Good Long-term Improvement after RTSA in Patients Under Age 60
For younger patients with severe damage to the rotator cuff muscles, a reverse shoulder replacement provides lasting improvement in shoulder function, according to a study in The Journal of Bone & Joint Surgery.
“In the absence of treatment alternatives, reverse total shoulder arthroplasty [RTSA] is a justifiable treatment for patients with a massive, irreparable rotator cuff tear before the age of 60,” according to the study authors. Despite a substantial risk of complications, most patients are satisfied with the outcomes of RTSA at follow-up of a decade or more.
The researchers analyzed the long-term outcomes of RTSA in 20 patients with an average age of 57 years. All had massive, irreparable tears of the rotator cuff muscles that were causing shoulder pseudoparalysis, with little no ability to lift the arm.
This group of patients typically receive limited benefit from shoulder replacement with conventional implants, which rely on the rotator cuff muscles to provide shoulder movement. The RTSA technique uses other muscles to move the shoulder, providing an alternative when the rotator cuff is severely damaged or destroyed.
When first introduced, RTSA was performed mainly in older, low-demand patients. With refinements in technique and components, the procedure has been used in younger, more active patients. But there are concerns about how well the results of RTSA will hold up over time in this group of patients.
The new study focuses on long-term outcomes of RTSA in patients under age 60. The patients underwent follow-up examination between 8 and 19 years after surgery (average 11.7 years). Three patients had RTSA in both shoulders, for a total of 23 procedures.
Compared with their preoperative status, most patients had substantial long-term improvement after RTSA. The average Constant score improved from 24 to 59 (out of a possible 100) at final-follow-up.
Patients’ ratings of “subjective shoulder value” improved from 20% to 71% (compared with 100 percent for a normal shoulder). Shoulder movement and strength increased, while pain decreased. The improvement was similar for patients with and without prior shoulder surgery.
However, complications occurred in 39% of the shoulders. Further surgery was required in 6 shoulders; in 2 cases, the RTSA procedure was considered a failure.
When complications occurred, long-term shoulder functioning was not as good, but even with the high complication rate, 72% of patients rated their satisfaction level as excellent or good.
The results alleviate concerns that the clinical benefits of RTSA might not hold up over time in younger, more-active patients. Despite the high complication rate, the authors conclude that RTSA “provides substantial and lasting improvement” in shoulder function and pain, in a group of patients with limited treatment options.
Ernstbrunner L, Suter A, Catanzaro S, Rahm S, Gerber C. Reverse total shoulder arthroplasty for massive, irreparable rotator cuff tears before the age of 60 years: long-term results. J Bone Joint Surg Am. 2017 Oct 18;99(20):1721-1729. doi: 10.2106/JBJS.17.00095.