Reverse shoulder arthroplasty for postcapsulorrhaphy arthropathy results in similar clinical outcomes compared to glenohumeral osteoarthritis.

Abstract

Reverse shoulder arthroplasty (rTSA) is a reliable treatment option for various indications, including glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. Following either open or arthroscopic instability surgery, a certain portion of patients develop postcapsulorrhaphy arthropathy (PCA) and ultimately need shoulder replacement. While these patients often have an intact rotator cuff, alterations to the native soft tissue anatomy may compromise the success of anatomic total shoulder arthroplasty, leading some to consider rTSA. Limited literature currently exists evaluating the outcomes of rTSA as a treatment for PCA. Patients undergoing rTSA for the treatment of GHOA or PCA were retrospectively propensity score-matched in a 2.2:1 ratio based on age, sex, and body mass index, as well as preoperative American Shoulder and Elbow Surgeons score, forward elevation, and external rotation. Preoperative clinical outcomes at a minimum 2 years consisted of the visual analog scale for pain, Single Assessment Numeric Evaluation score, and American Shoulder and Elbow Surgeons score, as well as active forward elevation, internal rotation, and external rotation. The PCA cohort was stratified into subcohorts based on capsulorrhaphy technique (open or arthroscopic), all of which were soft tissue procedures. Univariate analysis was performed to compare cohort and subcohort demographics, clinical outcomes, and glenoid erosion patterns using the Walch classification system. After matching, the GHOA and PCA cohorts consisted of 82 and 37 patients, respectively, with no significant differences in age (GHOA 68 ± 6 years vs. PCA 66 ± 6 years; P = .082) or follow-up duration (GHOA 29 ± 12 months vs. PCA 29 ± 11 months; P = .493). Both groups demonstrated significant improvement in all clinical outcome metrics. The arthroscopic and open PCA subcohorts consisted of 19 and 18 patients, respectively. No significant preoperative or postoperative clinical outcome differences were observed between any cohort and subcohort studied (P > .05). There was a significant difference in Walch classification distribution between the GHOA and PCA cohorts (P = .014), with the most likely cause being a difference in frequency of A1 (GHOA 25.9% vs. PCA 36.3%) and B3 (GHOA 24.7% vs. PCA 12.1%) glenoid wear patterns. This study demonstrates that rTSA is a reliable and effective treatment option for patients with PCA. Furthermore, the surgical technique of the previous soft tissue instability procedure (arthroscopic vs. open) does not affect clinical outcomes after rTSA. Given the predictability of the outcomes associated with rTSA for PCA, consideration should be given for this as a treatment choice.