Reverse Total Shoulder Arthroplasty in Patients >60 Years of Age With Rotator Cuff Tear Arthropathy. Short-Term Outcomes and Complications
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Published:
Dec 16, 2021
Keywords:
Lateralized reverse arthroplasty, rotator cuff arthropathy, shoulder arthroplasty
Main Article Content
Abstract
Background: The purpose of this study is to show the short-term results and complications in a series of patients >60 who underwent a reverse arthroplasty for the treatment of rotator cuff arthropathy in a high complexity hospital.
Materials and Methods: We retrospectively analyzed our Service’s database to identify patients with rotator cuff arthropathy who had undergone a reverse shoulder arthroplasty between 2015 and 2019. Inclusion criteria: 60 years of age or older, functional deltoid, at least one year of follow-up. The range of motion was measured pre and postoperatively in flexion, external rotation, and internal rotation, as well as Constant score and visual analog scale for pain. The grade of arthritis, scapular notching, and prosthetic looseningwas radiographically assessed. We identified complications, satisfaction, and prosthesis survivorship.
Results: Forty shoulders in 38 patients of 72 years of age on average (61-91) underwent reverse shoulder arthroplasty, with 25 months of follow-up. Flexion increased from 82.86° to 136.71° (p<0,001), external rotation went from 16.59° to 32.11° (p<0,001), and internal rotation from L5 to L3 (p<0,001). Constant score rose from 28.25 to 69.97 (p<0,001) and visual analog scale for pain decreased from 8.34 to 1.26 (p<0,001). The complication rate was 12.5% and a 97.4% prosthesis survivorship was registered.
Conclusions: We believe that reverse shoulder arthroplasty represents an excellent option in the treatment of rotator cuff arthropathy in patients older than 60 in view of the satisfactory functional outcomes with an acceptable complication rate.
Materials and Methods: We retrospectively analyzed our Service’s database to identify patients with rotator cuff arthropathy who had undergone a reverse shoulder arthroplasty between 2015 and 2019. Inclusion criteria: 60 years of age or older, functional deltoid, at least one year of follow-up. The range of motion was measured pre and postoperatively in flexion, external rotation, and internal rotation, as well as Constant score and visual analog scale for pain. The grade of arthritis, scapular notching, and prosthetic looseningwas radiographically assessed. We identified complications, satisfaction, and prosthesis survivorship.
Results: Forty shoulders in 38 patients of 72 years of age on average (61-91) underwent reverse shoulder arthroplasty, with 25 months of follow-up. Flexion increased from 82.86° to 136.71° (p<0,001), external rotation went from 16.59° to 32.11° (p<0,001), and internal rotation from L5 to L3 (p<0,001). Constant score rose from 28.25 to 69.97 (p<0,001) and visual analog scale for pain decreased from 8.34 to 1.26 (p<0,001). The complication rate was 12.5% and a 97.4% prosthesis survivorship was registered.
Conclusions: We believe that reverse shoulder arthroplasty represents an excellent option in the treatment of rotator cuff arthropathy in patients older than 60 in view of the satisfactory functional outcomes with an acceptable complication rate.
