Long Term clinical and radiological outcomes of primary reverse total shoulder arthroplasty at a minimum follow-up of 15 years.

Abstract

Long-term data at 15 years following implantation of reverse total shoulder arthroplasty (rTSA) is very limited. It was the aim of this study to analyze patients at a minimum of 15 years following rTSA implantation. A prospectively followed database of rTSAs performed at a tertiary referral center was analyzed at a minimum follow-up of 15 years. Kaplan-Meier survival curves were used to estimate time to complication and reoperation/revision rates and to calculate predictive factors. Clinical outcomes included the absolute and relative Constant-Murley score (CSa and CSr), Subjective Shoulder Value (SSV), range of motion including CS internal rotation (CS IR) and CS pain. The radiographic measurement included analysis of notching, radiolucent lines, heterotopic ossification, stress shielding and tuberosity resorption. A total of 258 shoulders (249 patients, median age 72 [75% IQR, 66 to 78] years, 62% female) underwent rTSA implantation in the specified period. Kaplan-Meier Survival analysis revealed a complication-free rate of 80% (IQR, 78% to 83%) and 76% (IQR, 70% to 81%) and a reoperation-free rate of 84% (IQR, 80% to 89%) at 10 and 15 years, respectively. Risk factors for complications were younger age (Hazard ratio (HR) 0.97), female gender (HR 2.04), and revision surgery as indication (HR 2.08). Of those 258 shoulders, 52 rTSAs (52 patients, median age 64 (IQR, 59 to 70) years, 46% female) were available for complete clinical and radiographic analysis at a minimum follow-up of 15 years (median 15.1 (IQR, 14.9 to 16,6) years). The initial improvements observed for most clinical parameters could be maintained from 2-years to mid-term and long-term follow-up at 10 and 15 years, respectively, including a CSa of 64 (IQR, 46 to 71), CSr of 79% (IQR, 60% to 86%), SSV of 80% (IQR, 60% to 93%), CS pain of 15.0 (IQR, 10.0 to 15.0), abduction of 120° (IQR, 88° to 145°), external rotation of 20° (IQR, 10° to 40°), and CS IR of 4.0 (IQR, 2.0 to 8.0), as well as strength of 2.13 (IQR, 0.00 to 3.45) kg at 15 years follow-up. Only flexion showed worsening over time from 130° (IQR, 100° to 150°) at 2 years to 115° (IQR, 94° to 130°) at 15 years postoperatively. All radiographic parameters progressed from preoperatively to 10 years postoperatively with no further progression. RTSA provides a stable clinical and radiographic outcome at long-term follow-up of at least 15 years. However, complication and revision rates are still high.