Clinically significant subscapularis failure after anatomic shoulder arthroplasty: is it worth repairing?

Background: Symptomatic subscapularis (SC) failure after anatomic total shoulder arthroplasty (TSA) is difficult to treat. The purpose of this study was to determine the outcomes of reoperation for SC failure. Methods: All patients undergoing reoperation for SC failure after TSA were identified from a single-institution database. Patients underwent either revision SC repair or revision to reverse shoulder arthroplasty. At a minimum of 1 year after reoperation, complications, reoperations, and functional outcomes were collected. Results: Patients who initially underwent SC repair were significantly younger than patients who underwent revision to reverse shoulder arthroplasty (mean age, 59.3 years vs. 70.3 years; P = .004), had a better comorbidity profile (mean Charlson Comorbidity Index, 2.2 vs. 3.6; P = .04), and had a more acute presentation (mean time between injury and surgery, 9.1 weeks vs. 28.5 weeks; P = .03). Patients who underwent SC repair also had a significantly higher reoperation rate (52.9% vs. 0.0%, P = .01). At final follow-up, functional outcomes scores and patient satisfaction rates were not significantly different between treatment groups. Discussion: Decision making on how to treat patients with SC failure following TSA remains challenging and should be individualized to the patient's age, level of activity, comorbidities, timing and mechanism of SC failure, and functional expectations.