Are Age and Patient Gender Associated With Different Rates and Magnitudes of Clinical Improvement After Reverse Shoulder Arthroplasty?

Friedman, Richard J.; Cheung, Emilie V.; Flurin, Pierre-Henri; Wright, Thomas W.; Simovitch, Ryan W.; Bolch, Charlotte; Roche, Christopher P.; Zuckerman, Joseph D.

doi:10.1007/s11999.0000000000000270

Cited by 73 publications

(47 citation statements)

References 16 publications

(27 reference statements)

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“…Leathers et al 16 showed better range of motion and improvement in range of motion in younger patients, whereas the ASES score was not different from that in older patients at final review. Furthermore, Friedman et al 10 analyzed an international database of 660 RSA patients with a mean age of 72 years. They found that each 1-year increase was associated with an improved ASES score by 0.19 points ( P = .006) but with decreased forward flexion by 0.39° ( P = .001) per year.…”

Section: Discussionmentioning

confidence: 99%

Reverse shoulder arthroplasty in patients aged 65 years or younger: a systematic review of the literature

et al. 2019

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BackgroundReverse shoulder arthroplasty (RSA) is offered to young patients with a failed previous arthroplasty or a cuff-deficient shoulder, but the overall results are still uncertain. We conducted a systematic review of the literature to report the midterm outcomes and complications of RSA in patients younger than 65 years.MethodsA search of the MEDLINE and Cochrane electronic databases identified clinical studies reporting the results, at a minimum 2-year follow-up, of patients younger than 65 years treated with an RSA. The methodologic quality was assessed with the Methodological Index for Non-Randomized Studies score by 2 independent reviewers. Complications, reoperations, range of motion, functional scores, and radiologic outcomes were analyzed.ResultsEight articles were included, with a total of 417 patients. The mean age at surgery was 56 years (range, 21-65 years). RSA was used as a primary arthroplasty in 79% of cases and revision of a failed arthroplasty in 21%. In primary cases, the indications were cuff tear arthropathy and/or massive irreparable cuff tear in 72% of cases. The overall complication rate was 17% (range, 7%-38%), with the most common complications being instability (5%) and infection (4%). The reintervention rate was 10% at 4 years, with implant revision in 7% of cases. The mean weighted American Shoulder and Elbow Surgeons score, active forward elevation, and external rotation were 64 points, 121°, and 29°, respectively.ConclusionsRSA provides reliable clinical improvements in patients younger than 65 years with a cuff-deficient shoulder or failed arthroplasty. The complication and revision rates are comparable to those in older patients.

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Section: Discussionmentioning

confidence: 99%

Reverse shoulder arthroplasty in patients aged 65 years or younger: a systematic review of the literature

et al. 2019

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“…Factors including age, sex, smoking, and BMI are known to be related to the magnitude of clinical improvement after RTSA. 9 , 11 , 27 , 31 , 37 On the basis of the effect of obesity on the clinical outcomes of RTSA, increased body weight was significantly associated with deep infection after RTSA. 1 In our study, the overwhelming female majority made it difficult to identify negative effects on male patients.…”

Section: Discussionmentioning

confidence: 99%

“…To minimize selection bias from patient-related factors, which have been revealed to affect the outcomes of CTA or ICTs in RTSA, multiple factors, including patients' age, sex, and body mass index (BMI), were considered. 1 , 9 , 11 , 22 , 27 , 31 , 37 Propensity score (PS) matching was used to obtain reliable information by considering factors known to affect the clinical outcomes of RTSA. PS matching at a 1:2 ratio was performed based on the patients' age, sex, and BMI through logistic regression.…”

Section: Methodsmentioning

confidence: 99%

Clinical comparison of humeral-lateralization reverse total shoulder arthroplasty between patients with irreparable rotator cuff tear and patients with cuff tear arthropathy

