Prior Shoulder Arthroscopy is Associated with Inferior Clinical Outcomes Following Primary Reverse Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy

Background Various patient-related and condition-related factors can influence the clinical benefits of reverse shoulder arthroplasty (RSA). With the emergence of new potential joint-preserving arthroscopic interventions, understanding the impact of shoulder arthroscopy prior to RSA is increasingly relevant. Therefore, the purpose of this study was to understand the impact of previous ipsilateral shoulder arthroscopy on outcomes and shoulder function following RSA for rotator cuff tear arthropathy. Methods Patients who underwent RSA for rotator cuff tear arthropathy from June 2016 to September 2020 by a single surgeon were retrospectively reviewed from a prospectively collected clinical database. Patients were separated into two groups: 1) patients who underwent RSA following prior ipsilateral shoulder arthroscopy (RSAPA) and 2) patients who underwent RSA without previous shoulder surgery (RSA). Patient-reported outcomes (PROs), including SST, ASES, UCLA score, SAS score, and active shoulder range of motion were measured preoperatively and at a minimum 2 years postoperative. Results A total of 103 patients (n=38 RSAPA and n=65 control RSA) were analyzed. The mean duration of follow-up for patients with prior ipsilateral shoulder arthroscopy was significantly shorter compared to the control patients (RSAPA=33 months and RSA=50 months, p < 0.0001). All PROs improved postoperatively (p < 0.001). Improvements in PROs for RSAPA were diminished relative to RSA control group patients, including SST (RSAPA=5.4 vs RSA=7.6, p = 0.005), ASES (RSAPA=40.8 vs RSA=54.7, p = 0.021), and UCLA (RSAPA=16 vs RSA=20.7, p = 0.009) scores. Improvements in forward flexion (RSAPA=69° vs RSA=95°, p = 0.0003) and abduction (RSAPA= 67° vs RSA=83°, p = 0.003) were decreased in the RSAPA group compared to the control group (RSA). One patient (1.5%) with prior shoulder arthroscopy required revision due to recurrent instability, whereas no patients in the control group required revision surgery (p=0.25). Conclusion Patients with rotator cuff tear arthropathy who underwent RSA following prior shoulder arthroscopy demonstrated significant improvements in function and patient-reported outcomes, but these outcomes are diminished compared to those patients with no history of surgery.