Table 1: ROM of PRSA versus SRSA
ROM
|
PRSA
|
SRSA
|
P-value
|
Flexion
|
125° (SD: 39.6)
|
122° (SD: 35.3)
|
.598
|
Abduction
|
118° (SD: 38.2)
|
107° (SD: 32.3)
|
.184
|
ER
|
17° (SD: 18.7)
|
14° (SD: 17.8)
|
.552
|
IR
|
4 po (SD: 2.6)
|
3 po (SD: 1.9)
|
.169
|
No statistical relevancies were observed by differentiation in PRSA and PRSA; good functional results could be shown in both groups. Flexion, abduction, and ER are depicted in degrees, IR in points according to a subitem of Constant Score. The values are presented on average.
(ER – external rotation, IR – internal rotation, po - points ROM – range of motion, FRSA – fracture reversed total shoulder arthroplasty, PRSA – primary reversed total shoulder arthroplasty, SRSA – secondary reversed total shoulder arthroplasty, SD – standard deviation)
Table 2: ROM of SRSA
ROM
|
HHN SRSA
|
fORIF SRSA
|
THA SRSA
|
Flexion
|
137° (SD: 27.1)
|
96° (SD: 34.6)
|
142° (SD: 22.2)
|
Abduction
|
117° (SD: 29.6)
|
85° (SD: 23.6)
|
137° (SD: 25.0)
|
ER
|
13° (SD: 17.0)
|
7° (SD: 6.3)
|
27° (SD: 21.3)
|
IR
|
3 po (SD: 1.3)
|
3 po (SD: 1.4)
|
5 po (SD: 3.5)
|
|
|
|
|
|
A statistically relevant decrease of flexion (p = .046) and abduction (p = .037) was revealed in the SRSA subgroup following fORIF; all other values were similar. Flexion, abduction, and ER are depicted in degrees, IR in points according to a subitem of Constant score. Significant results are bold-marked. The values are presented on average.
(ER – external rotation, fORIF SRSA – reversed total shoulder arthroplasty following failed open reduction and internal fixation, HHN RSA – reversed total shoulder arthroplasty following humeral head, IR – internal rotation, po – points, ROM – range of motion, SD – standard deviation, THA - SRSA – reversed total shoulder arthroplasty following trauma hemiarthroplasty)
Table 3: Scores of PRSA versus SRSA
SCORES
|
PRSA
|
SRSA
|
P-value
|
VAS
|
1.1 (SD: 2.0)
|
0.9 (SD: 1.3)
|
.573
|
CS
|
60 (SD: 16.7)
|
56 (SD: 15.1)
|
.204
|
nCS
|
74 (SD: 19.7)
|
69 (SD: 18.1)
|
.211
|
QD
|
23 (SD: 20.7)
|
25 (SD: 16.7)
|
.291
|
SSV
|
76% (SD: 18.7)
|
75% (SD: 15.1)
|
.558
|
Similar results without statistical significance were evaluated in all scores. The SSV is displayed in percent, all other scores in points. The values are presented on average.
(CS – absolute Constant Score, nCS – normative Constant Score, FRSA – fracture reversed total shoulder arthroplasty, PRSA – primary reversed total shoulder arthroplasty, QD – Quick DASH, SD – standard deviation, SRSA – secondary reversed total shoulder arthroplasty, SSV – Subjective Shoulder Value, VAS – Visual Analog Scale)
Table 4: Scores of SRSA
SCORES
|
HHN SRSA
|
fORIF SRSA
|
THA SRSA
|
VAS
|
0.7 (SD: 1.3)
|
1.3 (SD: 1.5)
|
0.5 (SD: 1.0)
|
CS
|
58 (SD: 13.1)
|
52 (SD: 16.9)
|
69 (SD: 9.1)
|
nCS
|
70 (SD: 15.7)
|
62 (SD: 20.5)
|
83 (SD: 11.0)
|
QD
|
19 (SD: 9.2)
|
34 (SD: 22.2)
|
18 (SD: 7.6)
|
SSV
|
78% (SD: 15.5)
|
72% (SD: 16.2)
|
78% (SD: 12.6)
|
The subgroup differentiation revealed no statistical significance and comparable results in all groups (all scores p ≥ 0.05). The SSV is displayed in percent, all other scores in points. The values are presented on average.
(CS – Constant Score, fORIF SRSA – reversed total shoulder arthroplasty following failed open reduction and internal fixation, HHN SRSA – reversed total shoulder arthroplasty following humeral head necrosis, nCS – normative Constant score, PRSA – primary reversed total shoulder arthroplasty, QD – Quick DASH, SD – standard deviation, SRSA – secondary reversed total shoulder arthroplasty, SSV – Subjective Shoulder Value, THA SRSA – reversed total shoulder arthroplasty following trauma hemiarthroplasty, VAS – Visual Analog Scale)
Table 5: Clinical outcome of early versus late time from index to SRSA surgery
SCORES
|
<12 MONTHS
|
>12 MONTHS
|
P-value
|
VAS
|
0.95 (SD: 1.2)
|
0.875 (SD: 1.4)
|
.885
|
CS
|
55 (SD: 14.1)
|
57 (SD: 16.1)
|
.831
|
nCS
|
68 (SD: 16.8)
|
69 (SD: 19.4)
|
.883
|
QD
|
27 (SD: 21.7)
|
23 (SD: 13.1)
|
.533
|
SSV
|
75% (SD: 16.0)
|
76% (SD: 14.5)
|
.882
|
No statistical relevancies were observed; good functional results could be shown in both groups. The SSV is displayed in percent, all other scores in points. The values are presented on average.
