Saturday, April 6, 2013

Health-related quality of life and functionality after reverse shoulder arthroplasty

Health-related quality of life and functionality after reverse shoulder arthroplasty

This is a report of 80 patients having had a reverse total shoulder for either primary osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy. At a mean 5-year follow-up, the cumulative survival rate was 97.3% and there were significant improvements in the Constant score and range of motion when compared with the baseline values. The Constant score was 93.2% of the sex- and age-matched normal values and the postoperative SF-36 scores showed no significant differences compared with normative data. Younger patients and subjects with worse preoperative conditions achieved the greatest benefit after RSA.

The length of follow-up was found to be associated with the severity of scapular notching. The complications included two dislocations, one infection and one hematoma.

These are among the best results to be reported for reverse total shoulder. This may be due to the fact that all surgeries were performed by the same surgeon and that patients were excluded if they had a prior arthroplasty,  proximal humeral fracture, fracture sequelae, rheumatoid arthritis, tumors, evidence of an active infection, allergic reactions to metal implants, alcohol abuse, a predicted survival of less than 6 months, a patient’s unwillingness to cooperate, or legal incapacitation. It is also of note that the preoperative diagnoses included more benign diagnoses that those of many series: patients had a diagnosis of either irreparable massive rotator cuff tear (43%), cuff tear arthropathy (16%), or primary glenohumeral OA (41%).  Patient age was 72.5 5.0 years (range, 61-86 years). Average preoperative active flexion was 100 degrees (range 50 - 150 degrees). 

It seems that few of these patients met what used to be considered to be the 'classical' indications for a reverse total shoulder: pseudo paralysis or anterosuperior escape. 

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