Reverse Shoulder Arthroplasty: Evaluation of the Clinical and Functional Outcomes per Etiology

Storti, Thiago Medeiros; Ribeiro, Thiago da Silva; Faria, Rafael Salomon Silva; Simionatto, João Eduardo; Simionatto, Carolina; Paniago, Alexandre Firmino

doi:10.1055/s-0041-1731674

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Original Article • Rev. bras. ortop. 57 (05) • Sep-Oct 2022 • https://doi.org/10.1055/s-0041-1731674 copy

Reverse Shoulder Arthroplasty: Evaluation of the Clinical and Functional Outcomes per Etiology

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aimed to evaluate the clinical outcomes of reverse shoulder arthroplasty to treat several conditions.

Methods

Retrospective, longitudinal study analyzing the Constant and University of California at Los Angeles (UCLA) scores and range of motion of patients undergoing reverse shoulder arthroplasty.

Results

In total, 28 patients were analyzed, with a mean age of 75.6 years old. The mean duration of follow-up was 45 months. Overall, there was a significant variation (p< 0.0001) between the preoperative (10.2 points) and the postoperative UCLA scores (29.6 points), corresponding to a relative increase of approximately 200%. In addition, the mean Constant score was 67.8, and the complication rate was 17.8%. As for functional outcomes per etiology, fracture sequelae cases presented the best mean elevation (165°), Constant score (79 points), postoperative UCLA score (32.5 points), and absolute delta UCLA score increase (22 points), but with no statistical significance. However, cases operated for fracture sequelae showed significantly higher elevation (p= 0.027) and Constant score (p= 0.047) compared to rotator cuff arthropathy cases. In addition, the lowest mean postoperative Constant and UCLA scores were observed for the following etiologies: primary arthrosis, acute fracture, and arthroplasty revision.

Conclusion

Reverse shoulder arthroplasty showed satisfactory functional outcomes and may be a treatment option not only for rotator cuff arthropathy but for several other conditions.

Keywords
arthropathy; rotator cuff; rupture; arthroplasty, replacement, shoulder; shoulder pain; shoulder injuries; shoulder prosthesis

Variable
Age (years old)
mean±SD (minimum–maximum value)	75.6 ± 6.4 (58–86)
Age at surgery	N	%
> 75 years old	15	53.6
≤ 75 years old	13	46.4
Gender
male	3	10.7
female	25	89.3
Follow-up (months)
mean±SD (minimum–maximum value)	45±16.7 (24–84)
Shoulder
right	21	75.0
left	7	25.0
Condition
Rotator cuff arthropathy	11	39.3
Primary arthrosis	2	7.1
Acute fracture	2	7.1
Extensive rotator cuff injury	8	28.6
Prosthesis revision	3	10.8
Fracture sequelae	2	7.1

Variable
Constant score
mean±SD (minimum–maximum value)	67.8 ± 12 (28–93)
Preoperative UCLA score*
mean±SD (minimum–maximum value)	10.2±3.2 (3–17)
Postoperative UCLA score*
mean±SD (minimum–maximum value)	29.6±5.1 (9–34)
Absolute delta UCLA
mean±SD (minimum–maximum value)	19.4±5 (6–31)
Delta (%) UCLA
mean±SD (minimum–maximum value)	228 ± 180.2 (86.7–1,033)
Elevation (°)
mean±SD (minimum–maximum value)	137.6±25.1 (50–165)
Lateral rotation
mean±SD (minimum–maximum value)	16.7±17.7 (0–60)
Medial rotation (lumbar vertebrae)
mean	L1/L2
Satisfaction classification
not satisfied	1	3.6
satisfied	11	39.3
very satisfied	16	57.1

Variable	Rotator cuff arthropathy		Primary arthrosis		Acute fracture		Extensive rotator cuff injury		Arthroplasty revision		Fracture sequelae
Variable	n	mean	n	mean	n	mean	n	mean	n	mean	n	mean
Clinical variables	11		2		2		8		3		2
Age at surgery (years old)		75.6		79		78.5		75.3		80		64.5
Follow-up (months)		45.5		53		25		46.5		33.3		65
Range of motion
Elevation (°)		139.9		135		110		150.6		96.7		165
Lateral rotation (°)		19.5		0		10		24		0		20
Medial rotation (°; lumbar vertebrae)		13.5		17		16		14		15.5		14
Functional scores
Constant score		69.5		61.5		59		73.4		49		79
Preoperative UCLA score		10.5		10.5		−		11.1		6		10.5
Postoperative UCLA score		31.1		28		30		30.6		20.7		32.5
Absolute delta UCLA		20.5		17.5		−		19.5		14.7		22

	ANOVA	Comparison of paired conditions (Mann-Whitney test)
	ANOVA	1 × 2	1 × 3	1 × 4	1 × 5	1 × 6	2 × 3	2 × 4	2 × 5	2 × 6	3 × 4	3 × 5	3 × 6	4 × 5	4 × 6	5 × 6
Clinical variable
Age at surgery (years old)	0.31	0.43	0.49	1.00	0.43	0.11	1.00	0.69	1.00	0.12	0.23	0.56	0.12	0.15	0.064	0.083
Follow-up (months)	0.10	0.92	0.029	0.93	0.12	0.23	0.12	0.90	0.56	0.44	0.036	0.37	0.12	0.18	0.12	0.083
Range of motion
Elevation	0.005	0.16	0.071	0.071	0.067	0.027	0.10	0.035	0.55	0.083	0.036	0.77	0.10	0.018	0.035	0.076
Lateral rotation	0.022	0.027	0.68	0.61	0.009	0.32	0.083	0.034	1.00	0.083	0.59	0.046	0.083	0.013	1.00	0.046
Medial rotation	0.16	0.028	0.11	0.36	0.23	0.92	0.32	0.060	0.32	0.10	0.35	0.68	0.22	0.50	0.60	0.44
Functional scores
Constant score	0.041	0.058	0.073	0.53	0.10	0.047	1.00	0.049	0.56	0.12	0.067	0.56	0.12	0.15	0.36	0.083
Preoperative UCLA score	0.24	0.92	−	0.45	0.040	0.84		0.69	0.14	1.00	−	−	−	0.064	0.60	0.083
Postoperative UCLA score	0.18	0.069	−	0.80	0.13	0.42		0.18	0.55	0.10	−	−	−	0.17	0.23	0.14
Absolute delta UCLA	0.29	0.084	−	0.22	0.34	0.22		0.69	0.56	0.10	−	−	−	0.31	0.19	0.55

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Thiago Medeiros Storti, Hospital Ortopédico e Medicina Especializada (HOME), SGAS Quadra 613 - Conjunto C - Asa Sul Brasília, DF, Brazil (e-mail: thiago_storti@hotmail.com).