Pain relief and durable outcomes after revision reverse shoulder arthroplasty for failed primary arthroplasty

Outcomes following revision reverse total shoulder arthroplasty (revision rTSA) are variable, and the risk of re-revision remains considerable. The aim of the present study was to evaluate the clinical outcomes and outcome predictors after revision to rTSA following failure of a hemiarthroplasty (HA), anatomic total shoulder arthroplasty, or revision rTSA.

After institutional review board approval, a retrospective review was performed of patients who underwent revision rTSA for failed HA, TSA, or rTSA between December 2005 and December 2020, with ≥24 months of follow-up. Pre-operative and post-operative patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES], Quick Disabilities of the Arm, Shoulder, and Hand, Single Assessment Numeric Evaluation [SANE], SF-12 Physical Component Summary/Mental Component Summary, visual analog scale [VAS] pain, satisfaction) and range of motion were recorded. Relationships between subscapularis repair, humeral osteotomy, cement use, dominant-side surgery, and number of prior surgeries and final ASES, SANE, satisfaction, and pain were assessed. Subgroup analyses compared outcomes in patients with <5 years vs. ≥5 years of follow-up.

Of 41 eligible patients, 37 (90%) were available at final follow-up (25 male [68%], 12 female [32%]; mean age 63.5 ± 10.3 years; mean follow-up 82 ± 46 months). Index prostheses were HA (n = 17, 46%), anatomic total shoulder arthroplasty (n = 17, 46%), and reverse arthroplasty (n = 3, 8%). Indications for revision included rotator cuff failure (60%), infection (22%), instability (8%), aseptic glenoid loosening (5%), and refractory pain (5%). Significant improvements were observed in ASES (51.5 ± 11.1 to 72.1 ± 17.9; P < .001), Quick Disabilities of the Arm, Shoulder, and Hand (44.9 ± 11.8 to 34.7 ± 17.6; P < .001), daily pain VAS (3.3 ± 2.4 to 1.8 ± 2.1; P = .04), maximum pain VAS (7.7 ± 2.3 to 3.8 ± 3.2; P < .001), and SANE (42.5 ± 18.9 to 61.6 ± 26.6; P = .02). SF-12 Physical Component Summary/Mental Component Summary did not change (P > .05). Forward flexion improved significantly (P < .05). A greater number of previous surgeries correlated with lower final ASES (r_s = -0.43; P = .02). No other surgical variables were associated with outcomes. Short-term and long-term follow-up groups did not differ in function, pain, or satisfaction. Four patients (10.8%) underwent re-revision; 2 additional patients (5.4%) had complications (postoperative stiffness, acromial stress fracture).

Revision rTSA leads to an improvement in patient-reported outcome measures and pain levels and demonstrates high durability at mid-term follow-up with low complication and failure rates. However, the gains in patient-reported outcome measures generally remain limited to a modest level. In addition, having undergone multiple prior surgeries may negatively affect the outcome. Future studies are needed to characterize the mid-term outcomes and durability of revision rTSA as this study is limited by its heterogeneity.