Does preoperative diagnosis impact patient outcomes following reverse total shoulder arthroplasty?

Background

Reverse total shoulder arthroplasty (RTSA) has seen a tremendous increase in popularity over the last 2 decades. While initially developed for use in patients with irreparable rotator cuff disorders and cuff arthropathy, the evolution of RTSA and associated implants has led to implantation for a variety of pathologies.

Methods

A literature search was performed to examine outcomes of RTSA based on specific preoperative diagnoses. Articles including individual pathologies as well as articles comparing outcomes between different pathologies were included. Preoperative diagnoses include rotator cuff arthropathy/massive irreparable rotator cuff tears, primary glenohumeral arthritis with intact rotator cuff, inflammatory arthritis, proximal humerus fractures, and failed prior arthroplasty, as well as miscellaneous diagnoses such as tumor resection, septic arthritis, avascular necrosis, and glenohumeral arthritis following shoulder dislocation.

Results

RTSA provides generally satisfactory outcomes regardless of preoperative pathology. Direct comparison studies revealed overall superior outcomes of RTSA for glenohumeral arthritis with intact rotator cuff as compared to patients with rotator cuff arthropathy. Patients with diagnoses portending higher preoperative outcome scores were at risk for less overall improvement. Patients undergoing RTSA for inflammatory conditions, fractures, and arthroplasty revision are at higher risk for complications, which may explain the increased variability of outcomes in these groups.

Discussion

RTSA produces reliable improvements in function and pain, with small differences in risks and outcomes based on preoperative diagnosis. Patients should be adequately counseled in order to create appropriate expectations. Further long-term studies are needed to differentiate outcome differences between specific preoperative pathologies.