Ernstbrunner, J Bone Joint Surg Am 2017 - Reverse Total Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears before the Age of 60 Years: Long-Term Results - Article Summary

Reverse Total Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears before the Age of 60 Years: Long-Term Results

Ernstbrunner, Gerber, et al.·J Bone Joint Surg Am·2017·227 citations·Retrospective cohort

Background

There has been serious concern regarding the longevity and durability of outcomes of reverse total shoulder arthroplasty (RTSA) in younger patients. It was the purpose of this study to analyze long-term outcomes and complications of RTSA for irreparable rotator cuff tears in patients younger than 60 years.

Methods

20 patients (23 shoulders) with a mean age of 57 years (range, 47 to 59 years) were evaluated at a mean of 11.7 years (range, 8 to 19 years) after RTSA.
15 shoulders (65%) had undergone previous non-arthroplasty surgery.
Longitudinal clinical and radiographic outcomes were assessed.

Results

At the time of final follow-up, the mean absolute and relative preoperative Constant score (CS) (and standard deviation) had improved from 24 ± 9 to 59 ± 19 points (p < 0.001) and from 29% ± 11% to 69% ± 21% (p < 0.001), respectively.
The mean Subjective Shoulder Value (SSV) had increased from 20% ± 13% to 71% ± 27% (p < 0.001).
There were also significant improvements in the mean active anterior elevation (from 64° to 117°), active abduction (from 58° to 111°), pain scores, and strength (all p ≤ 0.001).
Clinical outcomes did not significantly deteriorate beyond 10 years and the functional results of patients with previous surgical procedures were not significantly inferior to the results of those with primary RTSA.
The grade of, and number of patients with, radiographically apparent notching increased over time; the mean relative CS was lower in patients in whom the notching was grade 2 or higher (57%) than it was in those with no or grade-1 notching (81%; p = 0.006).
Nine (39%) had ≥1 complication, with 2 failed RTSAs (9%).

Conclusions

RTSA in patients younger than 60 years leads to substantial subjective and functional improvement without clinical deterioration beyond 10 years. It is associated with a substantial complication rate, and complications compromise ultimate subjective and objective outcomes.

Level of evidence: Therapeutic Level IV. Copyright remains with the authors and publisher.

Supplemental

Reverse Total Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears before the Age of 60 Years: Long-Term Results.

Ernstbrunner, Gerber, et al.J Bone Joint Surg Am2017227 citationsRetrospective cohort