Clinical Outcomes of Upper Extremity Ambulators Post Reverse Total Shoulder Arthroplasty

Abstract Background Patients requiring upper extremity assist devices such as canes, walkers, and wheelchairs have shown an increased incidence of rotator cuff tears (RCTs), distal clavicle osteolysis, and osteoarthritis. The frequent combination of glenohumeral arthritis and RCTs (rotator cuff arthropathy) makes Reverse Total Shoulder Arthroplasty (rTSA) an attractive option in treating the shoulder pathology in these patients. The objective of this study is to determine the effectiveness of the rTSA procedure for treatment of shoulder pathology in the upper extremity ambulator population, and what role preoperative functional status plays on outcomes. Methods The study involved a retrospective analysis of 30 upper extremity ambulator patients (ages 48-88, average = 72.54 years) who underwent a rTSA procedure performed by the senior author (S.G.) in Milwaukee, WI, USA. Of these 30, 5 patients received bilateral rTSAs, for a total of 35 procedures. Average follow-up for these patients was 32 months, (range 24-84 months). The following preoperative and postoperative characteristics were recorded for each patient: range of motion, Visual Analog Scale (VAS) scores, American Shoulder and Elbow Surgeons (ASES) scores, Constant Murley scores, and Simple Shoulder Test (SST) scores. Data was analyzed using ANCOVA analysis. Results Average VAS scores improved from 6.40 to 2.08 (gain = 4.362; p Conclusion This study shows that rTSA reliably leads to significant postoperative improvements in range of motion, function, and pain relief in the upper extremity ambulator population. Patients with lower preoperative scores showed overall higher gains in both pain and function postoperatively, ultimately leading to similar postoperative outcomes to those who started at a high baseline function. These gains were irrespective of a patient's other preoperative characteristics, including diagnosis of diabetes, preoperative opioid use, and the type of upper extremity assist device used. Level of Evidence: Level III