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Gómez, D., Dainotto, T., Viollaz, G., Teruya, G., Tedeschi, A., Durán, R., & Muratore, Álvaro. (2021). Reverse Total Shoulder Arthroplasty in Patients >60 Years of Age With Rotator Cuff Tear Arthropathy. Short-Term Outcomes and Complications. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(6), 780-789. https://doi.org/10.15417/issn.1852-7434.2021.86.6.1209
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Clinical Research
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References
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2. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and
biomechanics. J Shoulder Elbow Surg 2005;14(1 Suppl.):S147-S61. https://doi.org/10.1016/j.jse.2009.03.011
3. Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff
deficiency. J Bone Joint Surg Am 2008;90(6):1244-51. https://doi.org/10.2106/JBJS.G.00775
4. Giráldez EÁ, Gavilán F. Efectividad y seguridad de las prótesis invertidas de hombro en artropatía del manguito rotador. Revisión sistemática de la literatura y criterios de uso adecuado.En: Informes, estudios e investigación. Ministerio de Sanidad, Servicios Sociales e Igualdad. Serie: Informes de Evaluación de Tecnologías Sanitarias. Agencia de Evaluación de Tecnologías Sanitarias de Andalucía. Disponible en:
https://www.aetsa.org/download/publicaciones/antiguas/AETSA_2011_12_ProtesisInvertida.pdf
5. Chawla H, Gamradt S. Reverse total shoulder arthroplasty: technique, decision-making and exposure tips. Curr Rev Musculoskelet Med 2020;13(2):180-5. https://doi.org/10.1007/s12178-020-09613-3
6. Constant CR, Murley AHG. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res
1987(214):160-4. PMID: 3791738
7. Bertona Altieri BA, Rossi L, Oñativia JI, Tanoira I, Bongiovanni SL, Maignon G, et al. Resultados a corto plazo de
la prótesis inversa de hombro según la patología. Rev Asoc Argentina Ortop Traumatol 2017;82(4):278-86.
https://doi.org/10.15417/683
8. Petrillo S, Longo UG, Papalia R, Denaro V. Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review. Musculoskelet Surg 2017;101(2):105-12.
https://doi.org/10.1007/s12306-017-0474-z
9. Wiater JM, Moravek JE, Budge MD, Koueiter DM, Marcantonio D, Wiater BP. Clinical and radiographic results of
cementless reverse total shoulder arthroplasty: A comparative study with 2 to 5years of follow-up. J Shoulder Elbow Surg 2014;23(8):1208-14. http://doi.org/10.1016/j.jse.2013.11.032
10. Bacle G, Nové-Josserand L, Garaud P, Walch G. Long-term outcomes of reverse total shoulder arthroplasty. J Bone Joint Surg Am 2017;99(6):454-61. http://doi.org/10.2106/JBJS.16.00223
11. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D. Grammont inverted total shoulder arthroplasty in
the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004;86(3):388-95. https://doi.org/10.1302/0301-620x.86b3.14024
12. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: Results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 2006;15:527-40. https://doi.org/10.1016/j.jse.2006.01.003
13. Zumstein M, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total
shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg 2011;20(1):146-57.
https://doi.org/10.1016/j.jse.2010.08.001
14. Bitzer A, Rojas J, Patten I, Joseph J, McFarland E. Incidence and risk factors for aseptic baseplate loosening of
reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2018;(12):2145-52. https://doi.org/10.1016/j.jse.2018.05.034
15. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics1992;16(1):65-8.
PMID: 8421661
16. Greene WB, Heckman JD. The shoulder. En: The clinical measurement of joint motion. Rosemont: American
Academy Orthopaedic Surgeons; 1994:15-26.
17. Hislop HJ, Avers D, Brown M. Daniels y Worthingham. Técnicas de balance muscular, 9a
ed. Philadelphia: Elsevier; 2014.
18. Huskisson EC. Measurement for pain. Lancet 1974;2(7889):1127-31. https://doi.org/10.1016/s0140-6736(74)90884-8
19. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A longterm observation. Clin Orthop Relat Res 1990;(254):92-6. https://doi.org/10.1097/00003086-199005000-00014
20. Sperling JW, Cofield RH, O’Driscoll SW, Torchia ME, Rowland CM. Radiographic assessment of ingrowth total
shoulder arthroplasty. J Shoulder Elbow Surg 2000;9(6):507-13. https://doi.org/10.1067/mse.2000.109384
21. Cuff D, Clark R, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency: a concise follow-up, at a minimum of five years, of a previous report. J Bone Joint Surg Am 2012;94(21):1996-2000. https://doi.org/10.2106/JBJS.K.01206
22. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty. Survivorship
analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 2006;(8):1742-7.
