RTSA Outcomes after Surgery for a Rotator Cuff Tear
Dr. Joseph King discusses the findings of a study, presented at the AAOS 2018 Annual Meeting, in which he and his colleagues compared outcomes in reverse total shoulder arthroplasty patients who did and who did not have prior rotator cuff repair.
Rotator cuff tears are common, and they become more common as individuals age. Between 250,000 and 400,000 rotator cuff repairs are performed annually in the United States, typically for symptomatic tears or tears that have not improved with conservative treatment.
Because these repairs can fail, such as from a re-tear or a failure of the repair to heal, surgeons may be faced with the challenge of managing patients who are still experiencing severe pain and disability even after a rotator cuff procedure. An option for these patients is reverse total shoulder arthroplasty (RTSA).
The issue: Does prior rotator cuff surgery compromise outcomes of RTSA?
To find out, Joseph J. King III, MD, from the University of Florida in Gainesville, and his colleagues compared clinical outcomes in patients who had RTSA after rotator cuff repair with outcomes in RTSA patients who had not undergone rotator cuff surgery. Their study was presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans.
They were surprised to find that in their study cohort, rotator cuff surgery before RTSA had no impact on clinical outcomes. “We thought that the group with prior rotator cuff repair would have at least slightly worse functional outcomes compared with the control group, but we did not find this to be the case,” Dr. King said. “We also thought that the rotator cuff repair group may have a higher complication rate, but they did not.”
Dr. King and his colleagues used a prospective research database to examine outcomes on patients who met the following inclusion criteria:
- Primary RTSA between 2004 and 2014
- History of prior rotator cuff surgery (arthroscopic or open)
- 2-year minimum follow-up
The same database was used to create a control group of age- and sex- matched patients (1:1) who had not undergone previous rotator cuff surgery. Both groups included 75 RTSA patients, 42 females and 33 males. The researchers then compared preoperative and postoperative active range of motion (ROM) and functional outcomes between groups.
Patients in the study group (RTSA plus rotator cuff surgery) had slightly worse ROM and functional scores, but the differences between the study group and the control group (RTSA only patients) were not statistically significant. After RTSA, patients in both groups experienced improved ROM and functional outcomes.
Dr. King said that based on the study findings, he and his colleagues do not believe there are any contraindications to RTSA in patients who have undergone prior rotator cuff surgery.
“The main point of this study is that even if an attempt at rotator cuff repair is not successful and the cuff has a re-tear or doesn’t heal, these patients still do well after RTSA,” Dr. King said.
Patel M, Stone WZ, Struk A, Farmer KW, Wright TW, King JJ. Does Having Prior Rotator Cuff Surgery Affect Outcomes in Reverse Shoulder Arthroplasty? (Paper 502). Presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons, March 6-10, 2018, New Orleans, Louisiana.
Dr. Patel, Dr. Stone, Ms. Struk, and Dr. King have no disclosures relevant to this paper. Dr. Farmer has disclosed that he is a paid consultant for Arthrex and that he is a paid consultant and paid speaker for Exactech. Dr. Wright has disclosed that he receives royalties and research support from and is a paid consultant for Exactech.