Clinical Outcomes of Bilateral Total Shoulder Arthroplasty

Victoria E Bindi; Kevin A Hao; Lacie M Turnbull; Jonathan O Wright; Thomas W Wright; Kevin W Farmer; Terrie Vasilopoulos; Aimee M Struk; Bradley S Schoch; Joseph J King

doi:10.5435/JAAOS-D-24-00325

Clinical Outcomes of Bilateral Total Shoulder Arthroplasty

J Am Acad Orthop Surg. 2024 Dec 3. doi: 10.5435/JAAOS-D-24-00325. Online ahead of print.

Authors

Victoria E Bindi¹, Kevin A Hao, Lacie M Turnbull, Jonathan O Wright, Thomas W Wright, Kevin W Farmer, Terrie Vasilopoulos, Aimee M Struk, Bradley S Schoch, Joseph J King

Affiliation

¹ From the Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL (Turnbull, J. Wright, T. Wright, Farmer, Vasilopoulos, Struk, and King), College of Medicine, University of Florida, Gainesville, FL (Bindi and Hao), Department of Anesthesiology, University of Florida, Gainesville (Vasilopoulos), and Department of Orthopaedic Surgery (Schoch), Mayo Clinic, Jacksonville, Florida.

PMID: 39637405
DOI: 10.5435/JAAOS-D-24-00325

Abstract

Objective: The purpose of this study was to evaluate the clinical outcomes in patients who underwent bilateral total shoulder arthroplasty (TSA) at a single institution. Secondarily, we evaluated the influence of the time interval between successive TSAs on clinical outcomes of the second TSA.

Methods: A single-institution shoulder arthroplasty database was reviewed for patients undergoing bilateral primary anatomic TSA (aTSA) or reverse TSA (rTSA) between 2000 and 2022. Clinical outcomes, including outcome scores, range of motion, and shoulder strength, were assessed in patients with minimum 2-year follow-up. Postoperative complications and achievement of the minimal clinical important difference, substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were evaluated. Statistical comparisons were made between first and second TSAs, between TSA variations, and based on time between TSAs (<1, 1 to 5, >5 years).

Results: We identified 180 bilateral TSA patients (68 aTSA/aTSA, 29 aTSA/rTSA, three rTSA/aTSA, 80 rTSA/rTSA). When evaluating side-to-side differences, the second rTSA in the aTSA/rTSA group had more favorable postoperative Shoulder Pain and Disability Index (P = 0.032) and forward elevation strength (P = 0.028) compared with the first aTSA. No other side-to-side comparisons were statistically significant or exceeded the minimal clinical important difference, SCB, or PASS. Patients undergoing second aTSA after first aTSA or undergoing first rTSA had superior SCB and PASS for active external rotation (P = 0.009 and P = 0.005, respectively). Complications were similar between strata, but revision rates were lowest after first rTSA in rTSA/rTSA patients. The time interval between successive TSAs did not influence the clinical outcome.

Conclusion: All bilateral TSA combinations demonstrated excellent outcomes with most patients achieving clinically relevant benchmarks, with no influence of timing between arthroplasties.

Level of evidence: III, retrospective comparative cohort study.