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Presenter: Patients with OA may benefit most from reverse shoulder arthroplasty

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BOSTON — Patients with certain forms of shoulder osteoarthritis may experience better long-term outcomes from an alternative procedure, such as reverse shoulder arthroplasty, than total shoulder arthroplasty, based on results presented at the American Shoulder and Elbow Surgeons Annual Meeting, here.

“I think there are certain forms of osteoarthritis [OA] that do not do well with traditional shoulder arthroplasty,” Mark A. Mighell, MD, said. “These types of OA tend to have eccentric glenoids, significant cystic changes and posterior subluxation. Alternative techniques may serve a role in treating these patients to provide us with good outcomes.”

Mighell and colleagues performed a retrospective study of 1,000 consecutive patients with shoulder OA who had intact rotator cuffs and underwent either total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) between 2007 and 2016. In all, 6.4% of patients underwent RSA and they typically had Walch type C glenoids, according to Mighell.

The 2-year data showed patients had similar outcomes whether they underwent TSA or RSA. Although patients with eccentric glenoids achieved better external rotation with TSA, Mighell noted they tended to experience glenoid implant loosening later.

Reoperations were required in patients with vacuous glenoid changes or cystic changes, as well as in patients with increased posterior subluxation, although this finding was not significant, he noted.

“When did we decide to perform a reverse?” Mighell said. “This was a preoperative decision in 65%, intraoperative decision-making [in] 35%.” – by Casey Tingle

Reference:

Streit JJ, et al. Paper #31. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 7-9, 2016; Boston,

Disclosure: Mighell reports he is a paid consultant and paid presenter/ speaker for DJ Orthopaedics and Stryker; received research support from DJ Orthopaedics; and is a board/ committee member of the Foundation for Orthopaedic Research and Education.