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. 2024 Aug 29;12(8):23259671241253282.
doi: 10.1177/23259671241253282. eCollection 2024 Aug.

Outcomes of Total Shoulder Arthroplasty With and Without Prior Rotator Cuff Repair: A Systematic Review

Jack C Hop  1 , John W Belk  1 , Braden K Mayer  1 , Rachel M Frank  1 , Adam J Seidl  1 , Eric C McCarty  1 , Jonathan T Bravman  1
Affiliations

Outcomes of Total Shoulder Arthroplasty With and Without Prior Rotator Cuff Repair: A Systematic Review

Jack C Hop et al. Orthop J Sports Med. .

Abstract

Background: The effect of prior rotator cuff repair (RCR) on clinical outcomes after total shoulder arthroplasty (TSA) is unclear.

Purpose: To systematically review the literature to compare the outcomes of TSA in patients with and without prior RCR.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching the PubMed, Cochrane Library, and Embase databases to identify studies comparing outcomes of TSA with and without prior RCR. The inclusion criteria were full-text studies that directly compared outcomes between patients undergoing anatomic or reverse TSA with and without prior RCR. A quality assessment was performed using the Modified Coleman Methodology Score (MCMS), and risk of bias assessment was performed using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. A total of 1542 articles were identified for review based on initial database queries. Weighted means of quantifiable demographics and patient-reported outcomes were calculated for all included studies and compiled, in addition to the MCMS and ROBINS-I tool.

Results: Twelve studies (10 level 3, 2 level 4) met inclusion criteria, including a total of 885 patients who underwent RCR before TSA (mean age, 68.2 years) and 2275 patients with no prior RCR (mean age, 70.0 years). Of all outcomes evaluated, patients with reverse TSA showed superior results in the no prior RCR group. Three reverse TSA studies found the no prior RCR group to have significantly higher postoperative American Shoulder and Elbow Surgeons scores when compared with the prior RCR group (P < .05). Multiple reverse TSA studies found the no prior RCR group to have significantly higher postoperative Simple Shoulder Test scores (P < .05) and significantly improved forward elevation (P < .05) when compared with the prior RCR group. Of all outcomes in anatomic TSA studies, only complication rate was different between groups, with 1 study finding a significantly lower complication rate in the no prior RCR group (P = .01).

Conclusion: Patients undergoing reverse TSA without prior RCR can be expected to experience statistically better outcomes when compared with patients with prior RCR, while patients undergoing anatomic TSA can be expected to have similar outcomes regardless of prior RCR status.

Keywords: arthroplasty; rotator cuff; shoulder; total shoulder replacement.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.K.M. has received hospitality payments from Stryker, Arthrosurface, and Medical Device Business Services and compensation for services other than consulting from Arthrosurface. R.M.F. has received consulting fees from Arthrex and compensation for services other than consulting from Arthrex; education payments from Arthrex, Gemini Mountain Medical LLC, and Pinnacle; and hospitality payments from Gemini Mountain Medical LLC, Joint Restoration Foundation, Smith+Nephew, Arthrex, and Stryker. A.J.S. has received consulting fees from Encore Medical and Medacta USA, honoraria from Encore Medical, and education payments from Arthrex. E.C.M. has received consulting fees from DePuy Synthes Products, Medical Device Business Services, Pacira Therapeutics, and Zimmer Biomet Holdings; royalty or license from Zimmer Biomet Holdings; education payments from Gemini Mountain Medical LLC; and compensation for services other than consulting from Arthrex. J.T.B. has received consulting fees from Encore Medical and Smith+Nephew, compensation for services other than consulting from Smith+Nephew, and education payments from Smith+Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval was not sought for the present study.

Figures

Figure 1.
Figure 1.
A flow diagram of the authors’ electronic search strategy after PRISMA guidelines. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RA, rheumatoid arthritis; RCR, rotator cuff repair.
Figure 2.
Figure 2.
Bar graph presenting risk of bias as a percentage across all included studies (green, low risk; yellow, unclear; red, high risk).
See this image and copyright information in PMC

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