Shoulder Arthroplasty Outcomes After Prior Non-Arthroplasty Shoulder Surgery
These authors compared the outcomes and complications in patients with and without a history of non-arthroplasty surgery prior to total shoulder arthroplasty (TSA, n=263) or reverse total shoulder arthroplasty (RTSA, n=243).
These authors compared the outcomes and complications in patients with and without a history of non-arthroplasty surgery prior to total shoulder arthroplasty (TSA, n=263) or reverse total shoulder arthroplasty (RTSA, n=243).
144 patients (28%) had an average of 1.9 ± 1.0 surgical procedures on the ipsilateral shoulder before arthroplasty. There were significant differences in age, BMI, smoking, and type of insurance between the two groups.
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. While both groups had preoperative SSTs of 3.5, the postoperative SST was 9.3 in the non-prior surgery group and 7.7 in the prior surgery group.
Postoperative complications were over four times as common in the prior surgery group.
Multivariate regression analysis revealed that prior surgery was a significant independent predictor of postoperative complications.
Comment: This paper demonstrates that prior ipsilateral shoulder surgery is risk factor for a suboptimal outcome from shoulder arthroplasty. There may be several reasons for this finding: (1) the presence of prior surgery may indicate more complex shoulder pathology, (2) the prior procedure may have altered the surgical anatomy, making the arthroplasty more complex, (3) the failure of a prior procedure to resolve the patient's problem may indicate that the patient has diminished pain tolerance, motivation, or compliance (note, for example the 10 fold greater rate of workers' compensation and the 4 fold increase of smoking in the prior surgery group), and (4) even though it was not noted in this study, prior surgery can be expected to increase the risk of Propionibacterium contamination, which may present as pain and stiffness, rather than clinically apparent infection.
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