Shoulder
Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon’s experience?

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Background

The goal of this study was to compare 2 consecutive series of 240 reverse total shoulder arthroplasties (TSA) in order to evaluate if the increase in surgeon experience modified the indications, clinical and radiographic results, and rate of complications.

Material and methods

Two hundred forty reverse TSA performed between July 2003 and March 2007 were clinically and radiographically evaluated by an independent examiner with a minimum follow-up of 2 years and compared with a previous published study (240 cases implanted by the same 2 surgeons between May 1995 and June 2003).

Results

The main etiology remained cuff tear arthropathy with an increase noted between the 2 studies. The rate of revision arthroplasty as an etiology decreased from 22.5% to 9.1%. Conversely, the rate of rheumatoid arthritis increased from 0.4% to 6.3%. The average postoperative Constant score was significantly better than the first series (66.9 vs 59.7, P < .001). The postoperative complication rate decreased with increased experience (from 19% to 10.8%), with dislocations reducing (from 7% to 3.2%), and infections reducing (from 4% to 0.9%). However, the number of nerve palsies increased. The revision rate decreased from 7.5% to 5%. The rate of glenoid notching remained stable, but the severity of notching decreased.

Conclusion

Experience did not lead us to operate on younger patients, but significantly modified patient selection, results, and complications. Increased experience with the reverse shoulder arthroplasty did not reduce the rate of glenoid notching.

Section snippets

Study group

Between July 2003 and March 2007, 240 reverse prostheses were implanted in 230 patients (10 bilateral cases) by 1 of the 2 senior authors (G.W. or L.N.J.) in the same center specializing in shoulder surgery. All consecutive reverse prostheses were included in the study. Patients were evaluated preoperatively with active and passive range of motion (ROM) measured with a goniometer in the sitting position and strength measured with a dynamometer.9 All patients had a preoperative complete set of

Baseline characteristics

Of the original 240 cases, 213 in 206 patients were available for 2-year follow-up. Seven patients (8 RSA) were deceased (none revised), 15 (17 RSA) were lost to follow-up, and 2 patients (2 RSA) refused to participate (neither revised). Comparing demographic data of the previous study with this study, there was no statistical difference regarding average age (72.7 years, range 23-86 vs 72.4 years, range 24-89), gender (female/male ratio 184/56 vs 194/46) nor shoulder dominance

Discussion

Acquired surgical experience in RSA modified patient selection between the 2 studies in 2 ways. First, the collection of 240 cases required half the time in the second study; this was influenced by a greater confidence in results that could be expected. Second, acquired experience led surgeons to maintain the indications involving the best functional outcomes (cuff tear arthropathy, primary OA with rotator cuff or glenoid deficiency, massive rotator cuff tear) and to decrease the indications

Conclusion

This study showed that the surgeons’ acquired experience during the implantation of the first series of RSA helped them refine patient selection, with greater confidence in the procedure to improve functional outcomes. Surgeons prioritized the etiologies linked with the best outcomes and reduced the number of revision surgery cases, which are related to a high complication rate.

The major indications of RSA were confirmed and new etiologies, which represent very advanced destruction of the

Disclaimer

Dr. Walch receives royalties from the Tornier Company related to the subject of this article. None of the other authors, their immediate families, and any research foundation with which they are affiliated received any financial payments or other benefits from any commercial entity related to the subject of this article.

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