TY - JOUR
T1 - Clinical outcomes of revision to anatomic total shoulder arthroplasty
AU - Zmistowski, Ben
AU - Rabinowitz, Justin
AU - Aleem, Alexander W.
AU - Chamberlain, Aaron M.
AU - Keener, Jay D.
N1 - Publisher Copyright:
© 2024
PY - 2024/6
Y1 - 2024/6
N2 - Background: Anatomic total shoulder arthroplasty (aTSA) remains the gold-standard for management of end-stage glenohumeral arthritis. However, in the setting of failed hemiarthroplasty or aTSA, the appropriate utilization of revision to an anatomic vs. reverse TSA remains unknown. This study aims to assess the outcomes of revision to aTSA. Methods: All revision shoulder arthroplasty cases at a single institution by one of five fellowship-trained surgeons were reviewed. All aseptic revision cases where the revision construct was an aTSA were included. Attempts were made to contact each case for enrollment in the institution's shoulder registry and ascertain any cases requiring revision surgery. Patient-reported outcome measures: American Shoulder and Elbow Surgeons score, single assessment numeric evaluation, visual analog scale for pain, patient satisfaction, and a validated scale of patient-reported shoulder range-of-motion were collected. Results: Twenty eight cases underwent revision aTSA between 2004 and 2019. The average age was 53.4 years (range: 23-66), 16 (57%) were male, and 14 (50%) were revised from a hemiarthroplasty while the remainder were revised from an aTSA. Seven (25%) cases required revision surgery at a mean 1.8 years. Three of these cases had been revised from hemiarthroplasty. Reasons for revision included: glenoid loosening (1), infection (1), rotator cuff failure (3), and persistent pain of nonspecific etiology (2). Ultimately, 6 (21%; 6/28) were revised to reverse TSA at a mean of 2 years (range: 1 month-5.7 years) postoperatively. Patients requiring further revision surgery were older (58.8 vs. 51.4 years; P = .06) than those not requiring further revision. Of the patients managed with lesser tuberosity osteotomy, the revision rate was 7.1% (1/14) compared to 42.9% (6/14) for the remainder of the cohort (P = .08). Of the 21 patients with retained aTSA, 15 (71%) provided clinical follow-up at an average of 4 years (range: 1-8). These patients had a mean American Shoulder and Elbow Surgeons score of 70.2 (range: 41-94), visual analog scale pain score of 2.8 (range: 0-6), single assessment numeric evaluation score of 52.1% (range: 14-92), and satisfaction of 73% (range: 1-100). Discussion: The outcomes of revision shoulder arthroplasty to an aTSA construct are varied. While in the appropriately indicated young patient high-quality results can be achieved, there is a high revision rate and highly variable patient-reported outcomes. Surgeons should be selective when recommending revision to an aTSA. Further study is needed to better predict successful outcomes in this patient population.
AB - Background: Anatomic total shoulder arthroplasty (aTSA) remains the gold-standard for management of end-stage glenohumeral arthritis. However, in the setting of failed hemiarthroplasty or aTSA, the appropriate utilization of revision to an anatomic vs. reverse TSA remains unknown. This study aims to assess the outcomes of revision to aTSA. Methods: All revision shoulder arthroplasty cases at a single institution by one of five fellowship-trained surgeons were reviewed. All aseptic revision cases where the revision construct was an aTSA were included. Attempts were made to contact each case for enrollment in the institution's shoulder registry and ascertain any cases requiring revision surgery. Patient-reported outcome measures: American Shoulder and Elbow Surgeons score, single assessment numeric evaluation, visual analog scale for pain, patient satisfaction, and a validated scale of patient-reported shoulder range-of-motion were collected. Results: Twenty eight cases underwent revision aTSA between 2004 and 2019. The average age was 53.4 years (range: 23-66), 16 (57%) were male, and 14 (50%) were revised from a hemiarthroplasty while the remainder were revised from an aTSA. Seven (25%) cases required revision surgery at a mean 1.8 years. Three of these cases had been revised from hemiarthroplasty. Reasons for revision included: glenoid loosening (1), infection (1), rotator cuff failure (3), and persistent pain of nonspecific etiology (2). Ultimately, 6 (21%; 6/28) were revised to reverse TSA at a mean of 2 years (range: 1 month-5.7 years) postoperatively. Patients requiring further revision surgery were older (58.8 vs. 51.4 years; P = .06) than those not requiring further revision. Of the patients managed with lesser tuberosity osteotomy, the revision rate was 7.1% (1/14) compared to 42.9% (6/14) for the remainder of the cohort (P = .08). Of the 21 patients with retained aTSA, 15 (71%) provided clinical follow-up at an average of 4 years (range: 1-8). These patients had a mean American Shoulder and Elbow Surgeons score of 70.2 (range: 41-94), visual analog scale pain score of 2.8 (range: 0-6), single assessment numeric evaluation score of 52.1% (range: 14-92), and satisfaction of 73% (range: 1-100). Discussion: The outcomes of revision shoulder arthroplasty to an aTSA construct are varied. While in the appropriately indicated young patient high-quality results can be achieved, there is a high revision rate and highly variable patient-reported outcomes. Surgeons should be selective when recommending revision to an aTSA. Further study is needed to better predict successful outcomes in this patient population.
KW - Anatomic
KW - Anatomic revision
KW - Failed shoulder arthroplasty
KW - Hemiarthoplasty
KW - Level IV
KW - Retrospective Case Series
KW - Revision
KW - Shoulder arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85188217588&partnerID=8YFLogxK
U2 - 10.1053/j.sart.2023.08.015
DO - 10.1053/j.sart.2023.08.015
M3 - Article
AN - SCOPUS:85188217588
SN - 1045-4527
VL - 34
SP - 283
EP - 289
JO - Seminars in Arthroplasty
JF - Seminars in Arthroplasty
IS - 2
ER -