Shoulder
Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis

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Background

Despite improved results with reverse shoulder arthroplasty (RSA), questions still remain regarding certain technical aspects of the operation. One particular area of question is the effect of subscapularis repair on complication rates, dislocation, pain, and overall range of motion. Some authors suggest that when a deltopectoral approach is used, not repairing the subscapularis leads to a higher complication rate, especially for dislocation.

Materials and methods

From a reverse total shoulder arthroplasty database of 3 surgeons at 1 institution, we identified 55 patients who underwent RSA using the deltopectoral approach without subscapularis repair and 65 patients with subscapularis repair.

Results

Complications were documented in 11 of 55 shoulders (20%) without subscapularis repair and in 13 of 65 shoulders (20%) with subscapularis repair. Dislocation occurred in 3 shoulders in the nonrepair group and in 2 shoulders in the repair group. These data indicate that nonrepair of the subscapularis did not have a significant effect on the risk of any complication, dislocation, infection, disassociation, or function.

Conclusion

Repairing the subscapularis has no appreciable effect on complication rate, dislocation events, or range of motion gains and pain relief.

Section snippets

Materials and methods

A retrospective review was conducted of the records of 154 patients who underwent RSA from June 2003 through August 2009 by 3 fellowship-trained shoulder surgeons. Patients were excluded if less than 6 months of clinical follow-up was available or if the operative note contained no mention of whether the subscapularis was repaired or irreparable at the conclusion of the procedure.

Data extracted from the records that could be used in analysis included general patient demographics, affected side,

Results

After application of exclusion criteria, 120 shoulders in 111 patients were available for analysis. The subscapularis was repaired in 65 shoulders (54.2%) and was not repaired in 55 (45.8%). The study group consisted of 31 male shoulders (26%) and 89 female shoulders (74%). Average age for the entire group was 68.5 years and was 67.3 years for men and 68.9 years for women. Follow-up ranged from 6 to 62 months, but was longer among patients who received a subscapularis repair (13.2 [standard

Discussion

Subscapularis integrity in relation to complications and dislocation after RSA has attracted much attention in recent publications. Boileau et al3 suggested in 2005 that an anterosuperior transdeltoid approach might decrease instability after RSA because of the preservation of the subscapularis. On the other hand, Wall et al28 using the Delta III (DePuy France, Saint Priest, France) and Aequalis Reversed (Tornier Inc, Eden Prairie, MN, USA) implants through a deltopectoral approach reported

Conclusion

If the subscapularis is not repaired using the RSP through a deltopectoral approach, there is no significant effect on postoperative complication or dislocation rates. Range of motion gains for active forward flexion, external rotation, and internal rotation also seem to be comparable between subscapularis-repair and nonrepair groups. Similar decreases in visual analog pain scores should also be expected.

Disclaimer

This study was supported by DJO Surgical.

Michael J. Kissenberth and Richard J. Hawkins are on the Board of Directors of the Orthopaedic Research Foundation of the Carolinas (ORFC). DJO Surgical provides research support to the ORFC. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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    This project was approved by the Institutional Review Board of Greenville Hospital System (Pro00000867).

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