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Increase in reverse arthroplasty leads to utilization concerns

Orthopedics Today reports on the increase in shoulder arthroplasty procedures performed in the U.S., and how some orthopedic surgeons associate this increase with the FDA approval of the reverse total shoulder arthroplasty.

Orthopedics Today spoke to Joshua S. Dines, MD, sports medicine surgeon at HSS, who discussed the expanded indications, positive outcomes and the limitations of this procedure.

“We will use [reverse shoulder arthroplasty] for primary arthritis with significant glenoid bone deficiency. We will use it for people with irreparable or massive cuff tears where the rotator cuff is unlikely to heal. We will use it for trauma, [and] tumor reconstruction.” Dr. Dines added, “The indications have expanded and it has become a boon to the orthopedic practice and shoulder surgeons, in general. It has also become a great bail out for failed anatomic shoulder arthroplasty.” The original indication for reverse shoulder arthroplasty was rotator cuff tear arthropathy in patients older than 65 years of age.

When reverse anatomic total shoulder arthroplasty (TSA) was first used, the complication rate ranged from 30-50 percent. At 10 years, survivorship has improved to about 90 percent. However, following a reverse TSA, there are some functional limitations, such as internal rotation, and potential for patients to be at risk for revision, depending on the primary surgical indication. Dr. Dines explained, “If you are [doing a reverse shoulder arthroplasty] for cuff tear arthropathy, those results are great. There is a long survivorship and the results are excellent. If you are doing it for a traumatic malunion, there is a higher risk of instability, infection, [and] things of that nature.”

The level of difficulty to revise a failed primary reverse TSA is dependent on the cause of the failure. “When you have already taken a shoulder ... with a rotator cuff [tear] and now you put in a reverse, you completely changed the mechanics of the shoulder [and] you start running out of bone and soft tissue to work around, if it fails,” said Dr. Dines. He advised orthopedic surgeons who are interested in adding reverse TSA to their armamentarium to learn the intricacies of the procedure and understand its appropriate indications. Dr. Dines concluded, “While [reverse shoulder arthroplasty] works in the majority of cases, it is a patient’s last procedure in many cases and it does have a high complication rate in certain cases, especially with [surgeons] who have not [had a lot of experience with it].”

Read the full text article at Healio.com.