Outcomes Following Revision Reverse Shoulder Arthroplasty for Infection

Payton Yerke Hansen; Clyde Fomunung; Alessia Lavin; Akshay Daji; Garrett R Jackson; Howard Routman; Vani J Sabesan

doi:10.1016/j.jse.2024.02.031

Outcomes Following Revision Reverse Shoulder Arthroplasty for Infection

J Shoulder Elbow Surg. 2024 Apr 8:S1058-2746(24)00233-7. doi: 10.1016/j.jse.2024.02.031. Online ahead of print.

Authors

Payton Yerke Hansen¹, Clyde Fomunung², Alessia Lavin², Akshay Daji³, Garrett R Jackson², Howard Routman³, Vani J Sabesan⁴

Affiliations

¹ Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, FL, USA.
² Palm Beach Shoulder Service Atlantis Orthopaedics, Palm Beach, FL, USA.
³ Palm Beach Shoulder Service Atlantis Orthopaedics, Palm Beach, FL, USA; JFK/University of Miami Orthopedic Surgery Residency Program, Palm Beach, FL, USA.
⁴ Palm Beach Shoulder Service Atlantis Orthopaedics, Palm Beach, FL, USA; JFK/University of Miami Orthopedic Surgery Residency Program, Palm Beach, FL, USA. Electronic address: sabes001@gmail.com.

PMID: 38599457
DOI: 10.1016/j.jse.2024.02.031

Abstract

Background: In comparison to primary reverse shoulder arthroplasty (RSA) procedures, revision arthroplasty can be a longer and more complex procedure leading to an increased risk of complications. The reported rates of infection in primary RSA range from 1% to 19% and the cost impact on patients and healthcare systems is significant, leading to multiple revision surgeries. The purpose of this study was to evaluate the postoperative outcomes, complications, and revision rates for revision reverse shoulder arthroplasty (rRSA) due to infection compared to rRSA for non-infectious causes.

Methods: Patients who underwent rRSA between 2009 and 2020 by a single fellowship-trained orthopedic surgeon at a single institution were retrospectively identified through a prospectively collected database. Patients were separated into two cohorts based on revision diagnosis: (1) rRSA due to infection (rRSAi), and (2) rRSA due to non-infectious causes (rRSAn). Patient-reported outcome scores (PROs), including the Simple Shoulder Test (SST), Constant score, American Shoulder and Elbow Surgeons (ASES) score, University of California-Los Angeles (UCLA), Shoulder Arthroplasty Smart score (SAS), and active range of motion (ROM) were collected preoperatively and at a minimum one year follow-up. Postoperative complications and revision rates were also collected.

Results: A total of 93 patients (n=19 rRSAi group, n=74 rRSAn group) with a mean age of 68 years were included in this analysis. All baseline demographics were comparable between groups. No significant differences were found in preoperative or postoperative PROs and ROM between the two groups. Postoperative complication rates and revision rates were comparable between the groups.

Conclusion: Revision reverse shoulder arthroplasty due to infection results in similar patient-reported outcome scores, range of motion, and revision rates when compared to rRSA for non-infectious causes. Our results suggest that despite the unique challenges associated with rRSA for infection, patient outcomes do not differ from cases attributed to non-infectious causes. Further efforts are warranted to further validate and contextualize these findings, considering the protentional influence of patient-specific and implant-specific factors.