Pain relief and durable outcomes after revision reverse shoulder arthroplasty for failed primary arthroplasty.

BACKGROUND

Outcomes following revision reverse total shoulder arthroplasty (revision rTSA) are variable, and the risk of re-revision remains considerable. The aim of the present study was to evaluate the clinical outcomes and outcome predictors after revision to rTSA following failure of a hemiarthroplasty (HA), anatomic total shoulder arthroplasty, or revision rTSA.

METHODS

After institutional review board approval, a retrospective review was performed of patients who underwent revision rTSA for failed HA, TSA, or rTSA between December 2005 and December 2020, with ≥24 months of follow-up. Pre-operative and post-operative patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES], Quick Disabilities of the Arm, Shoulder, and Hand, Single Assessment Numeric Evaluation [SANE], SF-12 Physical Component Summary/Mental Component Summary, visual analog scale [VAS] pain, satisfaction) and range of motion were recorded. Relationships between subscapularis repair, humeral osteotomy, cement use, dominant-side surgery, and number of prior surgeries and final ASES, SANE, satisfaction, and pain were assessed. Subgroup analyses compared outcomes in patients with <5 years vs. ≥5 years of follow-up.

RESULTS

Of 41 eligible patients, 37 (90%) were available at final follow-up (25 male [68%], 12 female [32%]; mean age 63.5 ± 10.3 years; mean follow-up 82 ± 46 months). Index prostheses were HA (n = 17, 46%), anatomic total shoulder arthroplasty (n = 17, 46%), and reverse arthroplasty (n = 3, 8%). Indications for revision included rotator cuff failure (60%), infection (22%), instability (8%), aseptic glenoid loosening (5%), and refractory pain (5%). Significant improvements were observed in ASES (51.5 ± 11.1 to 72.1 ± 17.9; P < .001), Quick Disabilities of the Arm, Shoulder, and Hand (44.9 ± 11.8 to 34.7 ± 17.6; P < .001), daily pain VAS (3.3 ± 2.4 to 1.8 ± 2.1; P = .04), maximum pain VAS (7.7 ± 2.3 to 3.8 ± 3.2; P < .001), and SANE (42.5 ± 18.9 to 61.6 ± 26.6; P = .02). SF-12 Physical Component Summary/Mental Component Summary did not change (P > .05). Forward flexion improved significantly (P < .05). A greater number of previous surgeries correlated with lower final ASES (rs = -0.43; P = .02). No other surgical variables were associated with outcomes. Short-term and long-term follow-up groups did not differ in function, pain, or satisfaction. Four patients (10.8%) underwent re-revision; 2 additional patients (5.4%) had complications (postoperative stiffness, acromial stress fracture).

CONCLUSION

Revision rTSA leads to an improvement in patient-reported outcome measures and pain levels and demonstrates high durability at mid-term follow-up with low complication and failure rates. However, the gains in patient-reported outcome measures generally remain limited to a modest level. In addition, having undergone multiple prior surgeries may negatively affect the outcome. Future studies are needed to characterize the mid-term outcomes and durability of revision rTSA as this study is limited by its heterogeneity.