Risk factors for complications and revision surgery after anatomic and reverse total shoulder arthroplasty

Aibinder, William R.; Schoch, Bradley S.; Parsons, Moby; Watling, Jonathan P.; Ko, Jia-Wei Kevin; Gobbato, Bruno; Throckmorton, Thomas W.; Routman, Howard; Fan, Wen; Simmons, Chelsey S.; Roche, Christopher P.

doi:10.1016/j.jse.2021.04.029

Cited by 54 publications

(18 citation statements)

References 34 publications

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“…Although several statistically significant differences existed, the only postoperative metric that exceeds the MCID between the two procedures was active external rotation, which was greater in aTSA. 35 Both procedures resulted in improvements (Table 4) in function and ROM within their respective groups that exceeded both the MCID and substantial clinical benefit. 35,36 The preoperative to postoperative improvements in the SST score, UCLA score, Constant score, and SPADI score were not significantly different between aTSA and rTSA, whereas ASES score and SAS score (rTSA 32.7 6 14.5, aTSA 35.9 6 13.9, P = 0.0197) improvements were significantly higher in the aTSA group (P = 0.0248).…”

Section: Resultsmentioning

confidence: 95%

“…35 Both procedures resulted in improvements (Table 4) in function and ROM within their respective groups that exceeded both the MCID and substantial clinical benefit. 35,36 The preoperative to postoperative improvements in the SST score, UCLA score, Constant score, and SPADI score were not significantly different between aTSA and rTSA, whereas ASES score and SAS score (rTSA 32.7 6 14.5, aTSA 35.9 6 13.9, P = 0.0197) improvements were significantly higher in the aTSA group (P = 0.0248). In contrast, trends in ROM improvements were variable.…”

Section: Resultsmentioning

confidence: 95%

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Comparison of Reverse and Anatomic Total Shoulder Arthroplasty in Patients With an Intact Rotator Cuff and No Previous Surgery

Friedman

Schoch

Eichinger

et al. 2022

J Am Acad Orthop Surg

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Introduction:This study's purpose is to compare clinical and radiographic outcomes of primary anatomic total shoulder arthroplasty (aTSA) and primary reverse total shoulder arthroplasty (rTSA) patients with osteoarthritis (OA) and an intact rotator cuff with no previous history of shoulder surgery using a single platform TSA system at a minimum follow-up of 2 years.Methods:A total of 370 aTSA patients and 370 rTSA patients matched for age, sex, and length of follow-up from an international multi-institutional Western Institutional Review Board approved registry with a minimum 2-year follow-up were reviewed for this study. All patients had a diagnosis of OA, an intact rotator cuff, and no previous shoulder surgery. All patients were evaluated and scored preoperatively and at latest follow-up using six outcome scoring metrics and four active range of motion measurements.Results:Mean follow-up was 41 months, and the mean age was 73 years. Preoperatively, the rTSA patients had lower outcome metrics and less motion. Postoperatively, aTSA and rTSA patients had similar clinical outcomes, motion, and function, with the only exception being greater external rotation in aTSA exceeding the minimal clinically important difference. Pain relief was excellent, and patient satisfaction was high in both groups. Humeral radiolucent lines were similar in both groups (8%). Complications were significantly higher with aTSA (aTSA = 4.9%; rTSA = 2.2%; P = 0.045), but revisions were similar (aTSA = 3.2%; rTSA = 1.4%; P = 0.086).Conclusion:At a mean of 41 month follow-up, primary aTSA and rTSA patients with OA and an intact rotator cuff with no previous history of shoulder surgery had similar clinical and radiographic outcomes. Greater external rotation was noted in aTSA patients at follow-up. However, aTSA patients had a significantly greater rate of complications compared with rTSA patients. rTSA is a viable treatment option in patients with an intact rotator cuff and no previous shoulder surgery, offering similar clinical outcomes with a lower complication rate.Level of Evidence:Level III

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 95%

Comparison of Reverse and Anatomic Total Shoulder Arthroplasty in Patients With an Intact Rotator Cuff and No Previous Surgery

Friedman

Schoch

Eichinger

et al. 2022

J Am Acad Orthop Surg

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“…Pierre Hoffmeyer MD 1 Where Are We Now? A lthough many muscles around the shoulder contribute to rotation, fine tuning is provided by the subscapularis for internal rotation and by the infraspinatus and teres minor for external rotation [2,3,5,6,10].…”

Section: Corr Insights®: No Strength Differences Despite Greater Post...mentioning

confidence: 99%

CORR Insights®: No Strength Differences Despite Greater Posterior Rotator Cuff Intramuscular Fat in Patients With Eccentric Glenohumeral Osteoarthritis

Hoffmeyer

2022

Clin Orthop Relat Res

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“…Whilst prior researchers have explored the effect of surgical technique, type of prosthesis and surgical indications on outcome following RTSA, [ 14 ] there is limited literature on the influence of post-operative rehabilitation on outcomes. The surgical procedure is often reserved for an elderly population who are at least 65 years of age, [ 15 ] and a younger age is a risk factor for post-operative complications [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial

et al. 2021

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Background Reverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups. Methods This randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over. Discussion RTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy. Trial registration This study is registered as NCT03719859 at ClincialTrials.gov.

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Risk factors for complications and revision surgery after anatomic and reverse total shoulder arthroplasty

Cited by 54 publications

References 34 publications

Comparison of Reverse and Anatomic Total Shoulder Arthroplasty in Patients With an Intact Rotator Cuff and No Previous Surgery

Comparison of Reverse and Anatomic Total Shoulder Arthroplasty in Patients With an Intact Rotator Cuff and No Previous Surgery

CORR Insights®: No Strength Differences Despite Greater Posterior Rotator Cuff Intramuscular Fat in Patients With Eccentric Glenohumeral Osteoarthritis

Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial

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