Revision of reverse shoulder arthroplasty by indication : a National Joint Registry study.

Abstract

Aims: Reverse shoulder arthroplasty (RSA), initially designed for cuff tear arthropathy (CTA), is now the most common choice of shoulder arthroplasty in both elective and trauma settings in the UK. Its use has rapidly increased for several indications, including osteoarthritis (OA) with an intact rotator cuff, acute trauma, and trauma sequalae. This study aims to review the revision rates of RSA by indication to assess how the implant is performing for indications for which it was not primarily designed.

Methods: Data from the National Joint Registry were obtained from 1 April 2012 to 31 March 2022. Data were linked to Hospital Episode Statistics for England and National Mortality Data. RSAs were identified and sorted into mutually exclusive groups by indication. The primary outcome was first revision and the secondary outcome was non-revision reoperation.

Results: The revision rates for RSA for CTA were 1.53% (95% CI 1.31 to 1.78) at one year, 3.21% (95% CI 2.86 to 3.60) at five years, and 4.97% (95% CI 4.23 to 5.84) at nine years. For primary OA, they were 1.21% (95% CI 0.95 to 1.54) at one year, 2.71% (95% CI 2.25 to 3.37) at five years, and 5.00% (95% CI 3.62 to 6.88) at nine years. For trauma, they were 1.51% (95% CI 1.15 to 1.99) at one year and 2.67% (95% CI 2.07 to 3.43) at five years. For trauma sequalae, they were 4.25% (95% CI 3.4 to 5.29) at one year and 7.12% (95% CI 5.90 to 8.59) at five years. Between indications, the revision rates were not statistically different except for trauma sequalae, which had a significantly increased risk of revision (p ≤ 0.001). Incidence of non-revision reoperation across the cohort was 1.1% (n = 283 patients), with the most common being manipulation under anaesthesia with or without capsular release (42.03%, n = 124) followed by subacromial decompression (21.02%, n = 62).

Conclusion: This study reports on the range of indications for which RSA is being used in the UK. It demonstrated that, based on the largest analysis of RSA across a range of indications, the revision rates and secondary surgery rates are broadly similar except for trauma sequalae.