Monday, October 26, 2020

Reverse total shoulder - early complications

Reverse total shoulder arthroplasty clinical and patient-reported outcomes and complications stratified by pre-operative diagnosis: a systematic review

These authors sought to investigate differences in clinical and patient reported outcomes (PROs), and complication type and rate amongst preoperative diagnoses following reverse total shoulder arthroplasty: rotator cuff tear arthropathy (CTA), primary osteoarthritis (OA), massive irreparable rotator cuff tear (MIRCT), proximal humeral fracture (PHFx), rheumatoid arthritis (RA), and revision of anatomic arthroplasty (Rev).

They searched three electronic databases for patients with (1) minimum 60 years of age with RTSA for the preoperative diagnoses; (2) minimum 2-year follow-up; (3) pre- and postoperative values for clinical and PROs

Fifty-three studies were included: 36 (68%) were level IV retrospective case series. 33 (62%) demonstrated high risk of bias on the MINORS tool, and the 3 randomized controlled trials demonstrated a low risk of bias on Modified Downs and Black. 

RTSA improved clinical and PROs for all preoperative diagnoses. Revisions had poorer final outcomes as noted by lower ASES (69) and pain score (1.8) compared to other preoperative diagnoses (78-82 and 0.4-1.4). 

The highest overall rate of complications was seen in the RA group with a rate of 28%. RA also had the highest rate of each type of complication with 41% having acromial or scapular spine fractures, 28% infections, 26% dislocations, and 10% nerve palsy. 

The lowest overall complication rate was seen in the OA group (1.4%) followed by the CTA group (7.4%). 

The PHFx aggregated rate for each category of complications was less than 2%. 

The most frequently occurring complication in the Rev and MIRCT groups was glenoid loosening (4% and 6.7%, respectively). It is unclear why the outcomes for MIRCT were worse than for other primary diagnoses.

Dislocation was reported as a complication in less than 2% for all preoperative diagnoses with the exception of RA.

They concluded that the RTSA literature is at high risk of bias.

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