Outcomes after a Grammont-style reverse total shoulder arthroplasty?
These authors evaluated 230 RTSAs performed by the senior author with 70% follow-up at a median of 3.4 years.
Increased postoperative glenoid inclination was significantly associated with increased VAS pain scores postoperatively.
Female gender, and lower body mass index (BMI) were associated with worse Simple Shoulder Test (SST) scores, ASES scores, and VAS-pain scores.
Female gender and lower BMI were associated with worse SST scores.
Postoperative distalization was associated with reoperation or complication. Adjusting for the other variables in the model, a 1-mm increase in distalization was associated with a 6% increased odds of reoperation or complication.
Of the included shoulders, 18% (41/230) suffered either a complication or reoperation postoperatively; 3.4% of shoulders had postoperative instability (8/230). One percent of shoulders developed a recurrence of a prior known infection (3/230), and 4% (9/230) of shoulders suffered a new postoperative infection (3 in primary RTSAs and 6 in revision RTSAs). Of these, 1% (3/230) were deep infections requiring operative irrigation and debridement and the other 3% (6/230) were superficial infections responding to antibiotics. Three percent of shoulders had a postoperative acromial fracture (7/230), and none of these
patients had a history of trauma. One percent of shoulders had persistent pain at the strap tendon requiring operative release (3/230), and 1% of shoulders had postoperative hematomas (2/230). Two percent of shoulders had glenoid loosening (2 in the context of a glenoid bone graft and 1 in the context of infection, 4/230). One percent (3/230) of shoulders had nerve injuries (1 median, 1 ulnar, and 1 diffuse plexopathy), all of which resolved. Two percent of shoulders (5/230) had other complications including a postoperative seizure, a postoperative fall with a glenoid neck fracture, and postoperative thromboembolic events.
Comment: This is an interesting study of the outcomes of a large single-surgeon experience. While 71% of the patients were female, female patients tended to have inferior outcomes. Contrary to common understanding, lower BMI was a risk factor for inferior outcomes. Superior gleonoid inclination was all a risk factor. And finally, increased distalization of the humerus was associated with inferior outcomes and complications. Of note the average distalization was 29 mm in this series.
To see a YouTube of our technique for a reverse total shoulder arthroplasty in which we try to minimize distalization, click on this link.
===
How you can support research in shoulder surgery Click on this link.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
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.
