Sunday, July 23, 2017

Reverse total shoulder in patients < 55 years of age.

Reverse shoulder arthroplasty in patients younger than 55 years: 2- to 12-year follow-up

These authors report on 67 patients (average age, 47.9 years; range, 21-54 years) having a reverse total shoulder (RSA)with an average 62.3 months of follow-up (24-144 months). 35 patients had the RSA for a failed arthroplasty and 32 patients had a primary RSA.

In the revision group, ASES score improved from 24.4 to 40.8 (P = .003), and SST score improved from 1.3 to 3.2  out of a maximum score of 12 (P = .043).

In the primary group, ASES score improved from 28.1 to 58.6 (P < .001), and SST score improved from 1.3 to 4.5 out of a possible 12 (P = .004).

The total complication rate was 22.4%. The total reoperation rate was 13.4%, and the revision rate was 8.9%;  infection the cause of all revisions.

The revision group had a complication rate of 25.7%.2 patients with humeral lucency (1 treated conservatively), 2 with glenoid screw lucency (treated conservatively), 2 with periprosthetic fractures (1 treated conservatively), 1 with humeral dissociation, 1 with infection, and 1 with recurrent instability (treated conservatively). 

The primary group had a complication rate of 18.7%. 1 patient with scapular fracture (healed conservatively), 1 patient with symptomatic hardware after fixation for an os acromiale at the time of index surgery, and 4 patients with periprosthetic infections.

Comment: Young patients with failed prior arthroplasty as well as those with other indications for RSA  (failed rotator cuffs, fractures, arthritis) present a major clinical challenge not only because of the difficulty presented by the pathology, but also because of their expectations and longevity.

This is a forthright presentation of the intermediate term results and complications of these procedures in the hands of a highly experienced surgeon. The relatively high complication rate and the relatively low patient-reported outcomes provide a cautionary tale for us to tell young patients considering this reconstruction.

The interested reader should compare these results with those achieved by the same surgeon for patients with massive cuff tears: Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement.

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