Outcomes of Reverse Total Shoulder Arthroplasty After Failed Rotator Cuff Repair, Superior Capsular Reconstruction, and Tendon Transfer.

Abstract

Background: There is limited evidence describing the effect of failed rotator cuff repair (RCR), superior capsular reconstruction (SCR), or tendon transfer (TT) before reverse total shoulder arthroplasty (RTSA) on postoperative outcomes.

Purpose: (1) To compare patient-reported outcome measure scores, range of motion, and complication rates in patients with previous ipsilateral shoulder surgery to those without previous surgery undergoing RTSA and (2) to compare the outcomes of patients with failed SCR or TT to those with failed RCR.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients who underwent RTSA from 2016 to 2021 were retrospectively identified through an institutional database. Patients who underwent RTSA after failed RCR, SCR, or TT (prior surgery [PS] group) were matched by age, sex, body mass index, and concomitant latissimus dorsi TT to patients who underwent RTSA for rotator cuff arthropathy with no prior surgery (NPS group). Primary outcome measures included rates of achieving the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) for the American Shoulder and Elbow Surgeons (ASES) score and Single Assessment Numeric Evaluation (SANE). Secondary outcome measures included Veterans RAND 12-Item Health Survey scores, complication rates, and postoperative range of motion. A subanalysis compared outcomes in patients with prior failed RCR to patients with prior failed SCR or TT.

Results: A total of 150 patients (PS: n = 60; NPS: n = 90) met inclusion criteria. The PS group consisted of 33 cases (55.0%) of primary RCR, 10 cases (16.7%) of revision RCR, 10 cases (16.7%) of SCR, and 7 cases (11.7%) of TT. Adjusted analysis showed that the NPS group had higher rates of achieving the MCID (93.3% vs 73.3%, respectively; P = .007), SCB (88.3% vs 56.7%, respectively; P < .001), and PASS (73.3% vs 26.7%, respectively; P < .001) for the ASES and higher rates of achieving the SCB (56.7% vs 20.0%, respectively; P < .001) and PASS (76.7% vs 35.0%, respectively; P < .001) for the SANE. The NPS group had greater forward flexion (P < .001) at final follow-up. The PS group had higher rates of overall complications (30.0% vs 13.3%, respectively; P = .022) and prosthetic instability or dislocations (10.0% vs 1.1%, respectively; P = .033). Subanalysis showed that the SCR/TT subgroup had significantly lower rates of achieving the SCB (ASES: P = .004; SANE: P = .034) and PASS (ASES: P = .014; SANE: P = .009) compared with the RCR subgroup.

Conclusion: Patients with a history of failed RCR, SCR, or TT to address rotator cuff insufficiency before RTSA had greater range of motion deficits, higher complication rates, and lower rates of achieving clinically significant outcomes than those without prior ipsilateral shoulder surgery.