Saturday, October 17, 2020

Does prior rotator cuff repair affect the outcome of total shoulder arthroplasty?

 Anatomic total shoulder arthroplasty after healed rotator cuff repair: a matched cohort

These authors evaluated the effect of a healed prior rotator cuff repair (RCR) on outcomes and complications after primary TSA. 

Thirty shoulders with a prior RCR were compared with 90 control patients without prior surgery at a mean follow-up of 43 months (range, 24-109 months). Groups demonstrated similar preoperative range of motion and patient-reported outcome measures.

Postoperatively, TSAs with a prior healed RCR demonstrated less forward flexion.

Complications were significantly more common in patients with a prior RCR (17% vs. 7%, P ..01). Postoperative rotator cuff tears were significantly more common in TSA with a healed prior RCR (13% vs. 1%, P . .014).

Comment: This study suggests that a "healed" rotator cuff repair is not of the same durability as a rotator cuff that had not needed a prior repair. In other words, RCR, even if successful, does not make the cuff "as good as new". 

It is interesting that even though the shoulders with prior RCR were at least as good preoperatively as those not having had prior RCR

The clinical outcomes were not as good

This is "news we can use": patients with prior RCR need to understand the risk of recurrent cuff tear and may wish to scale back on the vigor with which they use their shoulder arthroplasty.

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