A Longitudinal Assessment of Reverse Shoulder Arthroplasty Over Time
Theses authors sought to evaluate the long-term effects of reverse total shoulder (RSA)on overhead range of motion (ROM) and to investigate the concept of “deltoid fatigue” in a retrospective review of 165 RSAs over a 5 year period.
Diagnoses were limited to cuff tear arthropathy (CTA), osteoarthritis with rotator cuff deficiency (OA), and irreparable rotator cuff tear (RCT).
Any shoulder sustaining a postoperative complication or undergoing revision surgery was excluded in order to evaluate deltoid fatigue in the well-functioning RSA without a clinically identifiable cause for impairment.
Primary RSA shoulders were observed to lose 0.8° of forward elevation and abduction per year starting at 1 year postoperatively (p=0.006), without a significant drop at mid-term follow-up. No significant change in external rotation or internal rotation was observed.
Males and patients with a diagnosis of OA showed greater baseline overhead ROM at one year postoperatively, but the subsequent rate of functional decline occurred at similar rates regardless of age, gender or indication.
They concluded that a slow rate of decline in overhead ROM in well-functioning RSA shoulders was observed averaging 0.8 degrees of overhead ROM per year. This progressive deterioration occurs at a slightly greater rate than the that observed in the natural shoulder.
Comment: This study indicates that in the absence of complications, the functional outcomes of a reverse total shoulder arthroplasty are durable.
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