Lee¹,

Chun²,

Kim³

et al. 2020

JSES International

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Background This study aimed to compare the clinical and radiologic outcomes between patients with irreparable cuff tears (ICTs) and those with cuff tear arthropathy (CTA) after reverse total shoulder arthroplasty (RTSA) with a humeral-lateralization prosthesis. Methods A total of 127 patients with ICTs and CTA who underwent RTSA were enrolled and matched at a 1:2 ratio by propensity score. Preoperative shoulder function was assessed for all patients. Radiologic parameters including the acromion–deltoid tuberosity (ADT) distance, lateral humeral offset, and scapular notching were evaluated. Results Thirty-four patients in the ICT group and 68 patients in the CTA group were matched for comparison. Preoperatively, mean active forward flexion in the ICT group (89.7° ± 29.4°) was significantly better than that in the CTA group (65.5° ± 24.0°, P < .001). In the CTA group, fatty infiltration of the supraspinatus was worse (3.7 ± 0.5) and the ADT distance was shorter (134.0 ± 12.0 mm) compared with the ICT group preoperatively (3.3 ± 0.8 [ P = .008] and 140.7 ± 12.5 mm [ P = .001], respectively). There was no significant difference in postoperative functional or radiologic outcomes between the 2 groups. However, gains in active forward flexion (37.9° in ICT group vs. 61.5° in CTA group, P < .01) and abduction (42.1° in ICT group vs. 60.6° in CTA group, P < .01) were significantly greater in the CTA group than in the ICT group. Conclusions Shoulder function was significantly improved after RTSA regardless of the preoperative diagnosis. Postoperatively, radiologic findings were not significantly different between the 2 groups. Due to the fact that preoperative range of motion and rotator cuff status were better in patients with ICTs, improvements in active forward flexion and abduction were significantly greater in patients with CTA.

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confidence: 99%

“…Successful outcomes of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are well documented in the literature 1 , 7 , 8 , 18 , 23, 24, 25. However, concerns exist regarding the variability of results, such as the unpredictable improvement in internal and external rotation after rTSA 7 , 26 , 27 . Although several associations for total shoulder arthroplasty (TSA) have been previously identified, such as preoperative diagnosis, 4 , 28 weak deltoid function, 3 depression, 29 , 30 sex, 7 , 22 body mass index (BMI), 2 , 9 , 14 , 15 , 17 medical comorbidities, 21 and patient age at the time of surgery, 5 , 7 , 10 the contribution of each to different postoperative outcome measures is unknown.…”

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confidence: 99%

Preoperative parameters that predict postoperative patient-reported outcome measures and range of motion with anatomic and reverse total shoulder arthroplasty

et al. 2019

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Background: Preoperative factors that most influence postoperative outcomes of both anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are unknown. The purpose of this study was to identify the preoperative parameters that significantly influence postoperative outcomes of aTSA and rTSA. Methods: The outcomes of 1089 aTSA patients and 1332 rTSA patients (mean follow-up period, 49 months) from an international registry with a single platform system were analyzed. A multiple linear regression model with backward stepwise selection identified the preoperative parameters that were significant predictors of postoperative clinical outcome metric scores and motion measures for both rTSA and aTSA. Results: For both aTSA and rTSA patients, numerous preoperative parameters that influence postoperative outcomes were identified. Greater postoperative range of motion (ROM) was significantly influenced by greater preoperative ROM. For aTSA, greater postoperative American Shoulder and Elbow Surgeons (ASES) scores were significantly influenced by greater preoperative ASES scores, no history of shoulder surgery, and the presence of greater preoperative active external rotation. For rTSA, greater postoperative ASES scores were significantly influenced by greater preoperative ASES scores, no history of shoulder surgery, no history of tobacco use, less preoperative passive external rotation, and greater preoperative active external rotation. Conclusions: This study quantified the preoperative predictors of postoperative clinical outcome metric scores and ROM for both aTSA and rTSA. Numerous significant associations were identified, including demographic and comorbidity risk factors. These associations may be helpful for surgeons to consider when counseling patients regarding aTSA versus rTSA and to establish more accurate expectations prior to surgery.

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Are Age and Patient Gender Associated With Different Rates and Magnitudes of Clinical Improvement After Reverse Shoulder Arthroplasty?

Abstract: Level III, therapeutic study.

Cited by 73 publications

References 16 publications

Reverse shoulder arthroplasty in patients aged 65 years or younger: a systematic review of the literature

Reverse shoulder arthroplasty in patients aged 65 years or younger: a systematic review of the literature

Clinical comparison of humeral-lateralization reverse total shoulder arthroplasty between patients with irreparable rotator cuff tear and patients with cuff tear arthropathy

Preoperative parameters that predict postoperative patient-reported outcome measures and range of motion with anatomic and reverse total shoulder arthroplasty

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