Surgical outcome following rotator cuff tear repair in a low-income population. Impact of obesity and smoking

Abstract

Background Comorbidities and socioeconomic issues impact outcome of rotator cuff tear (RCT) repair. There are no data on RCT repair outcome from developing regions. We determined the impact of obesity and smoking following RCT repair in a low-income population. Methods This is a retrospective case series. Forty-seven shoulders of 42 patients subjected to open or arthroscopic repair of a RCT with a minimum of 2 years follow-up were cross-sectionally evaluated. Patients were seen in the Orthopaedic Service of the Hospital Geral de Fortaleza-CE, Brazil between March and September 2018. RCT were classified as partial or full-thickness lesions. Fatty infiltration (Goutallier) and tendon retraction (Patte) were recorded as well as obesity (BMI > 30), literacy [>/≤ 8 school years (SY)] and smoking status 6 months prior to surgery (present/absent). Outcomes included pain (visual analogue scale; VAS, 0–10 cm), range of motion [active forward flexion and external rotation (ER)], UCLA and ASES scoring. Results Patients were 59.9 ± 7.4 years-old, 35(74.4%) female with 19 (17.1–30.2 IQR) median of months from diagnosis to surgery and 25 median months of follow-up (26.9–34.0 IQR); over 90% declared < 900.00 US$ monthly family income and two-thirds had ≤8 SY. Forty patients (85.1%) had full-thickness tears, 7 (14.9%) had Goutallier ≥3 and over 80% had < Patte III stage. Outcomes were similar regardless of fatty infiltration or tendon retraction staging. There were 17 (36.1%) smokers and 13 (27.6%) obese patients. Outcome was similar when comparing obese vs non-obese patients. Smokers had more pain (P = 0.043) and less ER (P = 0.029) with a trend towards worse UCLA and ASES scores as compared to non-smokers though differences did not achieve minimal clinically important difference (MCID) proposed for surgical RCT treatment. After adjusting for obesity, VAS and ER values in smokers were no longer significant (P = 0.2474 and 0.4872, respectively). Conclusions Our data document outcomes following RCT repair in a low-income population. Smoking status but not obesity impacted RCT repair outcome though not reaching MCID for surgical treatment.

Impact of obesity on outcomes of rotator cuff repair: A systematic review and meta-analysis

“…Overall, 6 studies reported follow-up pain scores. Out of these, five assessed pain using the visual analogue scale (VAS) [ 17 – 19 , 25 , 27 ] and one using the PROMIS pain interference scale [ 23 ]. In both these scales, a higher score indicates greater pain intensity [ 28 , 29 ].…”

“…The subsequent comprehensive review of the full texts of the remaining 25 studies resulted in the exclusion of 14 more studies. Finally, we conducted our meta-analysis with data from 11 retrospective studies (Fig 1) [17][18][19][20][21][22][23][24][25][26][27].…”

Outcome of reverse shoulder arthroplasty secondary to rotator cuff arthropathy in a low-income population

“…Regarding the need for RSA, delayed RCT repair is linked to a higher chance of developing RCA. Thus, earlier referral and treatment for RCT might have impacted our results [ 1 ]. We may speculate that adequate timing of RCT repair in our hands could have reduced the need for replacement of the shoulder joint.…”

“…Reverse shoulder arthroplasty (RSA) is currently the most commonly employed surgical treatment for rotator cuff arthropathy (RCA), especially among elderly patients. This procedure can also be indicated in patients with irreparable rotator cuff injuries, severe proximal humerus fractures, inflammatory arthropathies as well as for revision of primary arthroplasty being contraindicated when there is severe impairment of the deltoid muscle [ 1 ].…”

Diabetes Mellitus and Obesity as Prognostic Factors in Arthroscopic Repair of Chronic Rotator Cuff Tears

“…Several factors have been described that may be determinant in establishing a favorable prognosis in the patient’s recovery after this surgery, including: demographic factors (minority age and male gender), clinical factors (absence of osteoporosis, absence of diabetes, high-performance athlete patient, and complete passive preoperative range of motion), factors related to the integrity of the rotator cuff or to the intervention (repair in the same procedure of the acromioclavicular or biceps joint) [ 1 , 3 , 11 ] and socioeconomic factors [ 12 ]. However, the relationship of diabetes with this pathology and its therapeutic management is not entirely clarified.…”