Effect of complications on outcomes after revision reverse total shoulder arthroplasty.

BACKGROUND: Revision reverse total shoulder arthroplasty (RTSA) reliably improves shoulder pain and function in patients with failed shoulder arthroplasty, although it can lead to significant postoperative complications. The purpose of this study was to determine the effect of postoperative complications on shoulder pain and function after revision RTSA. METHODS: We evaluated 36 patients at an average of 4.3 years (range, 2-8.6 years) after revision of a shoulder arthroplasty to RTSA. Of these patients, 9 had a failed anatomic total shoulder arthroplasty, 23 had a failed hemiarthroplasty, and 4 had a failed RTSA. The American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) pain score were evaluated postoperatively, and patients with and without postoperative complications were compared. RESULTS: The final ASES score and VAS pain score were 61 ± 23 and 2.4 ± 2.3, respectively. A major postoperative complication occurred in 7 patients (19%) (infection in 3, hematoma in 1, instability in 1, and acromial and/or scapular spine fracture in 2). Further surgical treatment was required in 5 patients (14%) (irrigation and débridement and component exchange for infection in 3, irrigation and débridement for hematoma in 1, and open reduction-internal fixation of scapular spine fracture in 1). On comparison of clinical outcomes between patients with and patients without complications, the ASES score and VAS pain score were significantly worse in patients with complications vs. those without them (ASES score, 43 ± 24 vs. 66 ± 21 [P = .04]; VAS pain score, 4.3 ± 2 vs. 2 ± 2.2 [P = .03]). CONCLUSION: Revision RTSA resulted in postoperative pain and shoulder function comparable to primary RTSA reported in the literature, although postoperative complications led to clinically significant declines in function and increases in pain.

Minimal clinically important differences in the American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale pain scores after arthroscopic rotator cuff repair.

BACKGROUND: Minimal clinically important differences (MCIDs) for different patient outcome scores have been reported for various shoulder diseases, including shoulder arthroplasty and the nonoperative treatment of rotator cuff disease. The purpose of this study was to assess the MCID for the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, the Simple Shoulder Test (SST), and a visual analog scale (VAS) measuring pain, after arthroscopic rotator cuff repair. METHODS: A total of 202 patients who underwent arthroscopic rotator cuff repair were retrospectively reviewed. ASES, SST, and VAS pain scores were collected preoperatively and at 1 year postoperatively. The MCID was then calculated via a 4-question anchor-based method. RESULTS: The MCID results for the ASES, SST, and VAS pain scores were 27.1, 4.3, and 2.4, respectively. Age at time of surgery, sex, anteroposterior tear size, and worker's compensation status were not associated with MCID values (P > .05). CONCLUSION: The MCID values determined in the current study are higher than those previously identified for the nonoperative treatment of rotator cuff disease using the same anchor questions. Use of these higher values should be considered when evaluating improvements of individual patients after rotator cuff repair, to determine comparative effectiveness of various rotator cuff repair techniques and to determine sample sizes for prospective comparative trials of rotator cuff repair methods.

Structural glenoid allograft reconstruction during reverse total shoulder arthroplasty.

BACKGROUND: Large glenoid defects present a challenge during primary and revision reverse total shoulder arthroplasty (RTSA) especially when humeral head autograft is not available as a bone graft source. The purpose of this study was to evaluate the clinical and radiographic outcomes of RTSA with concomitant structural allografting to reconstruct large glenoid defects. METHODS: From May 2008 to July 2016, 22 patients underwent primary or revision RTSA with structural glenoid allografting. Of 22 patients, 19 (86%) were available for a minimum 2-year clinical follow-up (average, 2.8 ± 1.3 years), and 17 of 22 (77%) were available for a minimum 1-year radiographic follow-up. Functional outcomes, range of motion, radiographic deformity correction, allograft incorporation, and complication rates were determined. RESULTS: From preoperatively to postoperatively, significant improvements in the average Simple Shoulder Test score (2 ± 2 preoperatively vs. 10 ± 8 postoperatively, P = .002), the average American Shoulder and Elbow Surgeons score (31 ± 19 preoperatively vs. 70 ± 25 postoperatively, P < .001), and average active forward elevation (71° ± 41° preoperatively vs. 128° ± 28° postoperatively, P < .001) were noted. Coronal-plane radiographic correction was 29° ± 12° as measured with the reverse shoulder arthroplasty angle (P < .001) and 14° ± 11° as measured with the ß angle (P < .001). Postoperatively, of 17 patients with a minimum 1-year radiographic follow-up, 14 (82%) had complete radiographic incorporation of the graft. Acromial fracture nonunions developed in 2 patients and loosening and migration of the baseplate were found in 2 patients, although no patients elected to undergo further surgery. CONCLUSIONS: RTSA with allograft reconstruction of severe glenoid defects allows restoration of glenoid anatomy and leads to high rates of bony incorporation with low rates of glenoid loosening or requirement for revision. Structural allograft is an excellent alternative to autograft in revision RTSA to avoid graft-site morbidity.

An analysis of costs associated with shoulder arthroplasty.

BACKGROUND: The purpose of this study was to identify factors associated with variation in direct costs with shoulder arthroplasty. METHODS: This was a retrospective study of all shoulder arthroplasties performed at a single facility between July 1, 2011, and November 30, 2016. We collected patient factors, indications, procedure (including implant details), implant brand (A, B, and other), and complications. We collected direct costs over a 90-day period using a validated internal tool. We identified patient and procedure characteristics associated with costs using multivariable generalized linear models. RESULTS: A total of 361 patients were included, 19% with revision arthroplasty procedures, 32% with anatomic total shoulder arthroplasties, and 66% with reverse total shoulder arthroplasties (RTSAs). Of total costs, 13% were operative facility utilization costs and 58% were operative supply costs. Factors associated with increased total cost included younger age (P = .002) and an indication for surgery of other, that is, not osteoarthritis, a failed arthroplasty, or the sequelae of a rotator cuff tear (P = .030). Factors associated with increased operative costs included younger age (P = .002), use of an RTSA (P < .001), use of a bone graft (P < .001), implant brand B (P = .098), implant brands other than A and B (P = .04), the sequelae of a rotator cuff tear as an indication for surgery (P = .041), or an indication for surgery of other (P = .007). CONCLUSION: Most short-term (90-day) costs with shoulder arthroplasty are operative costs. Nonmodified factors associated with increased cost included younger age and less common indications for surgery, whereas potentially modifiable factors included the intraoperative use of a bone graft, implant brand, and RTSA use.