Comparison of Early Range of Motion in Reverse Shoulder Arthroplasty Based on Indication: A Single Center Retrospective Review

Abstract

Background Reverse shoulder arthroplasty (RSA) is commonly used in the treatment of rotator cuff arthropathy. Indications for RSA have expanded to include complex proximal humerus fractures. Studies directly comparing outcomes between traumatic and traditional elective indications are limited. The purpose of this study was to compare early active range of motion (aROM) within the first two years postoperatively between traumatic and non-traumatic primary RSA, as well as compare ASES scores, and patient satisfaction at final follow-up. Methods A retrospective analysis was conducted of all RSA performed by a single surgeon between January 2000 and December 2018. Patients were grouped by indication into traumatic and non-traumatic elective groups. Demographics, surgical data, and routine aROM data were collected. aROM was compared at 3, 6, 12, and 24 months. American Shoulder and Elbow Surgeons (ASES) score and patient satisfaction were determined at the time of this investigation. Results 367 RSA procedures were performed by the senior author during the study period, 88 for fracture (24%), and 279 for non-traumatic elective indications (76%). Forward elevation and external rotation were inferior in the fracture group at all time points in the first two years. Internal rotation was equivalent throughout the first two years. Final ASES scores were 77.6 versus 83.5 in the fracture and non-fracture groups, respectively ( p = .33). Conclusion Patients undergoing RSA for fracture had statistically significant inferior aROM in forward elevation and external rotation throughout the first two years. Despite having inferior aROM, ASES scores and patient satisfaction at final follow-up were statistically equivalent. Level of Evidence Level III; Retrospective Cohort Comparision; Prognosis Study

Comparison of Outcomes After Reverse Total Shoulder Arthroplasty in Patients With Proximal Humerus Fractures Versus Rotator Cuff Arthropathy

“…Recent literature has evaluated the clinical outcomes after rTSA for various surgical indications. 22 , 23 , 25 Chelli et al 25 conducted a retrospective study and evaluated various survivorship analyses stratified by primary rTSA versus revision rTSA, age (<60 years, 60 to 69 years, 70 to 79 years, ≥80 years), and sex. Our study found prosthetic survivorship of 90.5% in the PHF group and 85.2% in the RTCA group at the 3-year follow-up.…”

“…Moreover, PHF patients demonstrated the greatest improvements in change of ROM between 3-month and 6-month follow-ups; however, by the 2-year follow-up, they were unable to achieve similar ROM as RTCA patients. Doany et al 23 evaluated early ROM comparing patients who underwent rTSA for fracture versus nonfracture patients and similarly reported that patients demonstrated the greatest improvements in ROM between the 3-month and 6-month follow-up visits. Their cohort of patients also exhibited greater ROM at the 24-month visit in patients who underwent rTSA for nonfracture reasons (primary osteoarthritis, RTCA, and irreparable rotator cuff tear) when compared with patients with initial diagnosis of PHF.…”

“…8,9,[19][20][21] While many studies have reported outcomes after rTSA compared with another surgical management option to treat the same pathology, there are limited studies that conduct a granular comparison of rTSA performed for PHF versus RTCA. 22,23 Therefore, the purpose of this study was to report and assess shortterm survivorship of rTSA performed for PHFs and RTCA and secondarily to evaluate whether PHF patients can achieve similar functional outcomes and end range of motion (ROM) compared with RTCA patients.…”

Primary reverse total shoulder arthroplasty for fractures requires more revisions than for degenerative conditions 1 year after surgery: an analysis from the Dutch Arthroplasty Register

“…17,22 Several studies have compared traumatic vs. nontraumatic indications for RTSA, but each investigation has differed slightly from the other investigations with respect to design, exclusion criteria, and/or outcome. 4,5,8,11,13,14,16 One study compared patients with fractures vs. those with cuff tear arthropathy in a large cohort from a national database and showed that fractures treated with RTSA were associated with more short-term complications and discharges to extended-care facilities. 13 Another study compared fractures with elective indications but revealed no differences in adverse events and functional outcomes at a mean follow-up of >3 years.…”