Total shoulder arthroplasty performed after a failed arthroscopy can still produce good outcomes for patients with glenohumeral osteoarthritis, a new study finds.
Total Shoulder Arthroplasty Effective After Failed Arthroscopy
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Secondary#glenohumeralosteoarthritis#totalshoulderarthroplasty#comprehensivearthroscopicmanagement
“When comprehensive arthroscopic management for glenohumeral osteoarthritis fails, total shoulder arthroplasty may be needed, and it remains unknown whether previous comprehensive arthroscopic management (CAM) adversely affects outcomes after subsequent total shoulder arthroplasty,” the researchers of “Total Shoulder Arthroplasty After Previous Arthroscopic Surgery for Glenohumeral Osteoarthritis: A Case-Control Matched Cohort Study” wrote.
The study was published online on April 29, 2021 in The American Journal of Sports Medicine.
The researchers compared the outcomes of patients with glenohumeral osteoarthritis who underwent total shoulder arthroplasty (TSA) as a primary procedure compared with those who underwent TSA after CAM. All the patients were younger than 70 years.
Overall, 21 patients who underwent CAM-TSA were matched to 42 patients who underwent primary TSA by age, sex, and grade of osteoarthritis.
The researchers collected patient-reported outcomes (PRO) preoperatively and at final follow-up. They included the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH), 12-stem Short Form Health Survey Physical Component Summary, Visual Analog Scale (VAS), and patient satisfaction.
Only 56 of the patients were available for follow-up. A majority (71.4%) were male with a mean age of 57.8 years (range, 38.8-66.7 years).
They reported no significant differences in intraoperative blood loss (p > .999) or surgical time (p = .127) between the two groups.
There were four TSAs that failed and required revision surgery, but the rate between the two groups did not differ significantly (CAM-TSA: 5.3% vs. primary TSA: 8.1%; p > .999). Two other patients underwent revision arthroplasty because of trauma.
The 50 patients who did not experience failure completed PRO measures within about 5 years, with no significant differences between the two groups.
Both groups reported improved PRO scores at follow-up (p < .05). No significant differences between the two groups were observed.
ASES: 89.9 (interquartile range [IQR], 74.9-96.6) versus 94.1 (IQR, 74.9-98.3) (p = .545); SANE: 84.0 (IQR, 74.0-94.0) versus 91.5 (IQR, 75.3-99.0) (p = .246); QuickDASH: 9.0 (IQR, 3.4-27.3 versus 9.0 (IQR, 5.1-18.1) (p = .921); SF-12 PCS: 53.8 (IQR, 50.1-57.1) versus 49.3 (IQR, 41.2-56.5) (p = .065) and patient satisfaction: 9.5 (IQR, 7.3-10.0) versus 9.0 (IQR, 5.3-10.0) (p = .308).
The researchers wrote, “Patients with severe glenohumeral osteoarthritis who failed previous CAM benefited similarly from TSA compared with patients who opted directly for TSA.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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