively and at 24 months post-surgery between the groups on Mean VAS pain, OSS, DASH, ASES, FF, ABD, and ER. Adjustment for possible confounders in a regression model indicated that only prior surgery significantly influenced the VAS pain (p=0.031, 95%CI 0.574 - 11.67) after surgery. Deltoid reflection (p=0.068), age (p=0.466), sex (p=0.936), glenoid graft (p=0.091), prosthesis manufacturer (p=0.382) and preop VAS score (p=0.362) were not of influence. Results of this study show an extended deltopectoral approach for RSA is safe. Selected reflection of the anterior deltoid muscle improved exposure and prevents anterior deltoid muscle injury followed by re-attachment. Patients had similar functional scores preop and at 24 months compared to a comparative group. Furthermore, ultrasound evaluation showed intact re-attachments.

Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities.

Given the touted clinical and patient-reported outcomes of reverse shoulder arthroplasty (RTSA) in improving pain and restoring function, shoulder surgeons are rapidly expanding the indications and utilization of RTSA. Despite its increasing use, the ideal post-operative management ensuring the best patient outcomes is still debated. This review synthesizes the current literature regarding the impact of post-operative immobilization and rehabilitation on clinical outcomes following RTSA including return to sport. Literature regarding the various facets of post-operative rehabilitation is heterogeneous in both methodology and quality. While most surgeons recommend 4-6weeks of immobilization post-operatively, two recent prospective studies have shown that early motion following RTSA is both safe and effective with low complication rates and significant improvements in patient-reported outcome scores. Furthermore, no studies currently exist assessing the use of home-based therapy following RTSA. However, there is an ongoing prospective, randomized control trial assessing patient-reported and clinical outcomes which will help shed light on the clinical and economic value of home therapy. Finally, surgeons have varying opinions regarding return to higher level activities following RTSA. Despite no clear consensus, there is growing evidence that elderly patients are able to return to sport (e.g., golf, tennis) safely, though caution must be taken with younger or more high-functioning patients. While post-operative rehabilitation is believed to be essential to maximize outcomes following RTSA, there is a paucity of high-quality evidence that guides current rehabilitation protocols. There is no consensus regarding type of immobilization, timing of rehabilitation, or need for formal therapist-directed rehabilitation versus physician-guided home exercise. Additionally, surgeons have varied opinions regarding return to higher level activities and sports following RTSA. There is burgeoning evidence that elderly patients can return to sport safely, though caution must be taken with younger patients. Further research is needed to clarify the optimal rehabilitation protocols and return to sport guidelines.

Comparison of reverse shoulder arthroplasty and total shoulder arthroplasty for patients with inflammatory arthritis.

End-stage glenohumeral joint arthritis is common in patients with inflammatory arthritis. Reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA) are both indicated in this setting. RSA is often considered based on the impacts of long-standing inflammatory arthritis including glenoid and humeral bone erosion and rotator cuff insufficiency. However, acromial and scapular spine fractures following RSA have been reported more commonly in these patients, which can have a significant impact on outcomes. Currently, no study has directly compared the efficacy and complication rates of RSA vs. TSA in patients with inflammatory arthritis. This study aimed to investigate differences in clinical outcomes and complications in patients undergoing RSA vs. TSA with glenohumeral inflammatory arthritis. We performed a retrospective review of 86 patients with inflammatory arthritis treated with primary RSA (n=43) or TSA (n=43) with a minimum of 2 years' follow-up. American Shoulder and Elbow Surgeons scores, Simple Shoulder Test scores, visual analog scale scores for pain and function, active range of motion, and patient self-ratings of upper-extremity normality (Subjective Assessment of Normal Evaluation [SANE]) were collected preoperatively and at minimum 2-year follow-up. Radiographic classification of preoperative glenoid and humeral bone loss was performed, and postoperative complications were observed. Revision and complication details were compared. The study cohort had an average age of 72.1 years (range, 31-92 years) and average follow-up period of 51.6 months (range, 22-159 months). Both the RSA and TSA cohorts demonstrated improvements in patient-reported outcome measures and ranges of motion; however, patients treated with TSA showed a greater postoperative final Simple Shoulder Test score (P<.001), visual analog scale score for function (P=.0347), active elevation (P=.0331), active external rotation (P<.001), active internal rotation (P=.005), and Single Assessment Numeric Evaluation (SANE) score (P=.0161). Analysis of complication rates demonstrated no statistically significant difference between cohorts. Four acromial fractures occurred in the RSA group. When RSA patients who sustainedacromial fractures were removed from the analysis, there were minimal differences in outcomes between the RSA and TSA cohorts. TSA in patients with inflammatory arthritis leads to improved clinical outcomes but higher early revision rates when compared with RSA. RSA outcomes are negatively impacted by a high rate of postoperative acromial fractures.

