Clinical outcomes of revision to anatomic total shoulder arthroplasty

Ben Zmistowski, Justin Rabinowitz, Alexander W. Aleem, Aaron M. Chamberlain, Jay D. Keener

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)283-289
Number of pages7
JournalSeminars in Arthroplasty
Volume34
Issue number2
DOIs
StateAccepted/In press - 2024

Keywords

  • Anatomic
  • Anatomic revision
  • Failed shoulder arthroplasty
  • Hemiarthoplasty
  • Level IV
  • Retrospective Case Series
  • Revision
  • Shoulder arthroplasty

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