Clark, J Shoulder Elbow Surg 2012 - Complication Rates, Dislocation, Pain, and Postoperative Range of Motion after Reverse Shoulder Arthroplasty in Patients with and without Repair of the Subscapularis
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Complication Rates, Dislocation, Pain, and Postoperative Range of Motion after Reverse Shoulder Arthroplasty in Patients with and without Repair of the Subscapularis
Clark, Hawkins, et al.·J Shoulder Elbow Surg·2012·213 citations
Clark and colleagues compared complications, dislocation, pain and motion after deltopectoral reverse shoulder arthroplasty with and without subscapularis repair.
Retrospective review of 120 shoulders in 111 patients, one institution, June 2003 to August 2009, follow‑up 6 to 62 months. Supported by DJO Surgical.
Key Findings
Complications occurred in 13 of 65 repaired and 11 of 55 unrepaired shoulders, 20% in each group (p > 0.99).
Dislocation occurred in 2 repaired and 3 unrepaired shoulders (p = 0.52). Two unrepaired shoulders dislocated again, and closed reduction failed in every patient.
Covariate‑adjusted regression found no significant effect for any complication type, but intervals were very wide (any complication OR 0.53, 95% CI 0.09 to 2.9). The authors note too few events and a small sample.
Final forward flexion averaged 112° with repair vs 94° without, yet gains were similar (+54° vs +56°) because the unrepaired group started 20° lower.
Repair was left to the surgeon at closure, and surgeon was the only baseline difference between groups (p < 0.01). One surgeon repaired more often.
The authors hypothesize that the RSP's increased lateral offset tensions the deltoid and adds stability. They suggest repair may not be needed to prevent instability with this implant.
Authors' conclusion
Repairing the subscapularis has no appreciable effect on complication rate, dislocation events, or range of motion gains and pain relief.
Complication Rates, Dislocation, Pain, and Postoperative Range of Motion after Reverse Shoulder Arthroplasty in Patients with and without Repair of the Subscapularis
Clark, Hawkins, et al.·J Shoulder Elbow Surg·2012·213 citations
Clark and colleagues compared complications, dislocation, pain and motion after deltopectoral reverse shoulder arthroplasty with and without subscapularis repair.
Retrospective review of 120 shoulders in 111 patients, one institution, June 2003 to August 2009, follow‑up 6 to 62 months. Supported by DJO Surgical.
Key Findings
Complications occurred in 13 of 65 repaired and 11 of 55 unrepaired shoulders, 20% in each group (p > 0.99).
Dislocation occurred in 2 repaired and 3 unrepaired shoulders (p = 0.52). Two unrepaired shoulders dislocated again, and closed reduction failed in every patient.
Covariate‑adjusted regression found no significant effect for any complication type, but intervals were very wide (any complication OR 0.53, 95% CI 0.09 to 2.9). The authors note too few events and a small sample.
Final forward flexion averaged 112° with repair vs 94° without, yet gains were similar (+54° vs +56°) because the unrepaired group started 20° lower.
Repair was left to the surgeon at closure, and surgeon was the only baseline difference between groups (p < 0.01). One surgeon repaired more often.
The authors hypothesize that the RSP's increased lateral offset tensions the deltoid and adds stability. They suggest repair may not be needed to prevent instability with this implant.
Authors' conclusion
Repairing the subscapularis has no appreciable effect on complication rate, dislocation events, or range of motion gains and pain relief.