Clinical outcome of reverse total shoulder arthroplasty (comprehensive system) after failed rotator cuff repair with a medium-term follow-up: comparison with reverse total shoulder arthroplasty for massive rotator cuff tear without osteoarthritis

TL;DR

This study compares the outcomes of reverse shoulder surgery in patients with different shoulder conditions, finding that surgery after failed repair has worse results than primary surgery.

Contribution

The study provides a comparative analysis of clinical outcomes for different types of reverse total shoulder arthroplasty with medium-term follow-up.

Findings

Functional outcomes significantly improved postoperatively in all groups.

The fRCR group had worse outcomes compared to the mRCT and CTA groups.

Postoperative complications and radiologic outcomes were not significantly different between groups.

Abstract

We compared the clinical outcomes of primary reverse total shoulder arthroplasty (rTSA) in patients with massive rotator cuff tears (mRCTs) without osteoarthritis (OA), secondary rTSA in patients with failed rotator cuff repair (RCR), and primary rTSA in patients with cuff tear arthropathy (CTA) as a control group.

Among 364 patients who underwent rTSA between March 2014 and August 2019, 153 were included. All patients underwent surgery with a single implant type and were followed for a minimum of 4 years. Patients were categorized into three groups: primary rTSA for mRCT without OA (mRCT group, n = 24), primary rTSA for CTA (CTA group, n = 104), and rTSA for failed rotator cuff repair group (fRCR; fRCR group, n = 25). The mean age was 71.5 ± 6.3 (range, 53-83) years, with a mean follow-up of 54.7 ± 12.9 (range, 48-98) months. Functional outcomes were assessed using the active range of motion, the visual analog scale for pain, the simple shoulder test, the American Shoulder and Elbow Surgeons score, the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and the Constant score at the final follow-up.

All functional outcomes significantly improved postoperatively in each group (P < .05). However, the fRCR group presented worse outcomes compared to the other groups, including visual analog scale for pain (2.1 ± 0.5), forward flexion (126° ± 4°), external rotation (42 ± 4°), American Shoulder and Elbow Surgeons score (76 ± 5), and Constant score (55 ± 3) (P < .05). Postoperative complications and radiologic outcomes were not significantly different between the groups (P = .890).

Considering the worse clinical outcomes of secondary rTSA after failed RCR compared to primary rTSA for mRCT without OA and/or CTA, careful selection of appropriate candidates for RCR or primary rTSA as a treatment option for mRCT without OA is essential, according to their healing potential.

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