Comparative Clinical Outcomes of Reverse Total Shoulder Arthroplasty for Primary Cuff Tear Arthropathy Versus Severe Glenohumeral Osteoarthritis With Intact Rotator Cuff: A Matched-Cohort Analysis

J Am Acad Orthop Surg. 2020 Dec 1;28(23):e1042-e1048. doi: 10.5435/JAAOS-D-19-00493.

Abstract

Introduction: The purpose of this study was to compare the short- to mid-term outcomes of patients who underwent reverse total shoulder arthroplasty (RTSA) for severe glenohumeral osteoarthritis (GHOA) with an intact rotator cuff (RC) to a matched rotator cuff arthropathy (RCA) cohort.

Methods: Between 2004 and 2014, all patients who underwent RTSA for severe GHOA with a minimum 2-year follow-up were identified. Demographic and baseline variables were extracted from the medical records. Subjects were matched in the ratio of 1:2 to RTSA subjects with RCA, while controlling for the demographic and intraoperative variables. Postoperative active forward elevation (AFE), active external rotation, American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Scale (VAS), and Simple Shoulder Test were recorded. Complications and revision surgery rates were noted. Comparative multivariate analysis was performed. Preoperative Walch classification for each subject was obtained through radiograph review, and the impact of classification was assessed using one-way analysis of variance testing.

Results: One hundred thirty-six patients were available with mean follow-up 32.3 ± 12.3 months. Baseline range of motion and patient reported outcome scores were similar between the groups (P > 0.05), except for Simple Shoulder Test (intact rotator cuff: 5.7 ± 7.4 versus RCA: 2.4 ± 1.8, P = 0.037). The intact RC group had significantly, superior absolute outcome measures for active external rotation (P = 0.006), and SST (P = 0.048), but not for SANE (P = 0.055), VAS (P = 0.464), ASES (P = 0.084), and AFE (P = 0.099). No notable difference was observed between the groups for improvement in motion, survey scores, or complications. Walch osteoarthritis classification did not impact the outcome measurements in the severe GHOA with the intact RC group (P > 0.05).

Discussion: Patients who underwent RTSA for severe GHOA with intact RC demonstrate similar consistent improvement in outcomes to demographically similar patients with RCA. The severity of GHOA defined by the Walch classification did not impact the outcomes at the 2-year follow-up.

Level of evidence: Level III Therapeutic Study.

MeSH terms

  • Arthroplasty, Replacement*
  • Arthroplasty, Replacement, Shoulder*
  • Cohort Studies
  • Humans
  • Osteoarthritis* / surgery
  • Range of Motion, Articular
  • Retrospective Studies
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries* / surgery
  • Rotator Cuff Tear Arthropathy* / surgery
  • Shoulder Joint* / surgery
  • Treatment Outcome