Clinical outcomes of reverse shoulder arthroplasty for the treatment of failed fixation of proximal humeral fracrtures in the elderly patients

To evaluate the clinical outcomes of reverse total shoulder arthroplasty as a revision procedure for the failed fixation of proximal humeral fractures in the elderly patients. A retrospective analysis was performed on 8 patients with failed internal fixation of proximal humeral fractures from May 2014 to March 2020, including 3 males and 5 females, aged from 65 to 75 years old. All 8 patients underwent reverse total shoulder arthroplasty, and the mean time between initial fixation and reverse total shoulder arthroplasty ranged from 8 to 16 months. Range of motion(ROM), University of California at Los Angeles(UCLA) shoulder score, visual analogue scale (VAS), self-rating anxiety scale(SAS), and Constant-Murley score of shoulder function were assessed pre-operatively and at the last follow-up. Complications relating to the surgery were recorded. All 8 patients successfully followed up. The mean follow-up after reverse total shoulder arhroplasty ranged from 16 to 28 months. The range of motion (forward flexion, external rotation, abduction and internal rotation) of the affected shoulder was significantly improved after surgery, and the post-operative VAS, SAS and UCLA scores were also significantly improved. For the Constant-Murley score of shoulder joint function, the total scores and the subscores of pain, daily activities, range of motion and strength test at the last follow-up were all significantly improved. Scapular glenoid notch was observed in patient, which was evaluated as grade 1 on imaging. All the other patients did not develop specific or non-specific complications. Reverse total shoulder arhroplasty is an appropriate treatment as a revision surgery for failed fixation of proximal humeral fractures. It has shown satisfactory clinical outcomes, accelerating the rehabilitation of shoulder function and improving the quality of life.

Relationship between the prosthesis scapular neck angle and clinical outcomes in reverse shoulder arthroplasty.

Optimal glenosphere positioning in reverse shoulder arthroplasty (RSA) remains highly debated. We aimed to characterize the association between the prosthesis scapular neck angle (PSNA) and postoperative range of motion (ROM) and clinical outcome scores. A retrospective review of 284 RSAs using a single design with minimum 2-year follow-up was performed. Glenosphere tilt was measured postoperatively using PSNA. ROM and functional outcome scores were assessed preoperatively and at latest follow-up. The PSNA was dichotomized to inferior or superior groups (>90° vs ≤ 90°, respectively) and stratified into quartiles; ROM and outcome score measures were compared between groups controlling for inferior glenosphere overhang. No range of PSNA was consistently associated with superior ROM, clinical outcome scores, or rates of complications including scapular notching. However, greater preoperative to postoperative improvement in active FE was found for superiorly (PSNA ≤ 90°) versus inferiorly tilted glenospheres (37° ± 33° vs 53° ± 35°, P = 0.005) and the greater improvement in active FE (57° ± 35°, P = 0.004) was further isolated to the first quartile (mean 85.1° ± 3.5°). A lack of variation in clinical outcomes based on PSNA suggests negligible short-term (median follow-up 3.1 years) clinical significance when glenosphere tilt falls within the distribution of this cohort (mean 92.6° ± 6.2°).

Long-Term Results of Primary Reverse Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears Without Glenohumeral Arthritis with a Mean Follow up of 9.4 Years.

