Can the reverse total shoulder arthroplasty provide as good of an outcome as an anatomic shoulder arthroplasty

BackgroundReverse total shoulder arthroplasty (RTSA) is an excellent treatment option for a variety of shoulder pathologies. Anatomic total shoulder arthroplasty (TSA) remains an excellent treatment for patients with glenohumeral arthritis and a functioning rotator cuff. RTSA has become a much more common procedure than TSA in recent times. It is currently unclear if patients who have a good outcome following TSA outperform patients who have a good outcome following RTSA. The purpose of this study was to compare the 2-year outcomes of patients with good outcomes, defined as having forward flexion of >130° and American Shoulder and Elbow Surgeons score of >70, following TSA and RTSA.MethodsAll patients who underwent TSA or RTSA between 2015 and 2019 with minimum 2-year follow-up were eligible for inclusion. Patients were included if their postoperative forward flexion was >130° and American Shoulder and Elbow Surgeons score was >70. Patients were excluded if they were a revision surgery, were treated with an arthroplasty for fracture, or had a latissimus transfer. Demographic variables were analyzed between groups. Range of motion (ROM), strength, and patient-reported outcome (PRO) scores were compared between groups.ResultsOverall, 318 TSAs were included; 155 (49%) met the criteria for a “good” outcome. Among RTSAs, 428 were included; 154 (36%) met the criteria for a “good” outcome. When comparing PROs between groups, RTSA patients had worse preoperative and postoperative PRO scores (all P < .05). When comparing preoperative physical examination findings, RTSA patients had worse ROM and strength (all P < .05) and worse Constant Power scores and Constant scores (P < .001 in both cases). Postoperatively, RTSA patients had worse ROM and strength (all P < .05) and worse Constant scores (P = .028). The magnitude of change (delta) from preoperative to postoperative function was often greater following RTSA than TSA. There were no significant differences in whether expectations were met or exceeded between RTSA and TSA patients in regards to pain control (99% vs. 98%; P = .177), motion and strength (93% vs. 96%; P = .559), ability to return to activities of daily living (98% vs. 99%; P = .333), or return to sporting activities (95% vs. 91%; P = .268).ConclusionPatients do well following both TSA and RTSA. In patients who have a good outcome following either TSA or RTSA, those patients who underwent TSA have superior outcomes to patients following RTSA. However, the change in outcome scores from pre- to post-surgery is often more significant with RTSA, as they often start out with worse motion and clinical scores.     

Anatomic total shoulder arthroplasty for patients with preserved preoperative motion

BackgroundFor patients with end-stage glenohumeral osteoarthritis, anatomic total shoulder arthroplasty (TSA) serves as a reliable option for pain relief and improving function. It is not well understood if patients with pain due to osteoarthritis but preserved preoperative active range of motion (ROM) experience a similar postoperative benefit compared with those with more pronounced preoperative ROM deficits.MethodsA multicenter shoulder arthroplasty registry was queried to identify all patients who underwent TSA with minimum 2-year clinical follow-up. These patients were separated into two cohorts: (1) preserved preoperative active motion, defined as both forward flexion (FF) and external rotation (ER) at the side a minimum of one standard deviation greater than the mean (>140° FF and >45° ER), and (2) a control group with restrictions in preoperative motion, defined by both preoperative FF < 140° and ER < 45°. Controls were matched 2:1 to study patients by preoperative visual analog pain scale ± 1.5 points, sex, and age ± 2 years. Outcome measures were patient-reported outcomes, active ROM, and strength and satisfaction at a minimum of 2 years postoperatively.ResultsThirty patients were identified in the preserved preoperative motion group (mean baseline 154 ± 10° FF and 57 ± 11° ER). Sixty control patients with restricted motion were matched (mean baseline 97 ± 24° FF and 23 ± 16° ER). There were no significant differences in other baseline patient characteristics other than the Constant-Murley score and strength. At 2-year follow-up, there were no significant differences in visual analog pain scale (0.8 vs. 1.1, P = .446), all patient-reported outcomes, or any ROM measures other than FF which was higher in the preserved group (158 ± 15° vs. 146 ± 19°, P = .003). The change in ROM was significantly higher for all ROM measurements in the restricted motion cohort with restricted preoperative motion compared with study patients. Patients with restricted motion had a significantly greater increase in Constant scores than those with preserved motion (32.6 vs. 19.0, P < .001). There were no significant differences in rates of patients who were satisfied with their surgical result for all domains assessed between groups.ConclusionPatients undergoing TSA with preserved preoperative active ROM can expect similar final pain levels and improvement in pain compared with patients with greater limitations in preoperative ROM. As expected, patients with more restricted preoperative ROM have substantially greater improvement in ROM after TSA. However, there are no differences in satisfaction at 2 years after TSA regardless of preoperative active ROM.Level of evidenceLevel III; Retrospective Cohort Comparison; Treatment Study     

