These authors compared the outcomes of 15 total shoulder arthroplasties (TSA) and 10 reverse total shoulder arthroplasties (RTSA) after anterior stabilization surgical procedures. The TSA group’s mean age at surgery was 54.9 years, with an average follow-up period of 4.0 years. The RTSA group’s mean age was 65.4 years, with an average followup period of 3.3 years.
In the TSA group, 4 patients underwent prior bony procedures (27%), all of which were Bristow procedures. One underwent multiple other non-arthroplasty shoulder surgical procedures, and another underwent 4 previous arthroscopic surgical procedures. The remaining 11 patients underwent previous soft-tissue procedures that included the following: 7 with arthroscopic anterior labral repairs and 4 with open anterior capsular reconstructions.
In the RTSA group, 4 prior bony procedures (40%) were performed: 3 were Bristow procedures (1 patient also underwent a prior open rotator cuff repair) and 1 was a glenoid osteotomy. The remaining 6 patients underwent previous softtissue procedures that included the following: 3 with open anterior labral and capsular repairs (one of these with a total of 3 open reconstructive procedures), 2 with arthroscopic labral repairs, and 1 with a thermal capsulorrhaphy for instability with rotator cuff repair in the same setting.
In the RTSA group, 4 prior bony procedures (40%) were performed: 3 were Bristow procedures (1 patient also underwent a prior open rotator cuff repair) and 1 was a glenoid osteotomy. The remaining 6 patients underwent previous softtissue procedures that included the following: 3 with open anterior labral and capsular repairs (one of these with a total of 3 open reconstructive procedures), 2 with arthroscopic labral repairs, and 1 with a thermal capsulorrhaphy for instability with rotator cuff repair in the same setting.
In the TSA group, all the subscapularis tendons were deemed of adequate quality in the operative reports.
In the RTSA group, 3 subscapularis tendons were intact, 3 were poor quality, 2 were scarred, and 1 was deficient; in 1 case, the tendon quality was not recorded in the operative report. The intact subscapularis tendons were repaired. One of the poor-quality tendons and one of the scarred tendons were repaired using suture. The remaining subscapularis tendons were left as tenotomies.
In the TSA group the rotator cuff tendons were documented as being of adequate quality in all patients.
In the RTSA group, the supraspinatus was intact in 2, partially torn or poor quality in 3, and absent (or with a full-thickness tear) in 4. The infraspinatus was intact in 5, poor quality in 1, and absent (or with a full-thickness tear) in 3. The teres minor was intact in 6, partially torn or poor quality in 2, and absent in 1.
In the RTSA group, 3 subscapularis tendons were intact, 3 were poor quality, 2 were scarred, and 1 was deficient; in 1 case, the tendon quality was not recorded in the operative report. The intact subscapularis tendons were repaired. One of the poor-quality tendons and one of the scarred tendons were repaired using suture. The remaining subscapularis tendons were left as tenotomies.
In the TSA group the rotator cuff tendons were documented as being of adequate quality in all patients.
In the RTSA group, the supraspinatus was intact in 2, partially torn or poor quality in 3, and absent (or with a full-thickness tear) in 4. The infraspinatus was intact in 5, poor quality in 1, and absent (or with a full-thickness tear) in 3. The teres minor was intact in 6, partially torn or poor quality in 2, and absent in 1.
The Simple Shoulder Test scores improved from averages of 3.9 to 8.9 in the TSA group and from 3.4 to 11.2 in the RTSA group.
There were no complications or re operations in the RTSA group. TSA patients had a 33% complication rate and a 20% reoperation rate. 2 TSA patients underwent revision to RTSA. One TSA was converted to RTSA after aseptic glenoid loosening, and one was converted to RTSA because of subsequent rotator cuff failure. One TSA patient had a dislocation, which was treated with closed reduction and did not require further surgery.
Comment: Glenohumeral arthritis developing after prior surgery for anterior instability - "capsulorrhaphy arthropathy" - can be complicated by subscapularis, rotator cuff, glenoid bone deficiencies, and residual glenoid hardware. Each of these factors can complicate the surgeon's ability to achieve solid glenoid component fixation and a stable anatomic arthroplasty. It is of interest that the surgeons elected TSA in patients a decade younger than those having RTSA. The soft tissues were more compromised in the RTSA group.
Even though this is a small case series of patients that are dissimilar in some important ways, it does point out the challenges of attempting an anatomic TSA and the potential benefit of the RTSA in managing the complex pathology of arthritis after a prior instability repair.
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Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
