# Clinical results of reverse shoulder arthroplasty after failed arthroscopic rotator cuff repair compared to primary cases: a case–control study

## TL;DR

This study found that reverse shoulder arthroplasty after failed rotator cuff repair has similar outcomes to primary cases.

## Contribution

The study provides evidence that prior failed rotator cuff repair does not worsen RSA outcomes.

## Key findings

- RSA after failed ARCR showed comparable UCLA and JOA scores to primary RSA cases.
- Complication rates were similar between the two groups (4.0% vs 3.3%).
- Patients with prior ARCR still achieved significant functional improvements post-RSA.

## Abstract

Although reverse shoulder arthroplasty (RSA) is a popular treatment, its efficacy in patients with failed rotator cuff repair (ARCR) remains unclear. In this study, we aimed to evaluate the clinical results of RSA for following failed ARCR. We hypothesized that RSA after failed ARCR would lead to improved clinical outcomes comparable to those of RSA performed without prior surgeries.

Between January 2017 and December 2022, 143 patients underwent RSA at our institution. We included 85 patients who met the study criteria and followed them for a minimum of 2 years. The patients were divided into two groups: those who underwent RSA for failed ARCR (group A: 25 patients; mean age, 77.7 years) and those who underwent primary RSA (group B: 60 patients; mean age, 77.9 years). The University of California, Los Angeles (UCLA) scores, Japanese Orthopaedic Association (JOA) scores, range of motion (ROM), Numerical Rating Scale (NRS) scores, and complication rates were compared between the two groups.

At the 2-year postoperative follow-up, both groups showed significant improvements in all items. Postoperative outcome or complication rate demonstrated no significant difference between group A and group B: UCLA scores (29.7 ± 3.9 vs 29.3 ± 3.6), JOA scores (87.4 ± 6.1 vs 87.4 ± 8.6), ROM forward elevation (129.1 ± 20.1 vs 133.9 ± 24.1), ROM external rotation (29.1 ± 12.7 vs 29.4 ± 10.7), ROM internal rotation (2.4 ± 1.0 points vs 2.3 ± 1.1 point), NRS scores (0.9 ± 1.2 vs 1.1 ± 1.3), and complication rates (4.0% vs 3.3%). Group A exhibited improvement in all items, and the results were comparable to those in group B.

RSA in patients with prior rotator cuff repair demonstrated similar functional outcomes and complication rates to those in patients who underwent RSA without prior surgeries. The study demonstrated that prior ARCR would not be a negative predictor. For patients who are afraid of or cannot consent to artificial joint surgery, recommending ARCR first may be an option.