title: Early outcomes of staged bilateral reverse total shoulder arthroplasty: a case-control study.
abstract: Some surgeons are reluctant to perform a reverse total shoulder arthroplasty (RTSA) on both shoulders because of concerns regarding difficulty with activities of daily living post-operatively as a result of limited rotation of the shoulders. Nevertheless, we hypothesised that outcomes and patient satisfaction following bilateral RTSA would be comparable to those following unilateral RTSA. A single-surgeon RTSA registry was reviewed for patients who underwent bilateral staged RTSA with a minimum follow-up of two years. A unilateral RTSA matched control was selected for each shoulder in those patients undergoing bilateral procedures. The Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Values (SSV), visual analogue scale (VAS) for pain, range of movement and strength were measured pre- and post-operatively. The mean CMS, ASES, SSV, VAS scores, strength and active forward elevation were significantly improved (all p < 0.01) following each operation in those undergoing bilateral procedures. The mean active external rotation (p = 0.63 and p = 0.19) and internal rotation (p = 0.77 and p = 0.24) were not significantly improved. The improvement in the mean ASES score after the first RTSA was greater than the improvement in its control group (p = 0.0039). The improvement in the mean CMS, ASES scores and active forward elevation was significantly less after the second RTSA than in its control group (p = 0.0244, p = 0.0183, and p = 0.0280, respectively). Pain relief and function significantly improved after each RTSA in those undergoing a bilateral procedure. Bilateral RTSA is thus a reasonable form of treatment for patients with severe bilateral rotator cuff deficiency, although inferior results may be seen after the second procedure compared with the first.
authors.affiliation: Beaumont Health System, 3535 W, Thirteen Mile Road, Ste 744, Royal Oak, Michigan 48073, USA.
authors.forename: B P
authors.initials: BP
authors.lastname: Wiater
authors.forename: C R
authors.initials: CR
authors.lastname: Boone
authors.forename: D M
authors.initials: DM
authors.lastname: Koueiter
authors.forename: J M
authors.initials: JM
authors.lastname: Wiater
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods* / Q000534:rehabilitation; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D012785:Shoulder Joint / Q000502:physiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Bilateral; Cuff tear arthropathy; Functional outcomes; Humeral rotation; Reverse total shoulder arthroplasty; Rotator cuff dysfunction