The influence of computed tomography preoperative planning on clinical outcomes after anatomic total shoulder arthroplasty: a matched cohort analysis

BackgroundEvaluation, characterization, and correction of glenoid deformity are an important part of performing anatomic total shoulder arthroplasty (TSA). Three-dimensional computed tomography (3D CT) planning has been shown to improve implant position, but the impact on clinical outcomes is less clear. The purpose of the current study is to compare clinical outcomes of TSA performed with 3D CT preoperative planning with matched controls performed without CT-based planning.MethodsUtilizing a multicenter shoulder arthroplasty registry, patients who underwent a TSA with 2-year clinical follow-up were retrospectively identified. These patients were divided into two cohorts based on technique for glenoid guide pin placement based on surgeon preference: 1) those who utilized 3D preoperative templating with or without patient-specific instrumentation (PSI) and 2) a control group of TSAs performed without 3D CT preoperative planning. The two groups were matched 1:1 based on age, sex, and baseline American Shoulder and Elbow Surgeons (ASES) score. Patient-reported outcomes and active range of motion (ROM) obtained at 2 years postoperatively were assessed and compared between the two cohorts. A subgroup analysis was also performed comparing outcomes in patients with 3D CT preoperative planning with and without PSI.ResultsData collection was performed on 84 study patients with 3D CT preoperative planning (51 with PSI and 33 without) and 84 matched control patients without CT-based planning (168 patients in total). Baseline characteristics were similar between the groups. Improvement from baseline for the ASES score (study group: 45.4, controls: 39.0, P = .029) and external rotation at 90^° of abduction (study group: 42^° vs. 29^°, P = .009) was significantly greater in the CT-based planning group than that in matched controls. There were no other significant differences in improvement in outcomes or ROM between the two groups. Within the 3D CT cohort, there were no significant differences in patient-reported outcomes or ROM between TSAs performed with or without PSI. A significantly greater percentage of patients with 3D CT planning achieved a patient acceptable symptomatic state than controls (89% vs. 75%, P = .016).ConclusionTSAs performed with 3D CT preoperative glenoid planning with or without utilization of PSI were associated with statistically significantly greater improvement from baseline in ASES scores and external rotation at 90^° of abduction than TSA performed without 3D CT planning. The clinical significance of this finding is unclear, as the differences failed to meet a clinically significant threshold.     

Evaluation of alignments that can cause acromion impingement using computed tomography images after reverse total shoulder arthroplasty

Hypothesis and/or BackgroundWe hypothesized that in cases where the distance between the center of rotation and the greater tubercle is longer than that from the center of rotation of the glenosphere to the acromion, acromial impingement may occur, which may affect clinical results. We aimed to investigate the possibility of acromial impingement and its clinical implications using postreverse shoulder arthroplasty computed tomography images, in which the distance from the center of rotation to the acromion and the three-dimensional distance to the greater tuberosity after implant insertion were measured considering the degree of humeral lateralization.MethodsSeventy reverse shoulder arthroplasty cases were performed from April 2018 to April 2020. Of those 70 cases, eight were excluded for fracture. A total of 62 cases (20 males and 42 females; average age at surgery, 77 ± 6.1 years) were included in this study. Measurements were made on postoperative radiographs and computed tomography images for evaluation. Clinical scores, such as range of motion and pain at 1 year after surgery, were evaluated. The distance from the center of rotation to the greater tuberosity and the distance to the acromion were measured; the group with the former less than the latter was evaluated as the risk group for acromial impingement.ResultsFlexion and external rotation abduction were less in the acromial impingement risk group (both P < .001), and no significant difference in external rotation was noted between the groups. There were no complications related to dislocation, infection, or nerve palsy. The group with shorter distance from the center of rotation to the greater tuberosity than the distance to the acromion had zero cases (0%) of acromion fracture, and the risk group had four cases (17.3%) (P = .019).DiscussionThis study showed that the acromial impingement risk group had significantly more acromion fractures. This finding suggests that the collision between the acromion and humerus may be one of the causes of acromion fracture. In this study, height (short stature) and sex (female) were risk factors for acromion impingement.ConclusionsThe clinical implications of the findings were that the angles of forward and lateral elevations were significantly lower in the acromial impingement risk group. Therefore, in patients with larger distance from the center of rotation to the greater tuberosity than the distance to the acromion, decreased forward and lateral elevation angles should be suspected and appropriately managed.     

