Difficulty in performing activities of daily living associated with internal rotation after reverse total shoulder arthroplasty

• Published in: Journal of shoulder and elbow surgery 2020-01, Vol.29 (1), p.86-94
• Main Authors: Kim, Myung Seo, Jeong, Ho Yeon, Kim, Jong Dae, Ro, Kyung Han, Rhee, Sung-Min, Rhee, Yong Girl
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder - methods; clinical outcome; cuff tear arthropathy; Female; Follow-Up Studies; Humans; internal rotation; Male; massive rotator cuff tear; Middle Aged; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Reverse total shoulder arthroplasty; Rotation; Rotator Cuff Injuries - physiopathology; Rotator Cuff Injuries - surgery; Rotator Cuff Tear Arthropathy - physiopathology; Rotator Cuff Tear Arthropathy - surgery; Shoulder Joint - physiopathology; Time Factors; Treatment Outcome
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2019.05.031

Reverse total shoulder arthroplasty (RSA) is a widely accepted treatment for irreparable massive rotator cuff tear (mRCT) and cuff tear arthropathy (CTA), but its impact on activities of daily living (ADLs) remains unclear. We retrospectively analyzed 77 patients (age range, 54-87 years; follow-up range, 36.1-120.3 months) with irreparable mRCT and CTA treated by medialized RSA between 2008 and 2015. Ten activities considered essential for daily living were selected and scored from 0 to 3. The mean visual analog scale scores during motion and University of California at Los Angeles and Constant scores significantly improved at final follow-up (all P < .001). Active forward flexion, external rotation at the side, and internal rotation to the posterior (IRp) were 92.5%, 79.6%, and 48.4% of the contralateral side, respectively, at final follow-up. Active forward flexion and external rotation at the side recovered within 6 months after surgery, similar to the level at final follow-up, but IRp did not reach the preoperative status until final follow-up. ADLs with mean scores of less than 2.0 at final follow-up were “wash the opposite shoulder,” “wash the opposite axilla,” “use a back pocket,” “manage the toilet,” and “wash the back” (only 36.4% of patients were able to wash their back at final follow-up). RSA for irreparable mRCT and CTA showed satisfactory clinical outcomes. However, IRp was associated with a limited range compared with the other shoulder motions; therefore, all ADLs associated with internal rotation demonstrated lower recovery rates than expected.