Preoperative diagnosis and rotator cuff status impact functional internal rotation following reverse shoulder arthroplasty

Mahmoud Faisal Adam; Alexandre Lädermann; Patrick J Denard; Felipe Lacerda; Philippe Collin

doi:10.1016/j.jse.2023.11.020

Preoperative diagnosis and rotator cuff status impact functional internal rotation following reverse shoulder arthroplasty

J Shoulder Elbow Surg. 2024 Jan 11:S1058-2746(24)00021-1. doi: 10.1016/j.jse.2023.11.020. Online ahead of print.

Authors

Mahmoud Faisal Adam¹, Alexandre Lädermann², Patrick J Denard³, Felipe Lacerda⁴, Philippe Collin⁵

Affiliations

¹ CHP Saint-Gregoire, Saint-Grégoire, France; Faculty of Medicine, Luxor University, New Tiba City, Egypt. Electronic address: mahmoud.faisal@med.aswu.edu.eg.
² Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
³ Oregon Shoulder Institute, Medford, OR, USA.
⁴ CHP Saint-Gregoire, Saint-Grégoire, France; Orthopedic Center of Barra, Rio de Janeiro, Brazil; Clinica Meta, Rio de Janeiro, Brazil.
⁵ CHP Saint-Gregoire, Saint-Grégoire, France; Clinique Victor Hugo, Paris, France; American Hospital of Paris, Neuilly-sur-Seine, France.

PMID: 38218405
DOI: 10.1016/j.jse.2023.11.020

Abstract

Purpose: This study aimed to evaluate whether functional internal rotation (fIR) following reverse shoulder arthroplasty (RSA) differs based on diagnosis of either: primary osteoarthritis (OA) with intact rotator cuff, massive irreparable rotator cuff tear (MICT) or cuff tear arthropathy (CTA).

Methods: A retrospective review was carried out on RSAs performed by a single surgeon with the same implant over a 5-year period. Minimum 2-year follow-up was available in 235 patients; 139 (59.1%) were female, and the mean patient age was 72 ± 8 years. Additional clinical evaluation included the Subjective Shoulder Value and Constant score. Postoperative internal rotation was categorized as type I: hand to the buttock or hip; type II: hand to the lower lumbar region; or type III: smooth motion to at least the upper lumbar region. Type I was considered "nonfunctional" internal rotation, and type II and III were fIR.

Results: Preoperatively, internal rotation was classified as type I in 60 patients (25.5%), type II in 114 (48.5%), and type III in 62 (26%). Postoperatively, internal rotation was classified as type I in 70 patients (30%), type II in 86 (36%), and type III in 79 (34%). Compared with preoperative status, fIR improved significantly in OA patients (P < .001), with 49 (52.6%) classified as type II or III postoperatively. In CTA patients, there was no significant change (P = .352). In patients with MICTs, there was a significant loss in fIR postoperatively (P = .003), with 25 patients (30.8%) deteriorating to type I after having either type II or III preoperatively, and only 5 patients (6.1%) improving to either type II or III.

Conclusions: Patients who undergo RSA for primary OA have a better chance of postoperative fIR improvement. A decrease in fIR is common after RSA for MICTs.

Keywords: Range of motion; complication; glenohumeral osteoarthritis; massive cuff tears; rotator cuff arthropathy; tendon lesion.