Early outcomes of staged bilateral reverse total shoulder arthroplasty

Abstract

Some surgeons are reluctant to perform a reverse total shoulder arthroplasty (RTSA) on both shoulders because of concerns regarding difficulty with activities of daily living post-operatively as a result of limited rotation of the shoulders. Nevertheless, we hypothesised that outcomes and patient satisfaction following bilateral RTSA would be comparable to those following unilateral RTSA. A single-surgeon RTSA registry was reviewed for patients who underwent bilateral staged RTSA with a minimum follow-up of two years. A unilateral RTSA matched control was selected for each shoulder in those patients undergoing bilateral procedures. The Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Values (SSV), visual analogue scale (VAS) for pain, range of movement and strength were measured pre- and post-operatively. The mean CMS, ASES, SSV, VAS scores, strength and active forward elevation were significantly improved (all p < 0.01) following each operation in those undergoing bilateral procedures. The mean active external rotation (p = 0.63 and p = 0.19) and internal rotation (p = 0.77 and p = 0.24) were not significantly improved. The improvement in the mean ASES score after the first RTSA was greater than the improvement in its control group (p = 0.0039). The improvement in the mean CMS, ASES scores and active forward elevation was significantly less after the second RTSA than in its control group (p = 0.0244, p = 0.0183, and p = 0.0280, respectively). Pain relief and function significantly improved after each RTSA in those undergoing a bilateral procedure. Bilateral RTSA is thus a reasonable form of treatment for patients with severe bilateral rotator cuff deficiency, although inferior results may be seen after the second procedure compared with the first.

Functional internal rotation after shoulder arthroplasty: a comparison of anatomic and reverse shoulder arthroplasty

“…These limitations have likely influenced several authors to advocate against performing bilateral RSA, with fears of losing the ability to perform internal rotation tasks. 26 However, several small studies have suggested that common ADLs, such as perianal hygiene, may not be a problem in this cohort. 23,25 Results from this study demonstrated that the ability to perform perianal hygiene is effectively achieved in 88% (75% easily and 13% with difficulty) and 78% (33% easily and 45% with difficulty) of revision RSA patients (P ¼ .003).…”

“…10,22,23 This limitation has been the primary reason for some authors advocating against performing bilateral RSA because of a fear of complete loss of the ability to perform simple tasks like toileting. 26 Restoration of internal rotation after RSA may be less related to subscapularis function as Clark et al 3 reported no difference in internal rotation motion with and without subscapularis repair. It is more likely that impingement-free arc of motion 2,24 better defines the ability of RSA to restore internal rotation function.…”

Comparative analysis of anatomic and reverse total shoulder arthroplasty: in-hospital outcomes and costs

“…The sicker patient population and complexity of the procedure require greater physician involvement to minimize perioperative complications. Whereas complication rates remain higher for RTSA, patients consistently report improvements in functionality and a reduction in pain after this procedure, 18,31,51,54 indicating the benefits of this procedure. RTSA is often considered a salvage surgery, 31 yet despite being more expensive than ATSA or hemiarthroplasty, it has exhibited cost-effectiveness 13,43 due to improvements in quality of life.…”

Patient-reported activities after bilateral reverse total shoulder arthoplasties

“…There are three studies reporting the outcomes of staged bilateral RSA. [20][21][22] Two of them have reported the effects of bilateral RSA on some ADLs. 20,22 The principal conclusion is that patients with bilateral RSA are able to perform some of the most important ADLs requiring rotation.…”