Reverse shoulder arthroplasty in revision surgery-Indications and results

Background: The number of reverse shoulder arthroplasty (RSA) procedures performed worldwide has increased over the last 10 years, with a corresponding increase in revision shoulder arthroplasty (SRSA). SRSA is often used for post-traumatic revision surgery in cases of infections and failure of anatomical prostheses. Data on outcomes with specific detail for each indication for the prosthetic solution as a secondary treatment are scarce, and inhomogeneous.

Methods: The questionnaires were sent by mail to 65 patients who underwent SRSA between January 2014 and November 2023. Based on the indications for SRSA, patients were categorized into post-traumatic shoulder arthritis, humeral head necrosis, failed proximal humerus fractures, failed proximal humerus osteosynthesis, prostheses loosening, and infection groups.

Results: Of the 65 patients included in the study, 39 completed the questionnaire, and the mean follow-up duration was 44 months (range, 12-104 months). The Constant score ranged from 28 points for all 6 groups (range, 38-66). The post-infection group showed the highest results, with 66 points (range, 24-90) on the Constant score; followed by 26 points (range, 49-6) points on the DASH score; and 0.90 (range, 0.763-1) on the EQ-5D-5L. Failed proximal humerus fractures presented the lowest scores: 38 points (range, 22-63) on the Constant score; 51 points (range, 73-30) points on the DASH score; and 0.61 (range, -0.496-1) on the EQ-5D-5L.

Conclusions: No previous study has investigated the influence of indications on the clinical outcome of SRSA so circumstantial. In this study, the highest outcome scores were observed in the post-infection group, whereas the lowest scores were observed in the failed humerus fracture group. Our results underline the influence of the indication on the clinical outcome of SRSA.