Outcomes after anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty in patients with long-term disability claims

BackgroundStudies have shown that patients with workers' compensation claims have worse clinical outcomes after various orthopedic procedures. This study aimed to determine the influence of disability status on 2-year clinical outcomes after reverse total shoulder arthroplasty (RTSA) and anatomic total shoulder arthroplasty (ATSA).MethodsReview of an institutional database identified patients on disability with a minimum of 2-year follow-up and compared them to a comorbidity-matched cohort of patients without disability claims. Assessments between patients included preoperative and postoperative Visual Analog Scale (VAS) pain scores, American Shoulder and Elbow Surgeons (ASES) scores, strength, range of motion (ROM), and postoperative complications.ResultsForty-eight shoulders (45 patients) were in the ATSA cohort (24 with disability, 24 without disability) and 46 shoulders (45 patients) in the RTSA cohort (23 with disability, 23 without disability). Patients in the ATSA cohort with disability claims had higher 3-month and 2-year VAS scores (4 vs. 1, P = .003; 4 vs. 1, P = .02, respectively), lower 2-year ASES scores (58 vs. 87, P = .015), and decreased forward elevation ROM and internal rotation ROM (150 vs. 170, P = .017; 60 vs. 62.5, P = .024, respectively) compared to the cohort without disability. Significant differences in baseline values also were noted between cohorts (lower preoperative ASES: 31.7 vs. 40.5, P = .033; higher VAS: 7 vs. 6, P = .03; decreased forward elevation ROM: 90 vs. 110, P = .02). Patients in the RTSA cohort with disability claims had higher 3-month and 2-year VAS (5 vs. 1, P = .02; 3 vs. 0.5, P = .04, respectively) scores than those without claims. The baseline values for the disability cohort with RTSA demonstrated lower ASES (22.1 vs. 43.6, P = .005) and higher VAS (8 vs. 4, P = .004) scores. No significant differences were noted in improvement for the ATSA or RTSA cohorts in any parameter. The ATSA with disability cohort had a higher complication rate (45% vs. 16.6%, P = .0299). No differences were noted in complication rates in the RTSA group.ConclusionPatients who have reported disability status demonstrated worse outcomes after ATSA and RTSA compared to patients without disability claims. However, there was no significant difference in the amount of change in outcomes between groups, indicating that patients on disability can still realize significant improvements after shoulder arthroplasty.     

YouTube is a poor-quality source for patient information on the rehabilitation following total shoulder arthroplasty

BackgroundDespite the ubiquity of health information on YouTube, the quality of the information as it pertains to total shoulder arthroplasty (TSA) rehabilitation is unknown. The purpose of this study is to investigate the quality of information available on YouTube as it pertains to rehabilitation following TSA, including anatomic and reverse TSA.MethodsUtilizing predefined search terms, 480 videos regarding rehabilitation following TSA were screened for study inclusion. A total of 143 videos were included in the final analysis. Of these, 99 (69.2%) videos were on rehabilitation of anatomical TSA and 44 (30.8%) videos reported on rehabilitation after reverse TSA. Each video was reviewed using 3 scoring systems: (1) Journal of the American Medical Association (JAMA) benchmark criteria, (2) Global Quality Score (GQS), and (3) DISCERN instrument.ResultsYouTube videos regarding TSA are of suboptimal educational quality with a mean JAMA score of 2.5 ± 0.7, mean GQS of 2.7 ± 0.9, and mean DISCERN score of 33.2 ± 5.5 overall. Upon evaluation of video metrics based on classification it was found that educational nonphysician videos had significantly more likes than all other categories (P = .01). Educational physician videos were found to be significantly longer than all other categories (educational physician: 10.0 ± 14.8 minutes, educational nonphysician: 6.2 ± 3.2 minutes, personal testimony: 3.5 ± 2.6 minutes, commercial: 5.8 ± 5.4 minutes; P < .01) and had significantly higher JAMA (P < .01), GQS (P < .01), and DISCERN (P < .01).ConclusionYouTube videos are a poor source of educational information for patients regarding TSA rehabilitation. Educational videos prepared by nonphysicians accrued more likes than other video categories. Although educational videos by physicians provided statistically higher quality educational content as noted by JAMA, GQS, and DISCREN scores, the average scores across all author categories were classified as low (JAMA), moderate to poor (GQS), or poor (DISCERN) quality educational content. Additionally, our findings suggest that physician educational videos that are shorter in duration are more likely to be well received and watched to completion by viewers compared to longer videos. Patients should be provided trusted resources to learn more about TSAs.