Influence of Preoperative Diagnosis on Short-term Outcomes Following Reverse Total Shoulder Arthroplasty

Abstract

Reverse Total Shoulder Arthroplasty (RTSA) was initially employed exclusively for elderly, low-demand patients experiencing advanced rotator cuff tear arthropathy. Due to its encouraging results in these instances, the indication for this surgical procedure has expanded considerably to include a variety of preoperative shoulder conditions. It is being increasingly utilised as an effective intervention for the management of irreparable rotator cuff injuries, glenohumeral osteoarthritis in patients with an intact rotator cuff, acute proximal humerus fractures, complications stemming from proximal humerus fractures, tumours involving the proximal humerus, inflammatory joint diseases, young patients, and cases of unsuccessful anatomic total shoulder arthroplasty or hemiarthroplasty. This study aimed to analyse the one- year outcomes of patients undergoing RTSA for various indications at a single institution, explicitly focusing on pain relief, range of motion, and patient-reported outcome measures. We hypothesised that the preoperative aetiology would significantly influence the results. Methodology Our study was a retrospective analysis of patient records, surgical registry, and mortality reports of all patients who underwent shoulder arthroplasties at Chris Hani Baragwanath Academic Hospital (CHBAH) between 01 January 2019 and 31 December 2022. The documented functional outcomes were evaluated for objective and subjective parameters using the American Shoulder and Elbow Surgeons Score (ASES), Visual Analogue Score (VAS), and range of motion, focusing primarily on the preoperative assessment and the assessment performed at one-year follow-up. Results In 77 shoulders, RTSA was performed for rotator cuff arthropathy (n = 32), primary osteoarthritis (n = 18), avascular necrosis of the humeral head (n = 7), massive irreparable cuff tear (n = 6), rheumatoid arthritis (n = 4), failed rotator cuff repair (n = 4), chronic locked dislocation (n = 2), sequelae of proximal humerus fracture (n = 2) and revision arthroplasty (n = 2). The mean subjective pain scores in the overall series decreased from 8 preoperatively to 1.8 at the one-year follow-up. The average preoperative ASES score was 40 and improved to a mean of 70 points at 12 months. The shoulder diagnosis was not a significant predictor of the change in the VAS score or ASES scores. Patients with Rotator Cuff Arthropathy (RCA) iv achieved the most superior results in the categories of active shoulder abduction, forward flexion, and external rotation compared to other aetiological groups analysed 12 months after surgery. Conclusion The range of forward flexion and abduction motion, pain relief, and functionality were improved after RTSA across all aetiological groups, with the most favourable results seen for the diagnosis of RCA and the least advantageous results in primary osteoarthritis. This research report highlights the importance of recognising that the impact of preoperative diagnosis on the outcomes of RTSA is crucial for clinicians. This understanding not only enhances preoperative risk stratification but also plays a vital role in aligning patient expectations with potential surgical results.