Biceps tenodesis in the setting of total shoulder arthroplasty: A matched cohort analysis

Studies have theorized that pain refractory to anatomic total shoulder arthroplasty (aTSA) in patients who did not undergo a concomitant biceps tenodesis or tenotomy may be as a result of the pathologic interaction between the long head of the biceps tendon and the humeral prosthesis. This study evaluates the effect of concomitant biceps tenodesis during aTSA on long-term clinical and radiographic patient outcomes.

This retrospective study analyzed patients who underwent aTSA with or without biceps tenodesis from 2000 to 2017. Preoperative and postoperative range of motion (ROM), American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS), and Simple Shoulder Test (SST) scores were collected. Patients in the biceps tenodesis group were matched with those who underwent aTSA without tenodesis based on age, follow-up interval, sex, and preoperative ASES score.

The study included 88 shoulders (44 tenodesis, 44 no tenodesis), with median follow-up of 9.9 years (range 3.3-19.0). No significant differences were observed between cohorts in postoperative forward elevation, external/internal rotation, VAS, ASES, or SST scores at most recent follow-up. There were no significant differences in pre-to postoperative improvement in ROM and patient-reported outcome scores. Both groups demonstrated excellent implant survival, with similar revision rates at nearly 10 years postoperatively.

Patients who underwent aTSA with concomitant biceps tenodesis did not demonstrate inferior long-term clinical outcomes or pain scores in comparison to patients who underwent aTSA with preservation of the biceps tendon. Appropriately selected patients may experience equivalent, satisfactory outcomes after aTSA, independent of concomitant biceps tenodesis.