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Reverse Total Shoulder Arthroplasty
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Clinical Predictors for Optimal Forward Elevation in Primary Reverse Total Shoulder Arthroplasty.

David R Sollaccio1, Joseph J King1, Aimee Struk1

  • 1Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA.

Journal of Shoulder and Elbow Arthroplasty
|September 9, 2021
PubMed
Summary

Preoperative active forward elevation is the key predictor of achieving good shoulder function after reverse total shoulder arthroplasty (RTSA). This finding helps surgeons counsel patients on expected outcomes following RTSA surgery.

Keywords:
Active shoulder elevationelevation lagfunctional outcomesfunctional prognosispassive elevationreverse total shoulder arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Rehabilitation Medicine

Background:

  • Limited research exists on clinical factors influencing superoptimal and suboptimal forward elevation post-reverse total shoulder arthroplasty (RTSA).
  • This study investigates functional outcomes 12 months after primary RTSA, stratified by shoulder elevation.
  • The correlation between functional outcomes and patient-specific clinical factors is examined.

Purpose of the Study:

  • To identify clinical factors associated with varying degrees of shoulder elevation after primary RTSA.
  • To stratify functional outcomes based on active forward elevation at 12 months post-surgery.
  • To provide insights for patient counseling regarding prognosis after RTSA.

Main Methods:

  • Prospective data from 286 patients undergoing primary RTSA (June 2004-June 2013) were analyzed.
  • Patients were grouped based on 12-month postoperative active forward elevation: Group I (≥145°) and Group II (<90°).
  • Univariate and logistic regression analyses were used to correlate clinical variables with postoperative motion.

Main Results:

  • 90% of patients achieved at least 90° of active shoulder elevation 12 months post-RTSA.
  • Group I (≥145° elevation) showed significantly better outcomes than Group II (<90°), including younger age, lower ASA score, greater preoperative elevation, improved strength, and better rotation.
  • Preoperative active forward elevation was the sole independent predictor of improved postoperative forward elevation.

Conclusions:

  • Significant factors influencing functional active shoulder elevation after primary RTSA were identified.
  • Preoperative active forward elevation is a critical determinant of postoperative success.
  • These findings can aid surgeons in counseling patients on expected functional prognosis following RTSA.