title: The functional impact of bilateral reverse total shoulder arthroplasty.
abstract: BACKGROUND
  The use of reverse total shoulder arthroplasty (RTSA) has been increasing. However, many recommend against bilateral RTSA because of concerns over lack of internal rotation (IR) and the resultant difficulties with activities of daily living (ADLs).
  
  
  METHODS
  Data on 15 consecutive patients who underwent staged bilateral primary RTSA for cuff tear arthropathy (CTA) were retrospectively reviewed. All operations were performed by a single surgeon. The mean follow-up was 33.4 months from the second RTSA. The mean age of the patients at the time of the first operation was 72.9 years. The mean duration between arthroplasties was 21.6 months. Patients were evaluated preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and yearly with standardized clinical examinations and outcome measures questionnaires.
  
  
  RESULTS
  On both operative sides, elevation showed significant improvement from preoperative values; however, external rotation, abduction, and IR did not show significant improvement at an average follow-up of 33.4 months. Functional outcome scores of both RTSA shoulders showed significant improvement from preoperative values; however, the 12-Item Short-Form Health Survey scores on either shoulder did not show significant improvement. Evaluation of the outcome measures questionnaire revealed that all patients were able to perform perineal hygiene after their RTSAs.
  
  
  CONCLUSIONS
  Bilateral RTSA results in marked improvement in forward elevation, pain, and functional outcomes, and carries a high rate of satisfaction in subjective patient assessment. Common ADLs that require significant IR, such as perineal care, were not problematic in the cohort.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Stevens
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Struk
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA. Electronic address: wrightw@ortho.ufl.edu.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wright
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D019643:Arthroplasty, Replacement; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery
keywords: Reverse shoulder arthroplasty; activities of daily living; functional outcomes