title: Bilateral reverse total shoulder arthroplasty-functional outcome and activities of daily living.
abstract: BACKGROUND
  Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years, providing good shoulder elevation, yet less predictable rotations. Good rotations are crucial for performance of activities of daily living (ADLs), including personal hygiene. Concerns remain regarding bilateral rTSA over lack of rotations bilaterally and resultant difficulties with ADLs. This study examined the outcome of patients with bilateral rTSA in restoration of function and ADLs.
  
  
  METHODS
  Data were prospectively collected for 19 patients (15 women, 4 men; 38 shoulders), with a mean age of 74.5 years, who underwent staged bilateral rTSA between 2007 and 2013. Mean follow-up was 48.4 months (range, 24-75 months). Patients were evaluated clinically using the Constant score, patient's satisfaction, Subjective Shoulder Value, and the Activities of Daily Living External and Internal Rotations (ADLEIR) score. Video clips were also recorded for documentation at all visits.
  
  
  RESULTS
  Mean duration between staged operations was 18.2 months (range, 3-46 months). The Constant score improved from 18.7 to 65.1 points (age- and sex-adjusted, 100.2). Elevation improved from 57.5° to 143°, internal rotation (IR) from 9° to 81° (30 shoulders could reach above the sacroiliac joint), and external rotation (ER) from 20° to 32° (35 shoulders had >20° ER in adduction, 31 shoulders had full ER in elevation). The Subjective Shoulder Value improved from 2.1 of 10 to 9.2 of 10. Mean ADLEIR score was 33 of 36 (P < .001 for all). Most patients resumed their leisure and sport activities (gardening, golf, swimming, bowling).
  
  
  CONCLUSIONS
  Bilateral rTSA results in marked and predictable improvement in all movements, pain relief, and functional outcomes, with high patient satisfaction and high ADLEIR score. All patients were able to perform perineal hygiene after their rTSA. Most patients had no limitation in ADLs and their leisure activities.
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK. Electronic address: oferlevy@readingshoulderunit.com.
authors.forename: Ofer
authors.initials: O
authors.lastname: Levy
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Walecka
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
authors.forename: George
authors.initials: G
authors.lastname: Arealis
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
authors.forename: Oren
authors.initials: O
authors.lastname: Tsvieli
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Della Rotonda
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
authors.forename: Ruben
authors.initials: R
authors.lastname: Abraham
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Polyzois
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
authors.forename: Zac
authors.initials: Z
authors.lastname: Jurkowski
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
authors.forename: Ehud
authors.initials: E
authors.lastname: Atoun
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012399:Rotation; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery
keywords: ADL; Shoulder; activities; arthroplasty; function; replacement; rotation; stemless