Reverse total shoulder arthroplasty in neglected anterior shoulder dislocation with glenoid bone defect: a...

Literature has reported favorable outcomes of reverse total shoulder arthroplasty (RSA) for treating neglected anterior shoulder dislocation (NASD). However, few studies have specifically addressed the treatment outcomes and management of NASD in the presence of glenoid bone loss. The aim of this study is to evaluate the clinical outcomes of RSA in patients with NASD associated with glenoid bone defects.

We conducted a retrospective cohort study of NASD patients treated with RSA from January 2018 to December 2022. Neglected dislocation was defined as lasting more than three weeks. Glenoid bone defect size and patient demographics were recorded. A matched control group of patients who underwent RSA for classical indications was included. NASD patients were divided into those who received autologous bone grafting (BG) and those who did not (N-BG). Outcome measures included range of motion (ROM), visual analogue scale (VAS) for pain, subjective shoulder value (SSV), Constant score (CS), and American Shoulder and Elbow Surgeons (ASES) score.

Twenty-four NASD patients (mean duration 3.0 ± 1.3 months) were included, with an average glenoid defect of 25.3 ± 8.5%. Eleven underwent bone grafting due to defect sizes ≥ 30%. Compared to cuff tear arthropathy patients, NASD patients had worse preoperative ROM and functional scores. At final follow-up, the NASD group demonstrated marked postoperative improvements in forward flexion (from 44.7° to 121.3°), external rotation (from 2.2° to 26.9°), and abduction (from 57.8° to 95.9°). Functional outcomes were comparable between the NASD group and the matched cuff tear arthropathy group, with VAS scores of 1.4 vs. 1.2 (p = 0.370) and CS, SSV, and ASES scores of 75.2 vs. 77.4 (p = 0.290), 80.3 vs 81.3 (p = 0.751), and 77.6 vs. 80.4 (p = 0.165), respectively. Similarly, no significant differences were observed between the BG and N-BG groups, with VAS scores of 1.6 vs. 1.2 (p = 0.187) and CS, SSV, and ASES scores of 74.4 vs. 75.8 (p = 0.730), 81.4 vs. 79.4 (p = 0.692), and 76.6 vs. 78.4 (p = 0.585), respectively.

RSA is effective for NASD with glenoid bone loss, yielding outcomes comparable to cuff tear arthropathy cases. Bone grafting for defects ≥ 30% provided favorable results without significant differences in functional recovery compared to non-grafted cases.