Early clinical results following staged bilateral primary total shoulder arthroplasty

The advantages of performing either a single- or 2-staged joint replacement has been reviewed extensively in the hip and knee arthroplasty literature, but far less data exist regarding total shoulder replacements. In the appropriate clinical setting, bilateral total shoulder arthroplasty yields excellent functional results with a low complication profile.

We evaluated retrospectively the records of 13 consecutive patients (26 shoulders) who underwent staged bilateral primary total shoulder replacements by a single surgeon, with a minimum follow-up of 12 months for each side (range, 12.0-61.5). The interval between replacements averaged 7.4 months (range, 0.5-26.0).

The mean unadjusted baseline Constant score for the first versus the second side was not significant (35 vs 41, P = .3). These scores improved to 73 and 72 by final follow-up (both P < .0001). Mean pain scores on the visual analog scale (VAS) improved from 6.9 to 0.9 (P < .0001). We found no difference in the estimated blood loss (EBL), operative time, or hospital length of stay (LOS) between the sides. Significantly higher mean scores were demonstrated in all components of the SF-36 questionnaire over a normalized cohort of U.S. age-matched males and females by final follow-up. All patients were satisfied with both procedures.

Staged, bilateral total shoulder arthroplasty results in excellent functional outcomes and high satisfaction in subjective patient assessment. We currently recommend a minimum of 6 weeks between replacements to allow for appropriate tissue healing and rehabilitation.

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