The influence of preoperative external rotation weakness or stiffness on reverse total shoulder arthroplasty

Some reverse total shoulder arthroplasty (rTSA) patients may have limited preoperative external rotation (ER) because of stiffness or weakness. Currently it is not known if this affects their clinical outcome or if their ER will improve after surgery.

A multicenter shoulder arthroplasty database was queried to analyze patients undergoing a primary rTSA using a single prosthesis design featuring a medial glenoid-lateral humerus. Their pre- and postoperative range of motion was evaluated in addition to 5 outcome measures. Patients with limited preoperative ER due to weakness or stiffness were compared to patients with normal preoperative range of motion. The following questions were asked: (1) Does a preoperative ER deficit impact the postoperative outcome? (2) Do patients with preoperative ER deficits due to stiffness or weakness regain ER after rTSA? and (3) Does a preoperative ER lag sign predict a poor outcome?

608 patients were included in this study. Active external rotation (preoperative/postoperative) was as follows for the 3 patient groups: Normal patients (45°/44°), Stiff (-4°/30°), and Weak (16°/32°). Weak patients had a preoperative ER lag of 30°, which improved by 16° after surgery. The clinical outcome scores for all 3 groups improved after rTSA. Stiff patients had significantly greater improvement than Weak and Normal patients. Outcome scores were equivalent for Normal and Stiff patients. Weak patients tended to have slightly lower outcome scores.

Patients with limited preoperative ER can obtain a good clinical result with rTSA using a medial glenoid-lateral humerus prosthesis, ER range of motion can improve after rTSA, and stiff patients have a particularly good prognosis for recovery.