Saturday, April 8, 2017

How durable are the results of a reverse total shoulder?

Long-Term Outcomes of Reverse Total Shoulder Arthroplasty

These authors provide a welcome longer-term (mean 150 months, minimum 120 months) follow-up of a previously reported series of 186 patients (191 shoulders) having a Grammont-style reverse total shoulder arthroplasty (RTSA) with a mean of 40 months follow-up.

Follow-up clinical evaluations were available for 84 patients (87 prostheses) and radiographic assessments were available for 64 patients (67 prostheses).

The mean absolute and relative Constant scores were 55 ± 16 points and 86 ± 26 points, respectively, with both having decreased significantly compared with the scores at the medium-term follow-up evaluation (p < 0.001 and p = 0.025, respectively).

The best results at both followup periods were in shoulders with rotator cuff arthropathy. In contrast, RTSA for a failed previous arthroplasty or posttraumatic arthritis was associated with limited functional outcomes.

Forty-nine shoulders (73%) exhibited scapular notching.

Forty-seven complications (29%) were recorded, with 10 cases (10%) occurring after 2 years. Sixteen (12%) of the original patients underwent revision surgery. 

The 10-year overall prosthetic survival rate using revision as the end point was 93%.

The authors concluded that despite a high arthroplasty survival rate and good long-term clinical results, RTSA outcomes showed deterioration when compared with medium-term results. They suggest that this deterioration may be related to patient aging, bone erosion and loss of deltoid function over time.

Comment: This report demonstrates the importance of long term follow-up for all forms of shoulder arthroplasty.  It helps us answer the question patients often ask, "how long will it last?". This paper needs to be viewed in light of the fact that these surgeries were performed by high volume surgeons with extensive experience.

Are newer versions of the reverse total shoulder likely to yield better results? See this link.

Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book.

Click here to see the new Rotator Cuff Book

Information about shoulder exercises can be found at this link.

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