The aim of this single-center study was to analyze the long-term clinical results of reverse shoulder arthroplasty in patients with massive, irreparable rotator cuff tears without glenohumeral arthritis. A retrospective cohort study of 105 patients (115 shoulders) was conducted. The mean age of the patient group was 76 years (range, 65 to 87 years). The mean clinical follow-up was 9.4 years (range, 5 to 17 years). Pain, range of motion, and complication rates were analyzed pre-operatively and at the last follow-up. The mean Constant-Murley score increased from 29 points (range, 21 to 34 points) preoperatively to 68.1 points (range, 57 to 81 points) postoperatively (p&lt;0.05). Scapular notching was present in 50 shoulders (43.5%) and it was grade 1 or 2 in 47 of 115 cases (40.9%) and grade 3 or 4 in 3 of 115 cases (2.6%). Complications occurred in 19 patients (17%). Seven patients (6%) underwent revision surgery. The mean satisfaction rate was 94%. Reverse shoulder arthroplasty is a viable treatment for massive, irreparable rotator cuff tears without glenohumeral arthritis with satisfactory clinical outcomes and low complication and reoperation rates with a mean follow up of 9.4 years after surgery.

Reverse Shoulder Arthroplasty for Patients with Massive Rotator Cuff Tears or Cuff Tear Arthropathies at a Minimum Follow-up of 7 Years.

To evaluate indications and factors that influence long-term clinical outcomes and revision rates for reverse shoulder arthroplasty (RSA) in shoulders with irreparable massive rotator cuff tears (mRCTs) or cuff tear arthropathies (CTAs). The authors retrospectively evaluated a consecutive series of shoulders with no fracture sequelae that underwent primary RSA between 2011 and 2013. Independent observers collected demographic data, surgical techniques, and implant types, as well as primary outcome measures such as American Shoulder and Elbow Society (ASES) score and Constant score (CS). Case series, level IV. From the initial series of 123 patients that underwent RSA, 29 patients died (24%) for reasons unrelated to the shoulder arthroplasty, 11 were lost to follow-up (9%), and 4 required revision surgery (3%). The final cohort of 79 patients comprised 55 women (70%), and 24 men (30%), aged 72.7 ± 7.0. At a final follow-up of 8.9 ± 0.6 years (range: 7.4-10.3) the absolute CS was 59.0 ± 16.2, the age-/sex-adjusted CS was 76.6 ± 41.2, and ASES was 77.1 ± 20.3. Univariable analysis revealed no associations for absolute CS, but revealed that age-/sex-adjusted CS was significantly lower for patients with high blood pressure (β = -15.8, p = .025). At a minimum follow-up of 7.4 years, the absolute CS was 59.0 ± 16.2, the age-/sex-adjusted CS was 87.4 ± 24.1 and ASES was 77.1 ± 20.3. When stratifying the outcomes of RSA by indication, there were no significant differences in patients with mRCTs versus CTA in terms of absolute CS, age-/sex-adjusted CS, and ASES. Univariable analysis revealed no association with absolute and age-/sex-adjusted CS for type of indication or surgical approach.

Reverse total shoulder arthroplasty for complex proximal humerus fracture in the elderly: clinical and radiological results

The use of reverse total shoulder arthroplasty (RSA) for the treatment of proximal humeral fractures (PHFs) is steadily increasing. Better clinical outcomes of RSA have been correlated with tuberosity reattachment and healing. The purpose of this study was to evaluate both the clinical and radiological results of reverse shoulder arthroplasty in the management of a proximal humerus fracture in the elderly. Retrospective study including 400 consecutive 3-4 part proximal humerus fractures treated with reverse shoulder arthroplasty with a minimum of 12-month follow-up. In all the cases, the greater tuberosity was reattached with a standardized suture technique and a local bone graft. All the patients were assessed at the 12-month follow-up with Constant-Murley Score (CMS). Radiographic healing of the greater tuberosity was noted. Complications and revision rates were reported. Mean final CMS for this cohort was 82 points. The greater tuberosity healed in anatomic position in 85% of the cases (N= 340), obtaining an average CMS of 85 in these patients. Healing of the greater tuberosity did not occur in 13% of the cases (N= 52) and displacement more than 5 mm occurred in 2% (N= 8) of the patients for an average CMS of 60. All patients scored above 120° in forward elevation with a mean of 150°. Mean active external rotation was 35°. The lateralization shoulder angle had a mean of 91° and the distalization shoulder angle had a mean of 54°. Low-grade scapular notching was reported in <1% of the cases. A total of 60 patients presented failure of healing or displacement of the greater tuberosity. Major complications were reported in nine patients. Of these nine patients, two acquired superficial wound infections, while two had deep shoulder prosthetic infection. Two other patients developed hematomas, one sustained an acromial stress fracture, and two had a stem loosening. There were 4 reoperations. Reverse shoulder arthroplasty, with the use of a fracture-specific stem, allows an improved rate of greater tuberosity healing and short-term clinical outcomes in the elderly population.

