Reverse total shoulder arthroplasty found beneficial for older adults without arthritis
Click Here to Manage Email Alerts
In patients older than 60 years with chronic rotator cuff tears without glenohumeral arthritis, use of reverse total shoulder arthroplasty may be a beneficial treatment, according to published findings.
Molly Vora, BA, and colleagues sought to examine national trends for surgical management of chronic rotator cuff tear in patients without glenohumeral arthritis.
“An increasing number of studies support the effectiveness of [reverse total shoulder arthroplasty] RTSA in treating older patients who have chronic irreparable [rotator cuff tear] RCT without arthritis, as measured by a wide number of outcomes, including pain, active forward flexion, and to a lesser extent, external rotation motion,” Vora, of the Boston University College of Medicine, and colleagues wrote.
The researchers evaluated data from a retrospective review between 2007 and 2015 of patients diagnosed without chronic shoulder arthritis.
Vora and colleagues identified 428,651 patients who had chronic rotator cuff tear without arthritis, with 84.9% received nonoperative treatment; 12.5% received rotator cuff repair (RCR); and 2.6% underwent RTSA.
Patients between the ages of 60 and 79 years had a 70.8% rate of surgical intervention, with 69.2% undergoing RCR and 78.4% receiving RTSA, the researchers wrote. There was a three-fold increase in RTSA use noted in patients 60 years or older compared with patients younger than 60 years.
The overall rate of revision at 2 years was 13% for patients between 60 and 79 years of age who underwent RCR compared to patients of the same age who underwent RTSA (3.7%), Vora and colleagues wrote. There were consistent revision rates over time after RCR (9.3% to 13%), while revision rates for RTSA reduced significantly (12.1% to 2.2%).
Perspective
Back to Top
Matthew Willis, MD
This was an excellent study describing the evolution of the treatment of rotator cuff disease over time. As mentioned by the authors, database limitations prevented better characterization of the specific tear patterns important in clinical decision-making (partial thickness, full thickness, tear size, atrophy, etc.). The likely explanation for increasing surgical intervention in the 60- to 79-year age group is the age-related progression to full-thickness tearing demonstrated by multiple authors. Despite decreasing rates of revision in the reverse shoulder arthroplasty group, rotator cuff repair should likely remain the preferred surgical treatment for rotator cuff tear without arthritis in all age groups when properly indicated. When rotator cuff repair is not indicated, the more recent emergence of several promising interventions offer additional non-arthroplasty options, particularly for younger active patients.
Pioneered by Teruhisa Mihata, MD, PhD, superior capsular reconstruction is one such option with good short- and intermediate-term data. Russell K. Stewart, MD, and colleagues published a systematic review of subacromial balloon spacers demonstrating good short-term outcomes, although these are not yet approved in the U.S. Further research will continue to define the best options for this population of patients moving forward.
Reference:
Stewart RK, et al. Orthop J Sports Med. 2019;doi:10.1177/2325967119875717.
Collapse
Read more about
Click Here to Manage Email Alerts