These authors sought to determine the comparative risk profile and clinical outcomes for patients undergoing reverse total shoulder arthroplasty (RTSA) for cuff tear arthropathy (CTA) without failed prior rotator cuff repair (RCR) compared to RTSA for CTA with prior RCR.
RTSA patients with failed prior RCR were matched in a 1:1 ratio to patients undergoing primary RTSA, while controlling for demographic factors, prosthesis design, and surgeon.
Of 262 patients, 192 (73.3%) were available at minimum 2-year follow-up.
The prior RCR cohort had a mean age of 64.1 (±8..6), whereas the RTSA group without prior RCR was significantly older with a mean age of 68.7 (±6.7). The average length of time elapsed between the most recent RCR and RTSA was 3.1 years (range, 0.31 to 10 years).
The prior RCR group had a significantly higher complication rate (17.4%, n=15) than the primary RTSA group (3.8%, n=4) (p=0.001).
At mean 36.3±26.1-month follow-up, the prior RCR group had statistically worse SST scores, ASES scores, and active forward elevation.
Comment: This study points out that prior cuff repair attempts can jeopardize the safety and outcome of reverse total shoulder. While not discussed in the manuscript, it seems likely that acromioplasty and section of the coracoacromial ligament - both often performed at the time of attempted cuff repair - may both contribute to instability and weaken the acromion, making it more susceptible to fracture. Prior surgery of any type may increase the risk of infection. Instability, fracture and infection can lead to revision of a failed reverse total shoulder.
Thus surgeons must be thoughtful about attempting rotator cuff repair in older individuals with large, degenerative rotator cuff tears. Non operative management or the smooth and move procedure for shoulders with retained active elevation (see this link) may be alternatives that merit consideration. For patients with degenerative cuff tears and pseudoparalysis, a primary reverse total shoulder may be an attractive alternative.
Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
How you can support research in shoulder surgery Click on this link.
Here are some videos that are of shoulder interest
