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Description
The annual rate of primary total shoulder arthroplasty (TSA) continues to increase, along with the consequent need for revision surgery.1 Although anatomic TSA (aTSA) has historically been the procedure of choice for patients with primary rotator cuff-intact glenohumeral osteoarthritis (RCI-GHOA), reverse TSA (rTSA) is increasingly used in this patient population due to historically high failure rates of aTSA, most commonly due to glenoid loosening (20% of failures) or rotator cuff failure (15% of failures).2,3 In these circumstances, revision to rTSA is often performed because it is not reliant on an intact rotator cuff for stability and achieves superior glenoid component fixation.
Despite historical concerns about the durability of aTSA,4,5 many surgeons still advocate for performing primary aTSA because it confers superior rotational range of motion (ROM)6 and does not have the increased risk of periscapular fractures and brachial plexus injury that constitute rare but devastating complications of rTSA.2 Although advancements in aTSA glenoid component design and implantation technique may eventually reduce their failure, our understanding of the natural history of rotator cuff disease suggests that rotator cuff failure will continue to be unpreventable in a subset of aTSA patients. Furthermore, it is currently unclear whether a well-performed modern primary rTSA has the potential durability to last a lifetime in young patients. Interest has grown in improving our ability to revise a failed aTSA to rTSA. However, it is unclear whether patients who undergo revision to rTSA after aTSA failure performed initially for RCI-GHOA would have ultimately achieved a better outcome by undergoing primary rTSA.
We sought to investigate whether patients with RCI-GHOA who initially underwent aTSA and were subsequently revised to rTSA due to rotator cuff failure or glenoid loosening ultimately attained a similar clinical outcome compared with patients who underwent a primary rTSA. We hypothesized that patients who required revision to rTSA would have poorer pain and functional outcomes compared with patients who underwent primary rTSA when compared at equal follow-up from the index arthroplasty. Secondarily, we evaluated for predictors of a poor outcome after revision rTSA in our cohort.
Learning Objectives
- Describe the common causes of anatomic total shoulder arthroplasty (aTSA) failure, including glenoid loosening and rotator cuff failure, and their implications for revision surgery.
- Compare the pain relief and functional outcomes of revision reverse shoulder arthroplasty (rTSA) following failed aTSA with those of primary rTSA in patients with rotator cuff–intact glenohumeral osteoarthritis (RCI-GHOA).
- Discuss the advantages and limitations of aTSA versus rTSA as initial surgical choices, including risks, durability, and functional range of motion considerations.
- Identify potential predictors of poor outcomes following revision rTSA after failed aTSA.
- Evaluate the surgical decision-making process for selecting primary versus revision rTSA in the context of patient age, rotator cuff integrity, and anticipated implant longevity
Director
Christopher Klifto, MD, FAAOS
Faculty
Kevin Hao, MD, Trevor G. Simcox, MD, Keegan M. Hones, MD, MS, Jonathan O. Wright, MD, BS, FAAOS, Thomas W. Wright, MD, FAAOS, Tyler LaMonica, MS, ATC, LAT, Bradley Schoch, MD, FAAOS
The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
If you are unable to attend the live webinar, you may still register to be notified upon the availability of the recorded session. Access to the recording will be granted for a duration of 2 years.