(CS – Constant Score, nCS – normative Constant Score, QD – Quick DASH, RSA – reversed total shoulder arthroplasty, SD – standard deviation, SRSA – secondary reversed total shoulder arthroplasty, SSV – Subjective Shoulder Value, VAS – Visual Analog Scale)
Table 6 - Radiographic tubercle changes of PRSA and SRSA
LOCALISATION
|
PRSA
|
SRSA
|
P-value
|
Major tubercle
|
31% (n = 13/42)
|
11% (n = 2/26)
|
|
Minor tubercle
|
|
|
|
Both tubercles
|
9% (n = 4/42)
|
|
|
TOTAL
|
40% (n = 17/42)
|
8% (n = 2/26)
|
.006
|
Statistically, significant positive tubercle changes were evaluated in the PRSA group; radiological changes contained dislocations and (partial) resorptions in this group. In the SRSA group, only postoperative partial resorptions were detected. Significant values are bold-marked.
(PRSA – primary reversed total shoulder arthroplasty, SD – standard deviation, SRSA – secondary reversed total shoulder arthroplasty)
Table 7 – Clinical outcome of healed versus non-healed tubercles
SCORES and ROM
|
HEALED
|
NON-HEALED
|
P-value
|
VAS
|
0.7 (SD: 1.3)
|
1.6 (SD: 2.5)
|
.162
|
CS
|
62 (SD: 14.1)
|
52 (SD: 19.5)
|
.029
|
nCS
|
75 (SD: 17.3)
|
64 (SD: 22.7)
|
.021
|
QD
|
19 (SD: 13.4)
|
34 (SD: 25.4)
|
.002
|
SSV
|
79% (SD: 14.4)
|
68% (SD: 21.0)
|
.017
|
Flexion
|
129° (SD: 36.4)
|
114° (SD: 39.6)
|
.125
|
Abduction
|
118° (SD: 37.7)
|
107° (SD: 35.3)
|
.245
|
ER
|
19.79° (SD: 19.1)
|
8° (SD: 15.8)
|
.019
|
IR
|
4 po (SD: 2.2)
|
3 po (SD: 2.6)
|
.355
|
|
|
|
|
|
Significant positive values were observed via healed tubercles. Flexion, abduction, and ER are displayed in degrees, IR in points according to a subitem of Constant Score. The SSV is displayed in percent, all other scores in points. Significant results are bold-marked. The values are presented on average.
(CS – Constant Score, ER – external rotation, IR – internal rotation, nCS – normative Constant Score, po – points, QD – Quick DASH, ROM – range of motion, SD – standard deviation, SSV – Subjective Shoulder Value, VAS – Visual Analog Scale)
Table 8 - Grade of scapular notching of PRSA and SRSA
NOTCHING
|
PRSA
|
SRSA
|
P-value
|
Grade 1
|
14% (n = 6/42)
|
12% (n = 3/26)
|
.598
|
Grade 2
|
5% (n = 2/42)
|
15% (n = 4/26)
|
.684
|
Grade 3
|
2% (n = 1/42)
|
|
|
Grade 4
|
|
|
|
In total
|
21% (n = 9/42)
|
27% (n = 7/26)
|
.687
|
Similar notching rates without statistical relevance were observed in both groups.
(PRSA – primary reversed total shoulder arthroplasty, SD – standard deviation, SRSA – secondary reversed total shoulder arthroplasty)
Table 9 - Adverse events
|
EVENT
|
MONTHS
|
INTERVENTION
|
CLASSIFICATION
|
1
|
spontaneous muscle hematoma (OAC)
|
60
|
conservative
|
minor
|
2
|
spontaneous muscle hematoma (OAC)
|
35
|
conservative
|
minor
|
3
|
instability with dislocation
|
10
|
inlay change
|
major
|
4
|
major tubercle impingement
|
7
|
conservative
|
minor
|
5
|
traumatic periprosthetic fracture (accident)
|
131
|
ORIF
|
major
|
6
|
scapular spine fracture
|
116
|
conservative
|
minor
|
7
|
shaft loosening
|
70
|
conservative (non vult)
|
major
|
8
|
traumatic periprosthetic fracture (fall)
|
25
|
ORIF
|
major
|
9
|
plexus neuropraxia
|
perioperative
|
conservative
|
minor
|
Displayed are major and minor complications of total FU in all patients. Their several time- and event-specifications are depicted. The time from RSA implantation to each adverse event is presented in months. The numbers from 1 to 7 involve PRSA patients, from 8 to 9 SRSA patients. Multiple events are possible in one patient.
(FU – follow-up, OAC - oral anticoagulants, ORIF – open reduction and internal fixation, PRSA – primary reversed total shoulder arthroplasty, RSA – reversed total shoulder arthroplasty, SRSA – secondary reversed total shoulder arthroplasty)