Although the indications for anatomic and reverse total shoulder arthroplasty (TSA) are different, better understanding of the rate of improvement with each type of surgery could help establish more realistic patient expectations for recovery—and help surgeons and physical therapists design different strategies for postoperative care. With those goals in mind, Simovitch et al. use prospectively collected data to compare, at a minimum 2-year follow-up, clinical and range-of-motion (ROM) outcomes among 505 anatomic TSA patients and 678 reverse TSA patients. The findings appear in in the November 1, 2017 issue of JBJS.
The authors tracked five clinical outcome scores (SST, UCLA Shoulder, ASES, Constant, and SPADI), along with 4 relevant ROM measures. In both groups, >95% of patients reported clinical improvement in all 5 clinical metrics by 6 months, and full improvement was noted by 24 months. Not surprisingly, the mean age of patients who underwent reverse TSA was >5 years older and their shoulder-function scores and ROM were generally worse than those of the anatomic TSA patients.
At the time of the latest follow-up, patients who underwent anatomic TSA fared significantly better than patients who underwent reverse TSA in 3 of the 5 clinical outcome metrics and in all 4 ROM measurements. On the other hand, those who had reverse TSAs had significantly larger improvements in the Constant score (which emphasizes strength more than the other 4 clinical metrics) and active forward flexion.
ROM-wise, at approximately 6 years after surgery, the authors noted a progressive decrease in the magnitude of improvement for abduction and forward flexion in both groups. According to Simovitch et al., the observed discrepancies between clinical and ROM outcomes at longer-term follow-up suggest that “subjective (e.g., patient-reported) assessments of outcome and function likely continue to be stable or improve despite range-of-motion worsening and, as such, may imply that patient expectations change with follow-up time.”
Reverse total shoulder arthroplasty (RTSA) has yielded promising medium-term outcomes, but what about longer-term results? In the March 15, 2017 edition of The Journal, Bacle et al. look at patient outcomes, prosthetic survival, and complications after a mean follow up of 12.5 years.
The good-news finding from this study was that the overall prosthetic survival rate (using revision as the end point) was 93%, confirming the reliability of the Grammont-style prosthesis. Time, however, took its toll on other outcomes. For example, both mean and absolute Constant scores among the cohort decreased significantly compared with the scores at the medium-term follow up (a minimum of 2 years). The cumulative long-term complication rate was 29%, with 10 of the 47 complications occurring at a mean of 8.3 years. Seven of those 10 delayed complications were attributed to mechanical loosening.
The authors suggest that the deterioration of RTSA outcomes seen in this study “is probably related to patient aging coupled with bone erosion and/or deltoid impairment over time.” They conclude that long-term RTSA outcomes “may be impacted by both the etiology of the shoulder dysfunction and the time since implantation.”
For more peer-reviewed content related to RTSA from JBJS Essential Surgical Techniques, click on the following links:
- Patient-Matched Implementation for Reverse Total Shoulder Arthroplasty
- Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty: Surgical Technique
- Technique for Reverse Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis with a Biconcave Glenoid