• BACKGROUND
    • As the utilization and success of reverse shoulder arthroplasty (RTSA) continues to grow, so have its surgical indications. Despite adoption of RTSA for the treatment of glenohumeral osteoarthritis (GHOA) with an intact rotator cuff and massive irreparable rotator cuff tears (MCTs) without arthritis, the literature remains sparse regarding the differential outcomes after RTSA amongst these varying indications. Thus, the purpose of this study is to examine postoperative clinical outcome of RTSA based upon indication.
  • METHODS
    • A retrospective review of two large institutional databases was performed to identify all patients undergoing RTSA between 2015 and 2019 with minimum 2-year follow-up. Patients were stratified by indication into three cohorts: GHOA, rotator cuff tear arthropathy (CTA), and MCTs. Baseline demographics were collected to determine differences between the three cohorts. Clinical outcome was measured pre- and postoperatively, including active range of motion (AROM), the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and Visual Analog Scale (VAS) for pain. Multivariate linear regression was performed to determine factors independently predictive of postoperative ASES score.
  • RESULTS
    • A total of 625 patients (383 GHOA, 164 CTA, and 78 MCT) with mean follow-up of 33.4 months were included in the analysis. Patients with GHOA had superior ASES (85.6 ± 15.7 versus 76.6 ± 20.8 in CTA [P < .001], versus 75.9 ± 19.9 in MCT [P < .001]), SANE (86 ± 20.9 versus 76.7 ± 24.1 in CTA [P < .001], versus 74.2 ± 25.3 in MCT [P < .001]), and VAS pain (median 0.0, interquartile range {IQR} 0.0 - 1.0, versus median 0.0, IQR 0.0 - 2.0 in CTA [P < .001], versus median 0.0, IQR 0.0 - 2.0 in MCT [P < .001]) scores postoperatively. Postoperative active FE (P < .001) and improvement in active ER (P < .001) were greatest in the GHOA cohort compared to other indications. Multivariate linear regression demonstrated that factors independently associated with postoperative ASES score included a diagnosis of GHOA (β-coefficient 7.557 [P < .001]), preoperative ASES score (β-coefficient 0.114 [P = .009]), female sex (β-coefficient -4.476 [P = .002]), a history of prior surgery (β-coefficient -3.957 [P = .018]), and a postoperative complication (β-coefficient -13.550 [P < .001]).
  • CONCLUSION
    • RTSA for the treatment of GHOA generally has superior patient-reported and functional outcomes when compared to CTA and MCT without arthritis. Long-term follow-up is needed to identify the lasting implications of such outcome differences.