Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
Exactech Inc., Gainesville, FL, USA.
J Shoulder Elbow Surg. 2020 Nov;29(11):2221-2228. doi: 10.1016/j.jse.2020.03.029. Epub 2020 Jun 9.
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.
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.
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).
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.
肩袖撕裂是解剖型全肩关节置换术（TSA）后失败的常见原因。本研究旨在评估先前愈合的肩袖修复（RCR）对初次 TSA 后结果和并发症的影响。我们假设，与无先前手术的患者相比，先前有愈合的 RCR 的患者会有相似的结果和并发症发生率。
使用多中心数据库，对 2005 年至 2017 年间所有初次 TSA 伴先前 RCR 的病例进行回顾性分析。30 例有先前 RCR 的肩部与 3:1 比例的最小 2 年随访的对照患者相匹配。比较了活动范围、力量、患者报告的结果测量、并发症和再手术。
30 例有先前 RCR 的肩部与 90 例无先前手术的对照患者在平均 43 个月（范围 24-109 个月）的随访中进行了比较。两组术前活动范围和患者报告的结果测量相似。术后，与无先前手术的对照组相比，先前愈合的 RCR 的 TSA 表现出较小的前屈（132° vs. 143°，P =.14）和力量（5.7 千克 vs. 6.4 千克，P =.55）；然而，这些没有达到统计学意义。有先前 RCR 的患者并发症明显更常见（17% vs. 7%，P =.01）。先前愈合的 RCR 的 TSA 术后肩袖撕裂明显更常见（13% vs. 1%，P =.014）。
与无先前手术的肩部相比，RCR 后的 TSA 可导致相似的功能改善。然而，在先前成功的 RCR 后，术后肩袖撕裂的风险显著增加。当向这些患者推荐初次 TSA 时，外科医生应考虑这种潜在的并发症。