Effect of tuberosity repair on functional outcome of reverse shoulder arthroplasty in proximal humerus fractures

PurposeUnsatisfactory results of hemiarthroplasty in Neer's 3- and 4-part proximal humerus fractures in elderly, have led to the shift towards reverse shoulder arthroplasty (RSA). The objective of our study was to repair the tuberosities that are generally overlooked during RSA and observe its impact on the functional outcome and shoulder scores. MethodsWe include elderly patients with acutely displaced or dislocated 3- or 4-part proximal humerus fractures from July 2013 to November 2019 who were treated with RSA along with tuberosity repair by non-absorbable sutures and bone grafting harvested from the humeral head. Open injuries and cases with neuro-muscular involvement of the deltoid muscle were excluded. According to the tuberosity healing on radiographs of the shoulder at 9th postoperative month, the patients were divided into 2 groups, as the group with successful tuberosity repair and the other with failed tuberosity repair. Statistical analysis of the functional outcome and shoulder scores between the 2 groups were done by independent t-test for normally distributed parameters and Mann-Whitney test for the parameters, where data was not normally distributed. ResultsOf 41 patients, tuberosity healing was achieved in 28 (68.3%) and failed in 13 (31.7%) cases. Lysis of the tuberosity occurred in 5 patients, tuberosity displacement in 2, and nonunion in 2. Mean age was 70.4 years (range 65 – 79 years) and mean follow-up was 58.7 months (range 18 – 93 months). There were no major complications. Group with successful tuberosity repair showed improvement in mean active range of movements, like anterior elevation (165.1° ± 4.9° vs. 144.6° ± 9.4°, p < 0.000), lateral elevation (158.9° ± 7.2° vs. 138.4° ± 9.6°, p < 0.000), external rotation (30.5° ± 6.9° vs. 35.0° ± 6.3°, p = 0.367), internal rotation (33.7° ± 7.5° vs. 32.6° ± 6.9°, p = 0.671) and in mean shoulder scores including Constant score (70.7 ± 4.1 vs. 55.5 ± 5.7, p < 0.000), American shoulder and elbow surgeons score (90.3 ± 2.4 vs. 69.0 ± 5.7, p < 0.000), disability of arm shoulder and hand score (22.1 ± 2.3 vs. 37.6 ± 2.6, p < 0.000). ConclusionSuccessful repair and tuberosity healing around the RSA prosthesis is associated with statistically significant improvement in postoperative range of motion, strength and shoulder scores. Standardized repair technique and interposition of cancellous bone grafts, harvested from the humeral head can improve the rate of tuberosity healing.

Influence of humeral lengthening on clinical outcomes in reverse shoulder arthroplasty

