In bilateral arthritis, how long after the first TSA should the contralateral TSA be done?

Staged bilateral total shoulder arthroplasty: improved outcomes with less than 6 months between surgeries

These authors analyzed 82 total shoulders  (41 patients, 70 ± 9 years old) comparing 4 “interval groups” based on timing between surgeries: <6 months, 6 to 12 months, 12 to 24 months, and >24 months.

Mean postoperative UCLA, Constant, and SST scores were 29, 72, and 9 points, respectively; 83% of patients reported satisfaction with both shoulders.

Patients with <6 months between surgeries (Group 1) demonstrated significantly better UCLA scores than 6- to 12-month interval patients (P = .04), greater Constant scores compared with all other groups (P < .001), and greater SST scores compared with 6- to 12-month and 12- to 24-month interval patients (P = .002), with no differences in length of follow-up between groups.

Thirty-four patients (83%) reported that they were satisfied with both shoulders and 3 patients (7%) were satisfied with 1 shoulder. Twenty-six patients (63%) reported that 1 side endured a more difficult recovery. Of these 26 patients, 17 (65%) reported that their first side was the more difficult side to recover from, whereas 13 (50%) reported their dominant side as the most difficult side to recover from.

The authors concluded that patients may be advised that having the second arthroplasty within 6 months of the first might optimize their postoperative functional outcomes and satisfaction compared with waiting a longer interval between surgeries.

Comment: The reasons that the < 6 month group seemed to have better outcomes than the longer interval groups are not clear. In that patients were not randomly assigned to different intervals between surgeries, one wonders what factors explained the different the timing selected by the patient and the surgeons.  It could be that the patients electing to have shorter intervals between surgery were more healthy or more optimistic.

In our practice we often consider the second side at about 6 months after the first so that the patient has time to regain their strength and to get far along with the rehabilitation of the first shoulder. As often is the case (as pointed out by these authors) external factors often influence the timing of the second side, for example patients may want to have both surgeries in the same calendar year so that they can avoid paying the insurance deductible for the the second side.

===

Consultation for those who live a distance away from Seattle.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.