Abstract
Purpose of Review
Reverse total shoulder arthroplasty (RTSA) is a procedure that has been increasingly utilized since its inception over 20 years ago. The purpose of this review is to present the most up to date practice and advances to the RTSA literature from the last 5 years.
Recent Findings
Recent literature on RTSA has focused on identifying complications, maximizing outcomes, and determining its cost-effectiveness. RTSA has become a valuable tool in the treatment of various shoulder pathologies from fractures to massive-irreparable rotator cuff tears. Maximizing outcomes, proper patient counseling, and limiting complications are vital to a successful procedure.
Summary
RTSA can be a difficult procedure; however, when utilized appropriately, it can be an invaluable tool in the orthopedic surgeon’s armament. Recent evidence suggests, more and more, that RTSA not only provides value to the patient, but it is also cost-effective.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
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• Torrens C, Marí R, Alier A, Puig L, Santana F, Corvec S. Cutibacterium acnes in primary reverse shoulder arthroplasty: from skin to deep layers. J Shoulder Elbow Surg. 2019;28(5):839–46. https://doi.org/10.1016/j.jse.2018.10.016Cultures were taken from primary RTSA patients with no previous surgical history.C. acnesisolated in cultures from 18.8% (17/90) of patients after taking a total of 1080 cultures from skin and dermis, and after implant placement; 5.7% (62/1080) of all cultures positive forC. acnesshow difficulty in isolatingC. acnes. Of patients with positive cultures, 35% (22/62) were positive before implant placement and 65% (40/62) were culture positive after implants.
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Chalmers PN, Beck L, Stertz I, Tashjian RZ. Hydrogen peroxide skin preparation reduces Cutibacterium acnes in shoulder arthroplasty: a prospective, blinded, controlled trial. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.03.038.
• Steinhaus ME, Gowd AK, Hurwit DJ, Lieber AC, Liu JN. Return to work after shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2019;28(5):998–1008. https://doi.org/10.1016/j.jse.2018.12.011A systematic review and meta-analysis of patients undergoing shoulder arthroplasty in general. Compared return-to-work (RTW) outcomes for TSA, RTSA, and HA. Overall RTW was 63.6% at an average of 2.3 months post-op. RTW was lower for heavy intensity occupations, and no differences were found in the RTW status between TSA and RTSA.
Garcia GH, Taylor SA, Mahony GT, DePalma BJ, Grawe BM, Nguyen J, et al. Reverse total shoulder arthroplasty and work-related outcomes. Orthopedics. 2016;39(2):e230–5. https://doi.org/10.3928/01477447-20160119-03.
Hurwit DJ, Liu JN, Garcia GH, Mahony G, Wu HH, Dines DM, et al. A comparative analysis of work-related outcomes after humeral hemiarthroplasty and reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(6):954–9. https://doi.org/10.1016/j.jse.2016.10.004.
Liu JN, Steinhaus ME, Garcia GH, Chang B, Fields K, Dines DM, et al. Return to sport after shoulder arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):100–12. https://doi.org/10.1007/s00167-017-4547-1.
Simovitch RW, Gerard BK, Brees JA, Fullick R, Kearse JC. Outcomes of reverse total shoulder arthroplasty in a senior athletic population. J Shoulder Elbow Surg. 2015;24(9):1481–5. https://doi.org/10.1016/j.jse.2015.03.011.
Johnson CC, Johnson DJ, Liu JN, Dines JS, Dines DM, Gulotta LV, et al. Return to sports after shoulder arthroplasty. World J Orthop. 2016;7(9):519–26. https://doi.org/10.5312/wjo.v7.i9.519.
Fink Barnes LA, Grantham WJ, Meadows MC, Bigliani LU, Levine WN, Ahmad CS. Sports activity after reverse total shoulder arthroplasty with minimum 2-year follow-up. Am J Orthop. 2015;44(2):68–72 (This article does not have a DOI).
Simovitch RW, Friedman RJ, Cheung EV, Flurin PH, Wright T, Zuckerman JD, et al. Rate of improvement in clinical outcomes with anatomic and reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2017;99(21):1801–11. https://doi.org/10.2106/JBJS.16.01387.
• Cabarcas BC, Gowd AK, Liu JN, Cvetanovich GL, Erickson BJ, Romeo AA, et al. Establishing maximum medical improvement following reverse total shoulder arthroplasty for rotator cuff deficiency. J Shoulder Elbow Surg. 2018;27(9):1721–31. https://doi.org/10.1016/j.jse.2018.05.029A systematic review establishing maximum medical improvement (MMI) for RTSA. MMI was found to be, on average, achieved at 1 year. No significant improvements were found past 1 year. Range of motion and passive range of motion improved up to 1 year, but no significant improvement was found afterwards.
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Chalmers PN, Kahn T, Broschinsky K, Ross H, Stertz I, Nelson R, et al. An analysis of costs associated with shoulder arthroplasty. J Shoulder Elbow Surg. 2019;28(7):1334–40. https://doi.org/10.1016/j.jse.2018.11.065.
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• Makhni EC, Swart E, Steinhaus ME, Mather RC, Levine WN, Bach BR, et al. Cost-effectiveness of reverse total shoulder arthroplasty versus arthroscopic rotator cuff repair for symptomatic large and massive rotator cuff tears. Arthroscopy. 2016;32(9):1771–80. https://doi.org/10.1016/j.arthro.2016.01.063Both RTSA and RCR were found to be superior to non-op care; RTSA = $15.5k/quality adjusted life year (QALY); RCR = $37.4k/QALY. Cost analysis favored RCR over RTSA due to lower costs and slightly improved outcomes. RCR was the preferred strategy as long as lifetime progression to cuff arthropathy was < 89%. Concluded that RCR is the more cost-effective initial strategy over primary RTSA; however, in the presence of previous failed cuff with poor tissue, RTSA is a better choice.
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Dr. Stephen Thon declares that he has no conflict of interest.
Dr. Adam Seidl reports personal fees from DJO and from Medacta, outside the submitted work.
Dr. Jonathan Bravman reports other from DJO, Smith & Nephew, Shukla Medical, and null, outside the submitted work.
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Dr. Rachel Frank declares that she has no conflict of interest.
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Thon, S.G., Seidl, A.J., Bravman, J.T. et al. Advances and Update on Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 13, 11–19 (2020). https://doi.org/10.1007/s12178-019-09582-2
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DOI: https://doi.org/10.1007/s12178-019-09582-2