Poster 254. Anatomic Total Shoulder Arthroplasty Following Healed Rotator Cuff Repair Leads to Worse Functional Outcomes Compared to Those Without Prior Rotator Cuff Repair: A Matched Analysis
TL;DR
Total shoulder arthroplasty following prior rotator cuff repair results in similar objective clinical outcomes compared to TSA without prior RCR, however, patients with prior RCR reported significantly lower functional outcome scores, suggesting a disconnect between clinical performance and patient-perceived recovery.
Abstract
Objectives: Currently, total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are the accepted surgical treatments for glenohumeral osteoarthritis and rotator cuff tear arthropathy, respectively.1 Over the past decade, the frequency of both TSA and RTSA has increased dramatically with increases in incidence of 17% and 66%, respectively.2,3 Prior studies have demonstrated clinical improvement in patients following both TSA and RTSA.4-9Erickson et al. investigated 14 patients who underwent TSA and had a prior history of ipsilateral rotator cuff repair (RCR). Outcomes were compared to a control cohort of 42 patients who underwent TSA with no history of ipsilateral RCR. In those who underwent TSA with a prior history of ipsilateral RCR, their ASES scores significantly improved from their baseline to 2 and 5 years follow up.10 However, there was no difference in clinical outcomes between patients with and without a prior ipsilateral RCR.10 Furthermore, Schoch et al. reported on 30 patients undergoing TSA following prior ipsilateral RCR. Patients in this study did not demonstrate a statistical difference preoperative or postoperative range of motion and patient-reported outcome measures (PROMs) compared to patients who underwent TSA without a prior RCR.11While these studies demonstrate that total shoulder arthroplasty can be associated with high rates of patient satisfaction, the small cohorts of patients focused on patients undergoing shoulder arthroplasty with prior rotator cuff repair highlights the need for further investigation and longer-term outcomes in this patient population. The purpose of this study is to investigate the clinical findings and clinical outcomes of TSA in patients with prior history of RCR and compare them to those who underwent TSA without a prior history of RCR. Methods: Patients who underwent TSA before 9/1/2022 at our institution with a previous RCR were included. These patients were then matched based on age, sex, and BMI to a similar cohort of patients who did not have a prior history of RCR. Chart review was conducted to determine demographic information, radiographic details, operative details for their RCR (if applicable) and their TSA, range of motion (ROM). Patients were contacted at least 2 years postoperatively via RedCap to obtain patient reported outcome measures (PROMs) such as American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and SF-12 scores. Statistical analysis was performed by student t-test or Mann-Whitney U tests to compare groups of 2 and ANOVA or Kruskal-Wallis tests to compare groups of 3 or more. Fisher's Exact test was used to compare categorical data. A p-value of <0.05 was considered to be significant for the purpose of this study. Results: All patients in the prior RCR group had healed rotator cuff tendons at the time of TSA. Compared to patients without prior RCR, those with a history of repair had significantly worse patient-reported outcomes. ASES scores were lower in the RCR group (55 vs 84.2), as were SANE scores (59.7 vs 82.9) and SF-12 Mental health scores (48 vs 55.9). Postoperative flexion and internal rotation were similar between groups, while external rotation trended higher in the prior RCR group (60.2 vs 46.2), though this difference did not reach statistical significance. Both groups demonstrated low complication and reoperation rates; however, two patients in the RCR group required conversion to reverse TSA. The average interval between RCR and TSA was 46.8 months. Conclusions: Total shoulder arthroplasty following prior rotator cuff repair results in similar objective clinical outcomes compared to TSA without prior RCR. However, patients with prior RCR reported significantly lower functional outcome scores, suggesting a disconnect between clinical performance and patient-perceived recovery. These findings highlight the importance of setting appropriate expectations in patients with a history of RCR, as their subjective satisfaction and perceived shoulder function may be negatively influenced despite preserved range of motion and low complication rates.