Key result
Following total shoulder arthroplasty for primary osteoarthritis, 29.9% of shoulders demonstrated superior humeral head migration and 11.3% developed postoperative superior rotator cuff tears.
Why the study?
What is the incidence of rotator cuff tears or dysfunction following total shoulder arthroplasty in patients with primary osteoarthritis?
Systematic Review (n=1,259)
What is the incidence of rotator cuff tears or dysfunction following total shoulder arthroplasty in patients with primary osteoarthritis?
Rotator cuff dysfunction following total shoulder arthroplasty for primary osteoarthritis may be more common than previously reported, with nearly 30% showing superior humeral head migration.
Rotator cuff dysfunction after TSA for primary OA may exceed prior estimates; challenges lower incidence benchmarks and supports enhanced postoperative surveillance.
Rotator cuff tears have been reported to be uncommon following total shoulder arthroplasty (TSA). Postoperative rotator cuff tears can lead to pain, proximal humeral migration, and glenoid component loosening. The purpose of this paper was to evaluate the incidence of post-TSA rotator cuff tears or dysfunction in osteoarthritic patients. A systematic review of multiple databases was performed using preferred reporting items for systematic reviews and meta-analyses guidelines. Levels I-IV evidence clinical studies of patients with primary osteoarthritis with a minimum 2-year follow-up were included. Fifteen studies with 1259 patients (1338 shoulders) were selected. Student's t-tests were used with a significant alpha value of 0.05. All patients demonstrated significant improvements in motion and validated clinical outcome scores (P < 0.001). Radiographic humeral head migration was the most commonly reported data point for extrapolation of rotator cuff integrity. After 6.6 ± 3.1 years, 29.9 ± 20.7% of shoulders demonstrated superior humeral head migration and 17.9 ± 14.3% migrated a distance more than 25% of the head. This was associated with an 11.3 ± 7.9% incidence of postoperative superior cuff tears. The incidence of radiographic anterior humeral head migration was 11.9 ± 15.9%, corresponding to a 3.0 ± 13.6% rate of subscapularis tears. We found an overall 1.2 ± 4.5% rate of reoperation for cuff injury. Nearly all studies reported indirect markers of rotator cuff dysfunction, such as radiographic humeral head migration and clinical exam findings. This systematic review suggests that rotator cuff dysfunction following TSA may be more common than previously reported. IV, systematic review of Levels I-IV studies.
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Levy et al. (2016) conducted a systematic review in Primary glenohumeral osteoarthritis (n=1,259). Total shoulder arthroplasty was evaluated on Incidence of superior humeral head migration (indirect marker of rotator cuff dysfunction). Following total shoulder arthroplasty for primary osteoarthritis, 29.9% of shoulders demonstrated superior humeral head migration and 11.3% developed postoperative superior rotator cuff tears.
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