2017 ISAKOS Biennial Congress Paper #104

 

Does Prior Shoulder Surgery Negatively Impact Shoulder Arthroplasty Outcomes?

Rachel M. Frank, MD, Aurora, CO UNITED STATES
Simon Lee, MD, MPH, Ann Arbor, MI UNITED STATES
Justin W. Griffin, MD, Charlottesville, VA UNITED STATES
Brian J. Cole, MD, MBA, Chicago, IL UNITED STATES
Gregory P. Nicholson, MD, Chicago, IL UNITED STATES
Nikhil N. Verma, MD, Chicago, IL UNITED STATES
Anthony A. Romeo, MD, Scarsdale, NY UNITED STATES

Rush University Medical Center, Chicago, IL, UNITED STATES

FDA Status Not Applicable

Summary

While patients who have undergone prior ipsilateral shoulder surgery derive benefit from shoulder arthroplasty, these patients are significantly younger, and their magnitude of improvement and final scores are significantly lower than patients without prior surgery.

Abstract

Background

The impact of prior ipsilateral shoulder surgery on outcomes following total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) is unknown. The purpose of this study was to determine the impact of prior shoulder surgery on patients undergoing TSA and RSA compared to patients without prior shoulder surgery.

Methods

A retrospective review of prospectively collected data was performed on 371 patients undergoing TSA (n=232) or RSA (n=139) between 2007 and 2012 with a minimum 2-year follow-up. All patients were evaluated at follow-up with the American Shoulder and Elbow Society (ASES), Simple Shoulder Test (SST), and Visual Analog Scale (VAS) outcomes assessments. For patients undergoing prior shoulder surgery, the number and type of procedure(s) were recorded. Statistical analysis was performed using one-way univariate and multivariate analysis of covariates (ANCOVA/MANCOVA) adjusting for age, Whitney-Mann U tests, and Chi-square or Fisher’s exact test, with P<0.05 considered significant.

Results

A total of 371 patients (176 males, 195 females) were included; 86 (23.2%) underwent prior shoulder surgery (PS group) while 285 (76.8%) did not (NPS group). Prior surgeries included rotator cuff repair (RCR, 49.4%), labral stabilization (12.7%), bony reconstruction (8.9%), and other arthroscopic procedures (debridement or subacromial decompression, 29.1%). PS group patients were significantly younger at the time of arthroplasty compared to the NPS group (60.03±11.16 vs. 67.14±8.94 years, P<0.0001). At an average follow-up of 52.53±22.22 months, both groups experienced significantly improved ASES, SST, and VAS scores (P<0.05 for all). Despite these improvements, ANCOVA analysis demonstrated significantly lower outcomes scores in the PS group compared to patients in the NPS group including ASES (68.74±23.56 vs. 80.06±18.14, P<0.0001), SST (6.82±3.33 vs. 8.34±2.99, P<0.0001), and VAS (2.35±2.68 vs. 1.21±1.85, P<0.0001). The NPS group demonstrated a significantly greater magnitude of improvement compared to the PS group with SST (P=0.026), but not ASES (P=0.089) or VAS (P=0.153). For the PS group, when comparing between different types of prior surgeries, there were no significant differences detected in outcome scores or magnitudes of change in outcomes between patients undergoing RCR or any of the other procedures. Age-adjusted MANCOVA analysis incorporating post-operative ASES, SST, and VAS scores showed that the NPS group in TSA patients continued to demonstrate significantly improved outcomes as compared to the PS group (P=0.031). Conversely, MANCOVA analysis of RSA patients showed no difference in outcomes between the groups (P=0.208).

Conclusions

While patients who have undergone prior ipsilateral shoulder surgery derive benefit from shoulder arthroplasty, these patients are significantly younger, and their magnitude of improvement and final scores are significantly lower than patients without prior surgery. This information can be used to counsel this challenging patient population on expected outcomes following shoulder arthroplasty procedures.