Anatomic total shoulder arthroplasty after healed rotator cuff repair: a matched cohort

Abstract

Background: Rotator cuff tears are a common cause of failure after anatomic total shoulder arthroplasty (TSA). The purpose of this study was to evaluate the effect of a healed prior rotator cuff repair (RCR) on outcomes and complications after primary TSA. We hypothesized that patients with a prior healed RCR would have equivalent outcomes and complication rates compared with patients without prior surgery.

Methods: A retrospective review of all primary TSAs with a prior RCR was performed using a multicenter database between 2005 and 2017. Thirty shoulders with prior RCR were case matched on a 3:1 ratio with a minimum 2-year follow-up. Range of motion, strength, patient-reported outcome measures, complications, and reoperations were compared.

Results: Thirty shoulders with a prior RCR were compared with 90 control patients without prior surgery at a mean follow-up of 43 months (range, 24-109 months). Groups demonstrated similar preoperative range of motion and patient-reported outcome measures. Postoperatively, TSAs with a prior healed RCR demonstrated less forward flexion (132° vs. 143°, P = .14) and strength (5.7 vs. 6.4 kg, P = .55) compared with control shoulders with no prior surgery; however, these did not meet statistical significance. Complications were significantly more common in patients with a prior RCR (17% vs. 7%, P = .01). Postoperative rotator cuff tears were significantly more common in TSA with a healed prior RCR (13% vs. 1%, P = .014).

Conclusions: TSA after RCR results in similar functional improvements compared with shoulders without prior surgery. However, the risk of a postoperative rotator cuff tear is significantly higher after prior successful RCR. Surgeons should consider this potential complication when indicating these patients for primary TSA.

Keywords: Total shoulder arthroplasty; aTSA; rcr; retear; revision; rotator cuff repair; rotator cuff tear.