These authors asked two questions:
(1) To what degree isprimary anatomic shoulder arthroplasty after prior non-arthroplasty surgery associated with inferior clinical outcomes and higher revision rates compared with arthroplasty without previous surgery?
(2) Does type, approach, or timing of previous surgery affect outcomes after anatomic arthroplasty?
They analyzed 640 patients undergoing anatomic shoulder arthroplasty (345 TSAs and 295 ream-and-run arthroplasties). Of these patients, 183 (29%) underwent previous non-arthroplasty surgery.
In patients undergoing TSA, previous non-arthroplasty surgery was associated with a significantly lower 2-year Simple ShoulderTest (SST) score, percentage maximum possible improvement (MPI), and Single Assessment Numeric Evaluation (SANE) score and a higher rate of reoperation.
The risk of reoperation was significantly higher (hazard ratio [HR], 20.79; 95% confidence interval [CI],
4.65-93.00; P < .001) in the previous surgery group.In the group with prior surgery, 2 patients underwent revision surgery for stiffness with downsizing of the humeral head component and 5 underwent revision for softtissue failure (rotator cuff or biceps). In the group without prior surgery, 1 patient underwent single-stage component exchange for suspected infection and 1 underwent revision because of rotator cuff failure.
In patients undergoing ream-and-run arthroplasty, these associations were present but were not statistically significant.In addition, the rates of MUA (7% vs. 7%, P . .911) and open revision (8% vs. 12%, P .340) were similar between groups. In the group with prior surgery, 3 patients underwent open release for stiffness, 5 underwent downsizing of the humeral head, 3 underwent single-stage exchange for suspected infection, and 1 underwent revision owing to rotator cuff failure. In the group without previous surgery, 1 patient underwent open release for stiffness, 8 underwent
downsizing of the humeral head, 2 underwent single-stage exchange for suspected infection, 1 underwent revision to TSA because of symptomatic glenoid wear, and 1 underwent revision surgery at an outside hospital for an unknown reason.
Among TSA and ream-and-run arthroplasty cases with prior non-arthroplasty surgery, prior fracture surgery carried the highest risk of revision (HR, 5.34; 95% CI, 0.96-29.61; P .055).
Comment: While this study does show a negative impact of prior non-arthroplasty surgery on the outcomes of TSA and RnR, it is reassuring that substantial gains in comfort and function can be realized in with these procedures for patients with previous surgery.
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