Abstract
Purpose
The purpose of this multi-centre study was to report outcomes of a large cohort of reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years and to determine patient and surgical factors that influence postoperative outcomes. The hypothesis was that surgical indication, surgical approach, and implant design would affect clinical outcomes significantly.
Methods
The authors reviewed records of 743 RSAs in patients with primary osteoarthritis (OA) with or without rotator cuff (RC) tears, secondary OA due to RC tears, and irreparable massive rotator cuff tears (mRCT). The deltopectoral (DP) approach was used in 540 and the anterosuperior (AS) approach in 203. Pre- and postoperative Constant scores (CS) were recorded. Multivariable linear analyses were performed to determine if CS was associated with indications for surgery, surgical approach, or implant design.
Results
Of the 743 shoulders, 193 (25.7%) were lost to follow-up, 16 (2.1%) died, and 33 (4.4%) were revised, leaving 501 for analysis. At a mean follow-up of 3.2 ± 0.9 years, net improvement in CS was 29.2 ± 17.0. Multivariable analyses revealed that postoperative CS decreased with age and was worse in shoulders that had preoperative rotator cuff deficiency and in shoulders operated by the AS approach. Multivariable analyses also revealed worse net improvement in shoulders operated for secondary OA due to RC tears or for irreparable mRCT, as well as shoulders operated by the AS approach.
Conclusion
This large multi-centre study confirms that, at two or more years following RSA, Constant scores are not associated with implant design, but rather with rotator cuff deficiency and surgical approach. Multivariable analysis revealed that postoperative CS was worse for shoulders with preoperative rotator cuff deficiency and for shoulders operated by the AS approach. Multivariable analysis also revealed that net improvement in CS was worse in shoulders treated for secondary OA due to RC tears and for shoulders with irreparable mRCT, as well as for shoulders operated by the AS approach.
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Acknowledgements
The authors are grateful to “GCS Ramsay Santé pour lʼEnseignement et la Recherche” for funding the statistical analysis and manuscript preparation for this study.
Contributors of ReSurg
Jacobus H Müller, MSc, PhD1
Aude Hibon, MEng1
Luca Nover, MSc1
1ReSurg SA, 1260 Nyon, Switzerland
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AG, CN, MG, NB, JK, SoFEC, LNJ, PC: conceptualization, investigation, resources, supervision
ReSurg: data curation, formal analysis, writing–original draft
MS: methodology, writing–review and editing, project administration
PC: funding acquisition
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Arnaud Godenèche reports fees from Tornier SAS outside of the submitted work.
Cécile Nérot reports royalties from DePuy Synthes outside the submitted work.
Mathieu Girard has nothing to disclose.
Nicolas Bonnevialle reports personal fees from Stryker and Conmed outside the submitted work.
Jean Kany has nothing to disclose.
SoFEC has nothing to disclose.
Jacobus Muller, Aude Hibon, and Luca Nover (contributors to ReSurg) have nothing to disclose.
Mo Saffarini has nothing to disclose.
Laurent Nove-Josserand is a consultant and receives royalties from 3S Ortho.
Philippe Collotte is a consultant and receives royalties from 3S Ortho.
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SoFEC-French Shoulder and Elbow Society, Paris, France
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Godenèche, A., Nérot, C., Girard, M. et al. Reverse shoulder arthroplasty renders better clinical scores at a minimum follow-up of two years for patients with no rotator cuff deficiency operated by the deltopectoral approach. International Orthopaedics (SICOT) 47, 2285–2293 (2023). https://doi.org/10.1007/s00264-023-05872-0
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DOI: https://doi.org/10.1007/s00264-023-05872-0