Previous Rotator Cuff Repair Is Associated With Inferior Clinical Outcomes After Reverse Total Shoulder Arthroplasty

Background: Although recent evidence suggests that any prior shoulder surgery may cause inferior shoulder arthroplasty outcomes, there is no consensus on whether previous rotator cuff repair (RCR) is associated with inferior outcomes after reverse total shoulder arthroplasty (RTSA). Purpose: To retrospectively compare outcomes in patients who underwent RTSA with and without previous RCR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with prior RCR and those without previous shoulder surgery (control) who underwent RTSA for cuff tear arthropathy or irreparable cuff tear were retrospectively identified from a prospective database. Exclusion criteria included revision arthroplasty, fractures, rheumatoid arthritis, dislocations, infection, prior non-RCR procedures, less than 12 months of follow-up, and latissimus dorsi tendon transfer. The American Shoulder and Elbow Surgeons (ASES) score, ASES Activities of Daily Living (ADL) score, visual analog scale (VAS) score for pain, Subjective Shoulder Value (SSV), and range of motion (ROM) were compared between groups. Results: Patients with previous RCR (n = 83 shoulders) were younger (mean ± SD, 67 ± 10 vs 72 ± 8 years; P < .001) and more likely to be male (46% vs 32%, P = .033) than controls (n = 189 shoulders). No differences were found in follow-up duration (25 ± 13 vs 26 ± 13 months, P = .734), body mass index, or any preoperative outcome variable or ROM measure. At final follow-up, patients with previous RCR had significantly lower ASES (76.5 [95% CI, 71.2-81.7] vs 85.0 [82.6-87.5], P = .015), lower SSV (76 [72-81] vs 86 [83-88], P < .001), worse pain (2.0 [1.4-2.6] vs 0.9 [0.6-1.1], P < .001), and less improvement in the ASES, ASES ADL, VAS, SSV, and forward elevation measures than controls. Multivariable linear regression analysis demonstrated that previous RCR was significantly associated with lower postoperative ASES score (B = –9.5, P < .001), lower ASES improvement (B = –7.9, P = .012), worse postoperative pain (B = 0.9, P = .001), worse improvement in pain (B = –1.0, P = .011), lower postoperative SSV (B = –9.2, P < .001), lower SSV improvement (B = –11.1, P = .003), and lower forward elevation ROM improvement (B = –12.7, P = .008). Conclusion: Patients with previous RCR attempts may experience fewer short-term gains in functional and subjective outcome scores after RTSA compared with patients with no history of shoulder surgery who undergo RTSA. However, the differences between groups were small and below the minimal clinically important differences for the outcome measures analyzed.

[1]  R. Tashjian,et al.  Determining the minimal clinically important difference for the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty. , 2017, Journal of shoulder and elbow surgery.

[2]  E. Makhni,et al.  Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears. , 2016, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  Phuong T. Vu,et al.  What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties , 2016, Clinical orthopaedics and related research.

[4]  D. Dines,et al.  What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty? , 2016, Clinical orthopaedics and related research.

[5]  V. Denaro,et al.  Deltoid muscle tropism does not influence the outcome of arthroscopic rotator cuff repair , 2016, MUSCULOSKELETAL SURGERY.

[6]  J. Levy,et al.  Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012. , 2016, Journal of shoulder and elbow surgery.

[7]  L. Higgins,et al.  Latissimus Dorsi and Teres Major Transfer With Reverse Shoulder Arthroplasty Restores Active Motion and Reduces Pain for Posterosuperior Cuff Dysfunction , 2015, Clinical orthopaedics and related research.

[8]  T. Maerz,et al.  Preoperative Deltoid Size and Fatty Infiltration of the Deltoid and Rotator Cuff Correlate to Outcomes After Reverse Total Shoulder Arthroplasty , 2015, Clinical orthopaedics and related research.

[9]  Y. Rhee,et al.  Alterations of the Deltoid Muscle After Open Versus Arthroscopic Rotator Cuff Repair , 2013, The American journal of sports medicine.

[10]  Benedict U. Nwachukwu,et al.  National utilization of reverse total shoulder arthroplasty in the United States. , 2015, Journal of shoulder and elbow surgery.

[11]  C. Gerber,et al.  Clinical outcome of reverse total shoulder arthroplasty combined with latissimus dorsi transfer for the treatment of chronic combined pseudoparesis of elevation and external rotation of the shoulder. , 2014, Journal of shoulder and elbow surgery.

[12]  E. McFarland,et al.  Uncommon Indications for Reverse Total Shoulder Arthroplasty , 2013, Clinics in orthopedic surgery.

[13]  Yuqing Zhang,et al.  Increasing incidence of shoulder arthroplasty in the United States. , 2011, The Journal of bone and joint surgery. American volume.

[14]  J. Hochreiter,et al.  Impact of previous rotator cuff repair on the outcome of reverse shoulder arthroplasty. , 2011, Journal of shoulder and elbow surgery.

[15]  D. Pupello,et al.  Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. , 2010, The Journal of bone and joint surgery. American volume.

[16]  Lauren Beaupre,et al.  Evaluating change in clinical status: reliability and measures of agreement for the assessment of glenohumeral range of motion. , 2010, North American journal of sports physical therapy : NAJSPT.

[17]  P. Asbach,et al.  Degenerative changes of the deltoid muscle have impact on clinical outcome after reversed total shoulder arthroplasty , 2010, Archives of Orthopaedic and Trauma Surgery.

[18]  G. Walch,et al.  Reverse total shoulder arthroplasty after failed rotator cuff surgery. , 2009, Journal of shoulder and elbow surgery.

[19]  C. Gerber,et al.  Comparison of the subjective shoulder value and the Constant score. , 2007, Journal of shoulder and elbow surgery.

[20]  N. Helmy,et al.  Impact of fatty infiltration of the teres minor muscle on the outcome of reverse total shoulder arthroplasty. , 2007, The Journal of bone and joint surgery. American volume.

[21]  Christian Gerber,et al.  Reverse Delta-III total shoulder replacement combined with latissimus dorsi transfer. A preliminary report. , 2007, The Journal of bone and joint surgery. American volume.

[22]  C Gerber,et al.  Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. , 2005, The Journal of bone and joint surgery. American volume.

[23]  G Walch,et al.  Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. , 2004, The Journal of bone and joint surgery. British volume.

[24]  Peter I Sallay,et al.  The measurement of normative American Shoulder and Elbow Surgeons scores. , 2003, Journal of shoulder and elbow surgery.

[25]  P. McClure,et al.  American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. , 2002, Journal of shoulder and elbow surgery.

[26]  Gilles Walch,et al.  Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear. , 2002, Orthopedics.

[27]  S. Tooke,et al.  Intramuscular deltoid pressure during shoulder arthroscopy. , 1989, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.