Saturday, August 22, 2015

Shoulder arthroplasty - the effect of prior surgery on outcome.

Does Prior Shoulder Surgery Negatively Impact Shoulder Arthroplasty Outcomes?  also presented as a poster presentation.

These authors sought to compare 71 patients undergoing total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) withour prior surgery to 50 patients having prior open and arthroscopic procedures at an average of 24 months (minimum 12 months) after arthroplasty. 

Prior surgeries included a mix of both open and arthroscopic procedures, including open
and arthroscopic rotator cuff repair, open and arthroscopic stabilization (with and without bone
augmentation), arthroscopic capsular release, and arthroscopic debridement.

They found a significant difference in postoperative ASES scores in the no-surgery group compared to the prior-surgery group (84.49 versus 71.67, P=0.0003) as well as in the SST scores (8.97 versus 5.47, P<0.0001). They concluded that shoulder arthroplasty after undergoing prior shoulder surgery results in overall clinically improved outcomes, however these results are inferior compared to patients without a history of prior shoulder surgery. 

Comment: There is substantial evidence from other sources to support this conclusion. This study would have been more helpful if the authors had considered the change in the scores (the difference between the ingo and the outcome) rather than only the outcome. That would let us know if the patients with prior surgery had worse functioning shoulders before surgery and whether the change in scores was similar for the two groups. 

The possible reasons for inferior outcomes in patients with prior surgery needs further study. Is this finding because 
(1) these patients are less motivated or less healthy?
(2) these patients have more complex pathology or different expectations?
(3) these shoulders are more likely to be infected?


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