Outcomes and Complications of Failed Anatomic Shoulder Arthroplasty Revised with Reverse Arthroplasty: A Systematic Review.
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BACKGROUND: Reverse shoulder arthroplasty (RSA) is an increasingly utilized option to address complications following anatomic total shoulder arthroplasty (TSA). This systematic review aims to identify the patient outcomes, complication rates, and re-revision rates following revision to a reverse shoulder replacement from a failed anatomic total shoulder arthroplasty. METHODS: MEDLINE, EMBASE, and CENTRAL were searched from inception until November 21, 2023 to identify studies reporting outcomes and/or complications for patients with a failed TSA revised to an RSA. Primary outcomes included the intra- and postoperative complication rate and secondary surgery rate. Secondary outcomes included the mean post-revision improvement in the ASES score, pain, Constant score, SST score, and range of motion. RESULTS: From 1,347 records, 26 studies (730 patients) assessing RSA following a failed TSA were included. The most common indications for revision were rotator cuff tear (32%), loosening (12%), and instability (12%). Postoperatively, clinically important improvements were found for the ASES score, VAS pain, Constant score, flexion, and abduction. Following revision to RSA, complications occurred in 22% of patients, with implant failure being the most prevalent (25%). Secondary surgery after RSA occurred in 12% of patients. CONCLUSION: The revision of a failed TSA to an RSA resulted in clinically significant benefits. The most common indication for TSA revision was due to rotator cuff pathology, followed by instability and loosening. Despite the high potential for improved patient outcomes post-revision, the procedure is accompanied by a higher complication rate relative to primary RSA, with implant failure and fractures being the most common.
