Total shoulder arthroplasty after previous arthroscopic surgery for glenohumeral osteoarthritis: a case-control matched cohort study
Background:When comprehensive arthroscopic management (CAM) for glenohumeral osteoarthritis fails, total shoulder arthroplasty (TSA) may be needed, and it remains unknown whether previous CAM adversely affects outcomes after subsequent TSA.Purpose:To compare the outcomes of patients with glenohumera...
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| Main Authors: | , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
April 29, 2021
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| In: |
The American journal of sports medicine
Year: 2021, Volume: 49, Issue: 7, Pages: 1839-1846 |
| ISSN: | 1552-3365 |
| DOI: | 10.1177/03635465211006479 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1177/03635465211006479
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| Author Notes: | Philip-C. Nolte, MD, MA, Bryant P. Elrick, MSc, Justin W. Arner, MD, T.J. Ridley, MD, Thomas E. Woolson, BS, Anna-K. Tross, MD, Kaare S. Midtgaard, MD, and Peter J. Millett, MD, MSc, investigation performed at the Steadman Philippon Research Institute, Vail, Colorado, USA |
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| 245 | 1 | 0 | |a Total shoulder arthroplasty after previous arthroscopic surgery for glenohumeral osteoarthritis |b a case-control matched cohort study |c Philip-C. Nolte, MD, MA, Bryant P. Elrick, MSc, Justin W. Arner, MD, T.J. Ridley, MD, Thomas E. Woolson, BS, Anna-K. Tross, MD, Kaare S. Midtgaard, MD, and Peter J. Millett, MD, MSc, investigation performed at the Steadman Philippon Research Institute, Vail, Colorado, USA |
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| 520 | |a Background:When comprehensive arthroscopic management (CAM) for glenohumeral osteoarthritis fails, total shoulder arthroplasty (TSA) may be needed, and it remains unknown whether previous CAM adversely affects outcomes after subsequent TSA.Purpose:To compare the outcomes of patients with glenohumeral osteoarthritis who underwent TSA as a primary procedure with those who underwent TSA after CAM (CAM-TSA).Study Design:Cohort study; Level of evidence, 3.Methods:Patients younger than 70 years who underwent primary TSA or CAM-TSA and were at least 2 years postoperative were included. A total of 21 patients who underwent CAM-TSA were matched to 42 patients who underwent primary TSA by age, sex, and grade of osteoarthritis. Intraoperative blood loss and surgical time were assessed. Patient-reported outcome (PRO) scores were collected preoperatively and at final follow-up including the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH), 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS), visual analog scale, and patient satisfaction. Revision arthroplasty was defined as failure.Results:Of 63 patients, 56 of them (19 CAM-TSA and 37 primary TSA; 88.9%) were available for follow-up. There were 16 female (28.6%) and 40 male (71.4%) patients with a mean age of 57.8 years (range, 38.8-66.7 years). There were no significant differences in intraoperative blood loss (P > .999) or surgical time (P = .127) between the groups. There were 4 patients (7.1%) who had failure, and failure rates did not differ significantly between the CAM-TSA (5.3%; n = 1) and primary TSA (8.1%; n = 3) groups (P > .999). Additionally, 2 patients underwent revision arthroplasty because of trauma. A total of 50 patients who did not experience failure (17 CAM-TSA and 33 primary TSA) completed PRO measures at a mean follow-up of 4.8 years (range, 2.0-11.5 years), with no significant difference between the CAM-TSA (4.4 years [range, 2.1-10.5 years]) and primary TSA (5.0 years [range, 2.0-11.5 years]) groups (P = .164). Both groups improved significantly from preoperatively to postoperatively in all PRO scores (P < .05). No significant differences in any median PRO scores between the CAM-TSA and primary TSA groups, respectively, were seen at final follow-up: ASES: 89.9 (interquartile range [IQR], 74.9-96.6) versus 94.1 (IQR, 74.9-98.3) (P = .545); SANE: 84.0 (IQR, 74.0-94.0) versus 91.5 (IQR, 75.3-99.0) (P = .246); QuickDASH: 9.0 (IQR, 3.4-27.3) versus 9.0 (IQR, 5.1-18.1) (P = .921); SF-12 PCS: 53.8 (IQR, 50.1-57.1) versus 49.3 (IQR, 41.2-56.5) (P = .065); and patient satisfaction: 9.5 (IQR, 7.3-10.0) versus 9.0 (IQR, 5.3-10.0) (P = .308).Conclusion:Patients with severe glenohumeral osteoarthritis who failed previous CAM benefited similarly from TSA compared with patients who opted directly for TSA. | ||
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