https://doi.org/10.2106/JBJS.E.00851
23. Nolan BM, Ankerson E, Wiater MJ. Reverse total shoulder arthroplasty improves function in cuff tear arthropathy. Clin Orthop Relat Res 2011;469(9):2476-82. https://doi.org/10.1007/s11999-010-1683-z
24. Valenti P, Sauzières P, Katz D, Kalouche I, Kilinc AS. Do less medialized reverse shoulder prostheses increase
motion and reduce notching? Clin Orthop Relat Res 2011;469(9):2550-7. https://doi.org/10.1007/s11999-011-1844-8
25. Cheung E, Sarkissian E, Sox-Harris A, Comer G, Saleh J, Diaz R, Costouros J. Instability after reverse total
shoulder Arthroplasty. J Shoulder Elbow Surg 2018,(11):1946-52. https://doi.org/10.1016/j.jse.2018.04.015
26. García-Fernández C, Lópiz-Morales Y, Rodríguez A, López-Durán L, Martínez FM. Periprosthetic humeral fractures associated with reverse total shoulder arthroplasty: incidence and management. Int Orthop 2015;(10):1965-9. https://doi.org/10.1007/s00264-015-2972-7
27. Chuinard C, Trojani C, Brassart N BP. Humeral problems in reverse shoulder arthroplasty. En: Walch G, Boileau P, Molé D, et al (eds.) Reverse shoulder arthroplasty. Clinical results, complications, revisions. Montpellier, France: Sauramps Medical; 2006:275-88. https://doi.org/10.1007/978-3-030-19285-3
28. Walch G, Mottier F, Wall B, Boileau P, Molé D, Favard L. Acromial insufficiency in reverse shoulder arthroplasties. J Shoulder Elbow Surg 2009;18(3):495-50. https://doi.org/10.1016/j.jse.2008.12.002
2. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and
biomechanics. J Shoulder Elbow Surg 2005;14(1 Suppl.):S147-S61. https://doi.org/10.1016/j.jse.2009.03.011
3. Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff
deficiency. J Bone Joint Surg Am 2008;90(6):1244-51. https://doi.org/10.2106/JBJS.G.00775
4. Giráldez EÁ, Gavilán F. Efectividad y seguridad de las prótesis invertidas de hombro en artropatía del manguito rotador. Revisión sistemática de la literatura y criterios de uso adecuado.En: Informes, estudios e investigación. Ministerio de Sanidad, Servicios Sociales e Igualdad. Serie: Informes de Evaluación de Tecnologías Sanitarias. Agencia de Evaluación de Tecnologías Sanitarias de Andalucía. Disponible en:
https://www.aetsa.org/download/publicaciones/antiguas/AETSA_2011_12_ProtesisInvertida.pdf
5. Chawla H, Gamradt S. Reverse total shoulder arthroplasty: technique, decision-making and exposure tips. Curr Rev Musculoskelet Med 2020;13(2):180-5. https://doi.org/10.1007/s12178-020-09613-3
6. Constant CR, Murley AHG. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res
1987(214):160-4. PMID: 3791738
7. Bertona Altieri BA, Rossi L, Oñativia JI, Tanoira I, Bongiovanni SL, Maignon G, et al. Resultados a corto plazo de
la prótesis inversa de hombro según la patología. Rev Asoc Argentina Ortop Traumatol 2017;82(4):278-86.
https://doi.org/10.15417/683
8. Petrillo S, Longo UG, Papalia R, Denaro V. Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review. Musculoskelet Surg 2017;101(2):105-12.
