Reverse total shoulder arthroplasty for patients with preserved active elevation and moderate-to-severe pain: a matched cohort study

M Tyrrell Burrus; Patrick J Denard; Evan Lederman; Reuben Gobezie; Brian C Werner

doi:10.1016/j.jseint.2021.10.004

Reverse total shoulder arthroplasty for patients with preserved active elevation and moderate-to-severe pain: a matched cohort study

JSES Int. 2021 Nov 19;6(1):1-6. doi: 10.1016/j.jseint.2021.10.004. eCollection 2022 Jan.

Authors

M Tyrrell Burrus¹, Patrick J Denard², Evan Lederman³, Reuben Gobezie⁴, Brian C Werner⁵

Affiliations

¹ Orthopaedic Associates of Central Texas, Austin, TX, USA.
² Southern Oregon Orthopedics, Medford, OR, USA.
³ Banner Health, Phoenix, AZ, USA.
⁴ The Cleveland Shoulder Institute, Beachwood, OH, USA.
⁵ Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.

Abstract

Background: Patients undergoing reverse total shoulder arthroplasty (RTSA) predictably report reduced pain and improved function postoperatively. However, it is not known if patients with differing preoperative active motion achieve the same benefit after surgery. The purpose of the present study is to evaluate patient-reported outcomes (PROs), range of motion (ROM), and satisfaction after RTSA in patients with moderate-to-severe pain with preserved active preoperative ROM compared with matched controls with restricted preoperative active ROM.

Methods: A multicenter shoulder arthroplasty registry was utilized to identify patients with at least two-year clinical follow-up after RTSA with a 135° implant. The study cohort with preserved motion included patients with greater than one standard deviation above the overall mean for preoperative forward elevation (FE) (140°) as well as a preoperative visual analog pain scale (VAS) ≥ 5.0. The control cohort with more restricted motion had preoperative FE of less than 140° and also with preoperative VAS ≥5.0. The control patients were matched 2:1 to study patients by age (±2 years), sex, and preoperative VAS (±1.5). Outcomes measured were as follows: PROs, ROM, strength, and strength and satisfaction.

Results: Twenty-seven patients were identified that comprised the preserved preoperative FE study cohort; 54 patients were included in the restricted elevation cohort as controls. The groups were similar at baseline for demographics, surgical diagnoses, and most PROs, other than the Constant-Murley, which was higher in the preserved motion cohort. At two years postoperatively, both cohorts demonstrated similar PROs, strength, and ROM (other than internal rotation with the arm abducted 90 degrees) and had a similar number of patients who rated the RTSA as meeting or exceeding their expectations. The change in ROM from preoperatively was significantly different with the restricted cohort, achieving a larger increase in forward flexion (51 ± 26° vs. -13 ± 35°, P < .001).

Conclusion: Patients indicated for RTSA with preserved preoperative FE and moderate pain achieve similar final ROM, pain reduction, increases, and strength compared with patients who undergo RTSA with restricted preoperative FE. Despite losing on average 13 degrees of FE from preoperatively by two years postoperatively, patients with preserved preoperative FE are comparably satisfied with their outcome.

Keywords: Glenohumeral arthritis; Pain; Reverse shoulder arthroplasty; Rotator cuff arthropathy; Shoulder motion.