Young, J Bone Joint Surg Am 2012 - Secondary Rotator Cuff Dysfunction Following Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis: Results of a Multicenter Study with More Than Five Years of Follow-Up
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Secondary Rotator Cuff Dysfunction Following Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis: Results of a Multicenter Study with More Than Five Years of Follow-Up
Young, Favard, et al.·J Bone Joint Surg Am·2012·254 citations
Young and colleagues measured how often the rotator cuff fails late after anatomic TSA for primary osteoarthritis, and which factors predict that failure.
Retrospective series from 10 European centers, 1991 to 2003: 518 of 704 Aequalis TSAs with complete data at a minimum of 5 years (mean 103.6 months).
Secondary cuff dysfunction would become more common with longer follow‑up and would worsen clinical and radiographic results.
Key Findings
The share of shoulders still without secondary cuff dysfunction was 100% at 5 years, 84% at 10 years (95% CI 79% to 88%) and 45% at 15 years (95% CI 34% to 57%).
Counting only moderate or severe superior subluxation, a radiographic proxy, 87 of 518 shoulders (16.8%) had secondary cuff dysfunction. Mild subluxation was excluded, so the true rate may be higher.
Besides length of follow‑up (p < 0.0001), the predictors were superior tilt of the glenoid component on the immediate postoperative radiograph (p < 0.001) and infraspinatus fatty infiltration of Goutallier stage 2 or higher (p < 0.05).
A supraspinatus tear found at surgery (p = 0.16), supraspinatus or subscapularis fatty infiltration, and patient age did not predict dysfunction. No power analysis was done, so these null results may reflect too few patients.
Shoulders with secondary cuff dysfunction did worse clinically: mean Constant score 55.4 vs 67.3 and active forward elevation 120.7° vs 141.9° (both p < 0.0001).
Dysfunction was associated with a higher glenoid radiolucent line score (11.5 vs 7.8), glenoid migration and radiographic loosening (all p < 0.0001). Revision rates did not differ significantly (5.7% vs 5.1%, p = 0.89), possibly for lack of power.
Board pearl
The authors suggest superior tilt of the glenoid component should be avoided to lower the risk of late cuff dysfunction and glenoid loosening. With infraspinatus fatty infiltration, they advise counseling and, in some cases, considering a reverse TSA.
Authors' conclusion
In this study, rates of secondary rotator cuff dysfunction with moderate or severe superior subluxation of the prosthetic humeral head increased with the duration of follow-up and significantly influenced the clinical and radiographic outcome of total shoulder arthroplasty performed for primary glenohumeral osteoarthritis. Preoperative fatty infiltration of the infraspinatus muscle and implantation of the glenoid component with superior tilt were prognostic factors.
Secondary Rotator Cuff Dysfunction Following Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis: Results of a Multicenter Study with More Than Five Years of Follow-Up
Young, Favard, et al.·J Bone Joint Surg Am·2012·254 citations
Young and colleagues measured how often the rotator cuff fails late after anatomic TSA for primary osteoarthritis, and which factors predict that failure.
Retrospective series from 10 European centers, 1991 to 2003: 518 of 704 Aequalis TSAs with complete data at a minimum of 5 years (mean 103.6 months).
Secondary cuff dysfunction would become more common with longer follow‑up and would worsen clinical and radiographic results.
Key Findings
The share of shoulders still without secondary cuff dysfunction was 100% at 5 years, 84% at 10 years (95% CI 79% to 88%) and 45% at 15 years (95% CI 34% to 57%).
Counting only moderate or severe superior subluxation, a radiographic proxy, 87 of 518 shoulders (16.8%) had secondary cuff dysfunction. Mild subluxation was excluded, so the true rate may be higher.
Besides length of follow‑up (p < 0.0001), the predictors were superior tilt of the glenoid component on the immediate postoperative radiograph (p < 0.001) and infraspinatus fatty infiltration of Goutallier stage 2 or higher (p < 0.05).
A supraspinatus tear found at surgery (p = 0.16), supraspinatus or subscapularis fatty infiltration, and patient age did not predict dysfunction. No power analysis was done, so these null results may reflect too few patients.
Shoulders with secondary cuff dysfunction did worse clinically: mean Constant score 55.4 vs 67.3 and active forward elevation 120.7° vs 141.9° (both p < 0.0001).
Dysfunction was associated with a higher glenoid radiolucent line score (11.5 vs 7.8), glenoid migration and radiographic loosening (all p < 0.0001). Revision rates did not differ significantly (5.7% vs 5.1%, p = 0.89), possibly for lack of power.
Board pearl
The authors suggest superior tilt of the glenoid component should be avoided to lower the risk of late cuff dysfunction and glenoid loosening. With infraspinatus fatty infiltration, they advise counseling and, in some cases, considering a reverse TSA.
Authors' conclusion
In this study, rates of secondary rotator cuff dysfunction with moderate or severe superior subluxation of the prosthetic humeral head increased with the duration of follow-up and significantly influenced the clinical and radiographic outcome of total shoulder arthroplasty performed for primary glenohumeral osteoarthritis. Preoperative fatty infiltration of the infraspinatus muscle and implantation of the glenoid component with superior tilt were prognostic factors.