Is shoulder replacement failure more likely to occur among patients who undergo a reverse total shoulder procedure? A study published earlier this summer in the Journal of Shoulder and Elbow Surgery suggests that this could be the case, at least during the early post-operative period.
According to the American Academy of Orthopaedic Surgeons, reverse total shoulder replacement is generally recommended for patients who have developed a complex type of shoulder arthritis called “cuff tear arthropathy.” These patients are more likely to experience pain and limited motion following traditional total shoulder arthroplasty. During a traditional total shoulder replacement, a plastic cup is fitted into the glenoid (shoulder socket), while a metal ball is attached to the top of the humerus. However, the socket and metal ball are switched in a reverse total shoulder replacement, which relies on the deltoid muscle, rather than the rotator cuff, to power and position the arm.
Reverse shoulder operations have significantly increased in recent years. To investigate complication and revision rates, the authors of a paper published in the June 2016 issue of the Journal of Shoulder and Elbow Surgery compared 6,658 traditional total shoulder arthroplasty patients to 4,186 patients who underwent reverse surgeries. The patient data was drawn from the California Office of Statewide Health Planning and Development database, and included patients who had undergone a shoulder replacement from 2011 to 2013. Rates of complications and revisions were compared at 30 days, 90 days, 1 year, and 2 years post- surgery.
The analysis indicated that the all-cause complication rate at 90 days and 2-years post-op was significantly higher for patients who had undergone reverse total shoulder replacements. Patients who underwent reverse procedures also had a significantly increased risk of infection and dislocation during the early and midterm post-op period. Male patients, those on workers’ compensation, patients with preoperative anemia, and individuals under the age of 65 appeared to be at the highest risk for complications.
While reverse total shoulder arthroplasty initially had a higher rate of implant failure during the early post-operative period, the authors of the study noted that failure rates for the two types of surgeries equalized at approximately the 1-year mark.