BackgroundDeltoid tensioning secondary to humeral lengthening after reverse shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving range of motion (ROM) but may predispose patients to acromial/scapular spine fractures and neurologic injury. Clinical evidence linking patient outcomes to humeral lengthening is limited. This study assesses the relationship between humeral lengthening and clinical outcomes after RSA. MethodsA single institution review of 284 RSAs performed in 265 patients was performed. Humeral lengthening was defined as the difference in the subacromial height preoperatively to postoperatively as measured on Grashey radiographs. The subacromial height was measured as the vertical difference between the most inferolateral aspect of the acromion and the most superior aspect of the greater tuberosity. The relationship between humeral lengthening and clinical outcomes was assessed on a continuous basis. Secondarily, clinical outcomes were assessed using a dichotomous definition of humeral lengthening (≤25 vs. >25mm) based on prior clinical and biomechanical work purporting a correlation with clinical outcomes. Improvement exceeding the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for ROM and outcome scores after RSA were also compared. ResultsHumeral lengthening demonstrated a nonlinear relationship with postoperative ROM, clinical outcome scores, and shoulder strength and their improvement preoperatively to postoperatively. Furthermore, there were minimal differences in ROM measures, outcome scores, and shoulder strength when stratified using the dichotomous definition of humeral lengthening. No difference in the proportion of patients exceeding the MCID or SCB when stratified by humeral lengthening ≤25 vs. >25mm was found. There was no difference in humeral lengthening in patients with versus without complications. ConclusionNo clear relationship between humeral lengthening and clinical outcomes was identified. The previously purported 25mm threshold for humeral lengthening did not predict improved patient outcomes. Outcomes after RSA are multifactorial; the relationship between humeral lengthening and outcomes is likely confounded by other patient and surgical factors. Level of EvidenceIV; Case Series.

Subscapularis-sparing deltopectoral approach in reverse total shoulder arthroplasty.

This study compared the clinical and radiologic results of reverse shoulder arthroplasty (RSA) using either the subscapularis-sparing deltopectoral approach (SSDA) or traditional deltopectoral approach (TDA) in cuff tear arthropathy patients. We retrospectively evaluated 71 patients who underwent RSA for cuff tear arthropathy between July 2014 and December 2018. Patients were divided into two groups according to the surgical approach: TDA (34 cases) and SSDA (37 cases). The mean patient age was 78.6 years, and the mean (range) follow-up period was 23.5 (12-48) months. Clinical results were assessed using the Visual Analogue pain Scale (VAS), American Shoulder and Elbow Surgeon score (ASES), Korean Shoulder Scoring System (KSS), and Constant score. Radiographic indicators prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), inferior overhang, acromion-greater tuberosity (AT) distance, and glenoid-greater tuberosity (GT) distance) were assessed, and notching severity was assessed according to the Nerot-Sirveaux classification. The radiographic indicator results of the TDA and SSDA groups were as follows: PSNA (131.4° ± 17.2°, 136.1° ± 7.7°), PGRD (18.7 mm ± 2.9 mm, 21.4 mm ± 2.0 mm), AT distance (38.3 mm ±6.9 mm, 37.5 mm ± 6.8 mm), GT distance (51.6 mm ± 6.3 mm, 51.4 mm ± 5.3 mm), and inferior overhang (4.4 mm ± 2.2 mm, 2.9 mm ± 1.3 mm). PGRD and inferior overhang showed statistically significant differences between groups, but the clinical results showed no significant differences. There were no complications such as neurovascular injury, implant loosening, surgical site infection, or acromion fracture in either group. SSDA for RSA showed no significant differences in clinical and radiological results compared with TDA. Therefore, SSDA is a viable alternative for RSA in cuff tear arthropathy.

Clinical outcomes of reverse shoulder arthroplasty and rotator cuff repair in patients with massive rotator cuff tears without osteoarthritis: comparison using propensity score matching.

