Is reverse shoulder arthroplasty a reasonable alternative for revision arthroplasty?
BACKGROUND
Reverse shoulder arthroplasty (RSA) improves function in selected patients with complex shoulder problems. However, we presume patient function would vary if performed primarily or for revision and would vary with other patient-specific factors.


OBJECTIVE
We compared (1) the shoulder scores and (2) complications in patients with RSA for revision arthroplasty with patients who had RSA as a primary procedure; and (3) identified patient-specific factors that affect (1) and (2).


METHODS
We retrospectively compared 28 RSAs for failed arthroplasty with a control group consisting of 28 primary RSAs. We determined the Penn Shoulder (PENN), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores. Followup for shoulder outcome measures averaged 17.4 (range, 4.1-34) and 20.8 months (range, 7.3-34.9) for the study and control groups, respectively.


RESULTS
All scores were higher in primary RSA than in revision RSA (PENN score, 79.5 versus 57.1; ASES score, 81.4 versus 56.3; SANE score, 73.8% versus 48.8%), and ROM was better (122.7° versus 83.75°). Both groups experienced increases in active forward flexion. Ten of the 28 study RSAs (35.7%) versus five of the 28 control RSAs (17.8%) had complications. No patient-specific factors other than reason for surgery correlated with scores.


CONCLUSIONS
Revision RSA is associated with lower function compared with primary RSA. However, we believe it a reasonable alternative and patients undergoing RSA for revision arthroplasty can expect improvements in function and shoulder scores to a mean of 50% of normal shoulders but must also accept a high complication rate.


METHODS
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
Luke
L
Austin
Benjamin
B
Zmistowski
Edward S
ES
Chang
Gerald R
GR
Williams
D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015143:Philadelphia; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome