Effect of Implant Size, Version and Rotator Cuff Tendon Preservation on the Outcome of Reverse Shoulder Arthroplasty

Introduction: Functional outcomes following reverse geometry shoulder arthroplasty can vary. This study assessed the effects of glenosphere size, humeral stem version, posterior rotator cuff status and subscapularis repair on patient-reported outcome and range of motion. Methods: A consecutive series of 132 patients from two orthopaedic centres that use the same onlay system for reverse shoulder arthroplasty were reviewed over a six-year period. Outcome measures consisted of the Oxford Shoulder score (OSS) and range of motion (ROM) at one year following surgery. These were assessed against glenosphere sizes (small (36-38 mm) and large (40-42 mm)), humeral stem retroversion (less or more than 20 degrees), rotator cuff status (posterior rotator cuff present or absent) and subscapularis tendon (repaired or not) at the end of procedure. Results: Larger glenospheres and less humeral stem retroversion yielded better ROM and OSS but this was not statistically significant. Subscapularis repair had no effect on outcomes. Preservation of posterior rotator cuff tendons improved functional outcomes. The number of tendons present at the end of procedure had a positive effect on outcome (best with two tendons and better with one compared to a completely bald humeral head). Conclusion: Preservation of posterior rotator cuff tendons during reverse shoulder arthroplasty improves clinical outcomes unlike subscapularis repair which was found to be unnecessary. Implant size and version in reverse geometry arthroplasty have no significant effects on clinical outcome.