https://doi.org/10.1007/s12306-017-0474-z
9. Wiater JM, Moravek JE, Budge MD, Koueiter DM, Marcantonio D, Wiater BP. Clinical and radiographic results of
cementless reverse total shoulder arthroplasty: A comparative study with 2 to 5years of follow-up. J Shoulder Elbow Surg 2014;23(8):1208-14. http://doi.org/10.1016/j.jse.2013.11.032
10. Bacle G, Nové-Josserand L, Garaud P, Walch G. Long-term outcomes of reverse total shoulder arthroplasty. J Bone Joint Surg Am 2017;99(6):454-61. http://doi.org/10.2106/JBJS.16.00223
11. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D. Grammont inverted total shoulder arthroplasty in
the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004;86(3):388-95. https://doi.org/10.1302/0301-620x.86b3.14024
12. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: Results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 2006;15:527-40. https://doi.org/10.1016/j.jse.2006.01.003
13. Zumstein M, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total
shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg 2011;20(1):146-57.
https://doi.org/10.1016/j.jse.2010.08.001
14. Bitzer A, Rojas J, Patten I, Joseph J, McFarland E. Incidence and risk factors for aseptic baseplate loosening of
reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2018;(12):2145-52. https://doi.org/10.1016/j.jse.2018.05.034
15. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics1992;16(1):65-8.
PMID: 8421661
16. Greene WB, Heckman JD. The shoulder. En: The clinical measurement of joint motion. Rosemont: American
Academy Orthopaedic Surgeons; 1994:15-26.
17. Hislop HJ, Avers D, Brown M. Daniels y Worthingham. Técnicas de balance muscular, 9a
ed. Philadelphia: Elsevier; 2014.
18. Huskisson EC. Measurement for pain. Lancet 1974;2(7889):1127-31. https://doi.org/10.1016/s0140-6736(74)90884-8
19. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A longterm observation. Clin Orthop Relat Res 1990;(254):92-6. https://doi.org/10.1097/00003086-199005000-00014
20. Sperling JW, Cofield RH, O’Driscoll SW, Torchia ME, Rowland CM. Radiographic assessment of ingrowth total
shoulder arthroplasty. J Shoulder Elbow Surg 2000;9(6):507-13. https://doi.org/10.1067/mse.2000.109384
21. Cuff D, Clark R, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency: a concise follow-up, at a minimum of five years, of a previous report. J Bone Joint Surg Am 2012;94(21):1996-2000. https://doi.org/10.2106/JBJS.K.01206
22. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty. Survivorship
analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 2006;(8):1742-7.
https://doi.org/10.2106/JBJS.E.00851
23. Nolan BM, Ankerson E, Wiater MJ. Reverse total shoulder arthroplasty improves function in cuff tear arthropathy. Clin Orthop Relat Res 2011;469(9):2476-82. https://doi.org/10.1007/s11999-010-1683-z
24. Valenti P, Sauzières P, Katz D, Kalouche I, Kilinc AS. Do less medialized reverse shoulder prostheses increase
motion and reduce notching? Clin Orthop Relat Res 2011;469(9):2550-7. https://doi.org/10.1007/s11999-011-1844-8
25. Cheung E, Sarkissian E, Sox-Harris A, Comer G, Saleh J, Diaz R, Costouros J. Instability after reverse total
shoulder Arthroplasty. J Shoulder Elbow Surg 2018,(11):1946-52. https://doi.org/10.1016/j.jse.2018.04.015
26. García-Fernández C, Lópiz-Morales Y, Rodríguez A, López-Durán L, Martínez FM. Periprosthetic humeral fractures associated with reverse total shoulder arthroplasty: incidence and management. Int Orthop 2015;(10):1965-9. https://doi.org/10.1007/s00264-015-2972-7
27. Chuinard C, Trojani C, Brassart N BP. Humeral problems in reverse shoulder arthroplasty. En: Walch G, Boileau P, Molé D, et al (eds.) Reverse shoulder arthroplasty. Clinical results, complications, revisions. Montpellier, France: Sauramps Medical; 2006:275-88. https://doi.org/10.1007/978-3-030-19285-3
28. Walch G, Mottier F, Wall B, Boileau P, Molé D, Favard L. Acromial insufficiency in reverse shoulder arthroplasties. J Shoulder Elbow Surg 2009;18(3):495-50. https://doi.org/10.1016/j.jse.2008.12.002