Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time?

Abstract

Background: The use of reverse shoulder arthroplasty has considerably increased since first introduced in 1985. Despite demonstrating early improvement of function and pain, there is limited information regarding the durability and longer-term outcomes of this prosthesis.

Questions/purposes: We determined complication rates, functional scores over time, survivorship, and whether radiographs would develop signs of loosening.

Patients and methods: We retrospectively reviewed 527 reverse shoulder arthroplasties performed in 506 patients between 1985 and 2003. Clinical and radiographic assessment was performed in 464 patients with a minimum followup of 2 years and 148 patients with a minimum followup of 5 years (mean, 7.5 years; range, 5-17 years). Cumulative survival curves were established with end points being prosthesis revision and Constant-Murley score of less than 30 points.

Results: Eighty-nine of 489 had at least one complication for a total of 107 complications. Survivorship free of revision was 89% at 10 years with a marked break occurring at 2 and 9 years. Survivorship to a Constant-Murley score of less than 30 was 72% at 10 years with a marked break observed at 8 years. We observed progressive radiographic changes after 5 years and an increasing frequency of large notches with long-term followup.

Conclusions: Although the need for revision of reverse shoulder arthroplasty was relatively low at 10 years, Constant-Murley score and radiographic changes deteriorated with time. These findings are concerning regarding the longevity of the reverse shoulder arthroplasty, and therefore caution must be exercised when recommending reverse shoulder arthroplasty, especially in younger patients.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

A graph shows the survival curve with removal of the reverse prosthesis or its conversion to hemiarthroplasty as the end point. The survival relating to removal of the reverse prosthesis or its conversion to hemiarthroplasty was 89% at 10 years.

Fig. 2

A graph shows the survival curve with an absolute Constant-Murley score of less than 30 points as the end point. The survival using a Constant-Murley score of less than 30 points was 72% at 10 years and showed a regular gradient with a break at approximately 8 years.