Functional and radiographic outcomes of reverse shoulder arthroplasty with a minimum follow-up of 10 years

Thibault Lafosse; Arno A Macken; Geoffroi Lallemand; Giovanni Caruso; Geert A Buijze; Laurent Lafosse

doi:10.1016/j.jse.2023.09.015

Functional and radiographic outcomes of reverse shoulder arthroplasty with a minimum follow-up of 10 years

J Shoulder Elbow Surg. 2023 Oct 20:S1058-2746(23)00740-1. doi: 10.1016/j.jse.2023.09.015. Online ahead of print.

Authors

Thibault Lafosse¹, Arno A Macken², Geoffroi Lallemand³, Giovanni Caruso⁴, Geert A Buijze⁵, Laurent Lafosse¹

Affiliations

¹ Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France.
² Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France; Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands. Electronic address: Arnomacken@gmail.com.
³ Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France; Department of Orthopaedics and Traumatology, Hôpital Riviera-Chablais (HRC), Vaud-Valais, Switzerland.
⁴ Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France; Shoulder Unit, Koelliker Hospital, Turin, Italy.
⁵ Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France; Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Orthopedic Surgery, Montpellier University Medical Center, Lapeyronie Hospital, University of Montpellier, Montpellier, France.

PMID: 37866752
DOI: 10.1016/j.jse.2023.09.015

Abstract

Background: The use of reverse shoulder arthroplasty (RSA) is becoming increasingly prevalent. However, few studies have been published reporting the long-term outcomes of RSA. This study aims to report the clinical, radiographic, and patient-reported outcomes of the Delta Xtend reverse shoulder prosthesis, performed by a single surgeon and with a minimum follow-up of 10 years.

Methods: All RSA procedures performed between 2005 and 2012 were identified. Patients were contacted and invited for a follow-up visit including clinical assessment, radiographs, and patient-reported outcome measures. Patients with a follow-up of less than 10 years were excluded. The revision-free implant survival was calculated at 10 years. Between 2005 and 2012, 119 procedures in 116 patients meeting inclusion criteria were identified. Of these patients, 35 were deceased before reaching the 10-year follow-up and 23 could not be reached. In total, 63 RSAs could be included in 61 patients (response rate: 75%). The median follow-up was 11.7 years (interquartile range [IQR]: 10.5-13.2).

Results: Of the 61 patients, 7 patients underwent a revision after a median of 3 years (IQR: 0.2-9.8) during the total follow-up period. The 10-year implant survival was 94% (95% confidence interval: 84-98). At final follow-up, the median anterior elevation was 135° (IQR: 130°-160°), the median abduction was 120° (IQR: 100°-135°), and the median level reached with internal rotation was L5 (IQR: sacrum-L5). The median Auto-Constant score was 68 (IQR: 53-78), the median Subjective Shoulder Value was 80 (IQR: 70-93), and the median pain score was 0.2/10 (IQR: 0-2). In total, radiographs could be obtained in 25 patients (40%). Scapular notching occurred in 10 patients (40%), which was classified as Sirveaux-Nerot grade IV in 3 patients (12%). Ossification occurred in 10 patients (40%), and stress shielding in 2 patients (8%). Radiolucencies were observed around the humeral component in 24 patients (96%) and around the glenoid component in 13 patients (52%).

Conclusion: The long-term results of RSA with a Delta Xtend prosthesis are favorable, with long-term improvement in range of motion and patient-reported outcome measures, and a satisfactory implant survival rate. Interestingly, the radiographical analysis showed high prevalence of signs associated with loosening, which did not seem to translate to high complication rates or inferior results.

Keywords: Reverse shoulder arthroplasty; long-term; patient-reported outcomes; radiographic outcomes; range of motion; revision; scapular notching; survival.