title: Reverse shoulder arthroplasty using an implant with a lateral center of rotation: outcomes, complications, and the influence of experience.
abstract: Reverse shoulder arthroplasty (RSA) has revolutionized treatment of arthritis and rotator cuff insufficiency and is performed using implants with either a medial or a lateral center of rotation. We conducted a study of the outcomes and the effect of surgeon learning after the first 60 consecutive lateral-center-of-rotation RSAs implanted by a single surgeon unaffiliated with the design team for this particular reverse shoulder prosthesis. At minimum 2-year followup, mean improvements in active forward elevation, abduction, and external rotation were 69°, 55°, and 23°, respectively; mean active internal rotation improved significantly as well (P < .001 for all). Mean Simple Shoulder Test (SST) scores improved from 1.8 (range, 0-6) to 6.9 (range, 0-12) (P < .0001), and mean final American Shoulder and Elbow Surgeons score was 72 (range, 27-100). Final radiographs showed scapular notching in 5 shoulders (11%). Gains in SST scores, active forward elevation, and active abduction were lower for the first 15 cases than for the next 45 cases, and 5 of the 8 reoperations were performed after the first 15 cases. Overall improvements in active motion and self-assessed shoulder function in this series are comparable to those previously reported by the design team. Experience with RSA appears to influence efficacy, but the learning curve may not be as steep as previously reported.
authors.affiliation: Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH. cfleckenstein@csmref.org.
authors.forename: Samer S
authors.initials: SS
authors.lastname: Hasan
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Gordon
authors.forename: Jason A
authors.initials: JA
authors.lastname: Ramsey
authors.forename: Martin S
authors.initials: MS
authors.lastname: Levy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012086:Reoperation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome