These authors compared the outcomes and complications in 506 patients with and patients without a history of non-arthroplasty surgery on the ipsilateral shoulder who later underwent total shoulder
arthroplasty (TSA 263) or reverse total shoulder arthroplasty (RTSA 243 ).
A total of 144 patients (28%) had an average of 1.9 ± 1.0 surgical procedures on the ipsilateral shoulder before arthroplasty. The average age in the prior surgery (PS) group was significantly younger at the time of arthroplasty compared with the non prior surgery (NPS) group (61.6 ± 10.2 years compared with 68.2 ± 8.6 years, p = 0.035).
At an average follow-up of 42.8 ± 16.4 months, both groups had significant improvements in ASES, SST, VAS, and range-of-motion values (p < 0.05 for all).
All outcome scores in the PS group were significantly lower than those in the NPS group (p < 0.001 for all). The PS group also had a significantly higher complication rate than the NPS group (19.4% compared with 4.4%, p < 0.001), and multivariate regression analysis revealed that prior surgery was a significant independent predictor of postoperative complications.
There were no differences between the PS and NPS groups in the number of postoperative infections (p = 0.679), reoperations (p = 0.553), or transfusions (p = 0.220).
Comment: So what might explain this finding? Here are several possibilities. (1) Prior surgery alters the anatomy, complicating both the pathology and the surgery. (2) Even though there was no apparent difference in infection rate, the revisions were not routinely cultured for the possibility of a stealth infection from Propionibacterium - prior surgery is known to increase the risk of such infections. (3) Patients and shoulders that fail one treatment are likely to have constitutional factors - such as poor compliance or low pain tolerance - that contribute to the failure of a subsequent procedure.
We need to continue to learn all we can from each suboptimal result.
Use the "Search" box to the right to find other topics of interest to you.
At an average follow-up of 42.8 ± 16.4 months, both groups had significant improvements in ASES, SST, VAS, and range-of-motion values (p < 0.05 for all).
All outcome scores in the PS group were significantly lower than those in the NPS group (p < 0.001 for all). The PS group also had a significantly higher complication rate than the NPS group (19.4% compared with 4.4%, p < 0.001), and multivariate regression analysis revealed that prior surgery was a significant independent predictor of postoperative complications.
There were no differences between the PS and NPS groups in the number of postoperative infections (p = 0.679), reoperations (p = 0.553), or transfusions (p = 0.220).
Comment: So what might explain this finding? Here are several possibilities. (1) Prior surgery alters the anatomy, complicating both the pathology and the surgery. (2) Even though there was no apparent difference in infection rate, the revisions were not routinely cultured for the possibility of a stealth infection from Propionibacterium - prior surgery is known to increase the risk of such infections. (3) Patients and shoulders that fail one treatment are likely to have constitutional factors - such as poor compliance or low pain tolerance - that contribute to the failure of a subsequent procedure.
We need to continue to learn all we can from each suboptimal result.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
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Use the "Search" box to the right to find other topics of interest to you.
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