The optimal management for massive rotator cuff tears (MRCTs) without osteoarthritis (OA) remains controversial. The purpose of this study was to evaluate and compare the clinical outcomes of reverse shoulder arthroplasty (RSA) vs. rotator cuff repair (RCR) in patients with MRCTs without OA. We conducted a retrospective data analysis of 68 patients treated for MRCTs via RSA and 215 patients treated for MRCTs via arthroscopic RCR between January 2014 and April 2019. Through propensity score matching, patients were matched for sex, age, tear size, and global fatty degeneration index. Thirty-nine patients in each group were included, and all patients had completed minimal 2-year follow-up. Postoperative radiologic evaluations of healing failure were performed. The visual analog scale score for pain, range of motion, and functional outcome measures including the American Shoulder and Elbow Surgeons score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Simple Shoulder Test score, and Constant score were assessed and compared between the 2 groups. Healing failure was observed in 10 patients in the RCR group (32.3%). No statistically significant differences in preoperative range of motion and functional scores were found between the RCR and RSA groups. Both groups showed significant pain relief and functional improvement at final follow-up. Patients in the RCR group showed significantly greater forward elevation (156.4°±23.8° vs. 139.7°±22.4°, P<.001) and internal rotation (thoracic vertebra, T8.2±1.2 vs. T9.7±2.6, P=.001). The average American Shoulder and Elbow Surgeons score was 88.3±12.2 in the RCR group and 81.8±16.1 in the RSA group (P=.045). The QuickDASH score was significantly higher in the RCR group (P=.019). A significantly higher Simple Shoulder Test score (9.7±2.8 vs. 8.1±3.0, P=.01) and a significantly higher Constant score (67.2±6.5 vs. 63.2±7.1, P=.011) were seen in the RCR group. Both RSA and RCR are effective and reliable treatment options for MRCTs without OA. However, the RCR group showed better shoulder function improvement than the RSA group. Considering the possible implications of RSA, RCR should be referred to as a first-line treatment option for patients with MRCTs without OA with proper indications.

Reverse shoulder arthroplasty with isolated latissimus dorsi or combined with teres major transfer for lack of external rotation: a comparative study

The objective of this study was to evaluate the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) associated with two techniques: L'Episcopo procedure (combined teres major and latissimus dorsi transfer) and modified L'Episcopo procedure (isolated latissimus dorsi transfer). A retrospective review of 36 RSAs (mean age 69.8years; SD 8.9) associated with either L'Episcopo procedure (Group 1, 21 cases) or modified L'Episcopo procedure (Group 2, 15 cases) was performed between 2007 and 2020. Clinical outcome measures consisted of range of motion (ROM), SSV, VAS, and Constant-Murley scores. These scores were compared between the two groups. Radiographs were assessed for transfer site bony lesions. With a mean follow-up of 40.8months (6-98; SD 28.8), no significant differences were revealed in the clinical outcomes: Constant score, SSV, VAS, ROM. The entire study group demonstrated a significant improvement in post-operative functional outcome scores and ROM parameters compared to their pre-operative state, IR measures being the only exception (p = 0.26). Radiographs demonstrated transfer site bony lesions in 60% of the patients (18/30). Three complications (8.3%) were noted in the study. At the short-term follow-up, RSA combined with either latissimus dorsi (LD) transfer in isolation or in association with teres major proved to be equally effective in restoring external rotation in the settings of an irreparable postero-superior cuff tear treated with RSA. Although the LD transfer group displayed a tendency towards superior ROM, this was not supported statistically. Post-operative radiographs confirmed the presence of bony lesions at the transfer fixation sites in both groups of patients (52% vs. 72%).

Short-term comparative outcomes between reverse shoulder arthroplasty for shoulder trauma and shoulder arthritis: a Southeast Asian experience.

BackgroundReverse shoulder arthroplasty (RSA), first introduced as a management option for cuff tear arthropathy, is now an accepted treatment for complex proximal humeral fractures. Few studies have identified whether the outcomes of RSA for shoulder trauma are comparable to those of RSA for shoulder arthritis.MethodsThis is a retrospective, single-institution cohort study of all patients who underwent RSA at our institution between January 2013 and December 2019. In total, 49 patients met the inclusion criteria. As outcomes, we evaluated the 1-year American Shoulder and Elbow Surgeons (ASES) and Constant shoulder scores, postoperative shoulder range of motion, intra- and postoperative complications, and cumulative revision rate. The patients were grouped based on preoperative diagnosis to compare postoperative outcomes across two broad groups.ResultsThe median follow-up period was 32.8 months (interquartile range, 12.6–66.6 months). The 1-year visual analog scale, range of motion, and Constant and ASES functional scores were comparable between RSAs performed to treat shoulder trauma and that performed for arthritis. The overall complication rate was 20.4%, with patients with a preoperative diagnosis of arthritis having significantly more complications than those with a preoperative diagnosis of trauma (34.8% vs. 7.7%).ConclusionsPatients who underwent RSA due to a proximal humeral fracture or dislocation did not fare worse than those who underwent RSA for arthritis at 1 year, in terms of both functional and radiological outcomes.

