Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoa
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ORIGINAL PAPER
Pre-operative factors affecting the indications for anatomical and reverse total shoulder arthroplasty in primary osteoarthritis and outcome comparison in patients aged seventy years and older Giovanni Merolla 1,2 & Mauro De Cupis 3 & Gilles Walch 4 & Vincenzo De Cupis 3 & Elisabetta Fabbri 5 & Francesco Franceschi 6 & Claudio Ascani 7 & Paolo Paladini 1 & Giuseppe Porcellini 8 Received: 30 October 2019 / Accepted: 31 January 2020 # SICOT aisbl 2020
Abstract Background We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. Methods Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant–Murley score (CS) were recorded pre and post-operatively. Preoperative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. Results RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). Conclusion RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement. Keywords Anatomical . Reverse . Total shoulder arthroplasty . Primary osteoarthritis . Elderly
Level of Evidence: Level III, Retrospective cohort design, Treatment study * Giovanni Merolla [email protected]; [email protected] 1
Shoulder and Elbow Unit, Cervesi Hospital, AUSL della Romagna, Via L. v. Beethoven 46, 47841 Cattolica, Italy
2
Biomechanics Laboratory, Cervesi Hospital, AUSL della Romagna, Cattolica, Italy
3
Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
4
Centre Orthopédique Santy, Hôpital Jean Mermoz, Ramsay GDS, Lyon, France
5
Research and Innovation Department – Rimini, AUSL della Romagna, Rimini, Italy
6
Shoulder and Elbow Unit, Campus Bio-Medico, University of Rome, Rome, Italy
7
Shoulder and Elbow Unit, Centro Ortopedico Traumatologico (CTO), Rome, Italy
8
Orthopaedic and Trauma Unit, University of Modena and Reggio Emilia,
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