Outcomes of reverse shoulder arthroplasty following failed superior capsular reconstruction.

Superior capsular reconstruction (SCR) can be used for massive irreparable rotator cuff tears in the absence of significant degenerative changes; however, those who fail an SCR may require reverse shoulder arthroplasty (RSA). The effect of a previously performed SCR on outcomes following RSA remains unknown. Subjects who underwent RSA from May 2015 to January 2021 at 2 separate institutions were retrospectively identified through prospectively collected databases. Patients who underwent RSA after failed SCR were matched to those who underwent RSA after failed rotator cuff repair (RCR) based on the number of previous ipsilateral shoulder procedures (n=1, 2, ≥3) and secondarily by age within 5 years. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Western Ontario Osteoarthritis of the Shoulder index (WOOS) scores were compared between groups. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds were calculated to determine clinically relevant differences between groups. Forty-five patients were included (32 RSA following RCR, 13 following SCR). There were more smokers (P=.001) and worker's compensation cases (P=.034) in the SCR group. The RCR cohort was older (P=.007) and had a greater incidence of mental health (P>.999) and somatic disorders (P=.698), although these did not reach statistical significance. The mean follow-up for the RCR and SCR groups were 24.2±23.3 and 20.4±14.9 months following RSA, respectively (P=.913). The time from index RCR or SCR to RSA were 94.4±22.2 and 89.2±5.3 months, respectively (P=.003). Pre- and postoperative range of motion were similar between groups, as was the overall change in forward flexion (P=.879), abduction (P=.971), and external rotation (P=.968) following RSA. The RCR group had lower postoperative VAS pain (P=.009), higher SANE (P=.015), higher ASES (P=.008), and higher WOOS (P=.018) scores. The percentage achieving the MCID (P=.676) and SCB (P>.999) were similar; however, 56.7% of the RCR group met the SANE PASS threshold compared with 0.0% in the SCR group (P=.005). There were no differences in postoperative complications (P=.698) or revision rates (P=.308) following RSA between cohorts. When matched for number of previous procedures to the ipsilateral extremity and age, patients who underwent RSA following failed SCR had worse clinical outcome scores than their RSA following failed RCR counterparts. No patient in the SCR group met the SANE PASS threshold, whereas more than half of the RCR group did.

Outcomes of reverse shoulder arthroplasty in patients under 55 years old: Results from the New Zealand joint registry.

The appropriate age at which to perform reverse shoulder arthroplasty is controversial. The aim of this study was to compare the outcomes of reverse shoulder arthroplasty between younger and older patients. Patients who underwent primary reverse shoulder arthroplasty between January 2000 and December 2019 were identified from New Zealand Joint Registry records. Patients were stratified into two cohorts according to age at the time of surgery: < 55 years and ≥ 55 years. These two groups were then compared with regard to baseline characteristics, indications for surgery, revision rates, and patient-reported outcomes using the Oxford Shoulder Score and American Shoulder and Elbow Score (ASES). A total of 5518 primary reverse shoulder arthroplasty cases were identified, with 75 patients < 55 years at the time of surgery (range: 34-54 years). The mean duration of follow-up was 2.36 years (range: 0.11-13.37 years) in the younger cohort and 3.10 years (range: 0.01-16.22 years) in the older patient cohort. Indications for surgery differed significantly between the two groups, with younger patients having higher rates of inflammatory arthritis (p < 0.001), posttraumatic arthritis (p < 0.001), and avascular necrosis (p = 0.049). The younger cohort had an inferior 6-month postoperative Oxford Shoulder Score compared to the older cohort (mean: 28.5 [younger cohort] vs. 35.7 [older cohort]; p < 0.001). There was no significant difference in revision rate between the younger and older patient cohorts during the study period (1.56 [<55 years] vs. 0.74 [≥55 years] revisions per 100 component-years; p = 0.332). Our early results suggest that younger patients undergoing reverse shoulder arthroplasty demonstrate high implant retention rates, comparable to older patients. Longer-term patient-reported outcomes in younger patients are required to guide appropriate patient selection for reverse shoulder arthroplasty. Level III, retrospective case-control study.