Characteristics of Rotator Cuff Repairs Revised to Shoulder Arthroplasty

Document Type : RESEARCH PAPER

Authors

1 Medical College of Wisconsin, Milwaukee, WI 2 University of California Irvine School of Medicine, Irvine, CA, USA

2 University of California Irvine School of Medicine, Irvine, CA, USA

3 Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA

4 Department of Orthopedics, The Permanente Medical Group, Sacramento, CA, USA

5 Department of Orthopedics, Southern California Permanente Medical Group, Harbor City, CA, USA

Abstract

Background: Successful repair of a torn rotator cuff may prevent progression to rotator cuff arthropathy. However,
previous studies have shown a substantial rate of failure after rotator cuff repair and characteristics of surgically
repaired rotator cuffs that go on to shoulder arthroplasty have not been fully elucidated. The purpose of this study was
to determine the patient characteristics and rate at which patients who underwent rotator cuff repair progressed to
shoulder arthroplasty.
Methods: This was a retrospective study of patients who underwent rotator cuff repair in a large, closed healthcare
system in 2008. The EMR was queried for rotator cuff repair CPT with ICD-9 codes for rotator cuff. The resultant dataset
was then cross-referenced with a separate internal shoulder arthroplasty registry to determine which patients went onto
shoulder arthroplasty. Demographic variables, descriptors of tear pathology and repair characteristics were collected
and compared between patients who subsequently underwent shoulder arthroplasty and those that did not.
Results: A total of 882 rotator cuff repair patients were included within this study. Of the initial 882 cuff repairs, there
were 12 patients (1.4%) that went on to have arthroplasty. Patients who underwent shoulder arthroplasty after rotator
cuff repair were significantly older at time of surgery and had greater comorbidity burdens. Patients who ended up with
shoulder arthroplasty had the procedure an average of 4.77 ± 3.28 (SD) years after rotator cuff repair, with 11 of 12
patients having a diagnosis of rotator cuff arthropathy at the time of shoulder replacement.
Conclusion: In a closed system, tracking rotator cuff repairs over 9.1 years revealed a small number that went on
to subsequent shoulder arthroplasty. Patients who underwent shoulder arthroplasty were significantly older and had
greater comorbidity burdens than those who did not. Patients who underwent shoulder arthroplasty usually either
had shoulder arthroplasty within 1 year or after 5 years. Enhanced understanding of which patients may progress to
arthroplasty may provide a better initial choice of operative intervention in those patients.
Level of evidence: III

Keywords

References

1. Dornan GJ, Katthagen JC, Tahal DS, Petri M, Greenspoon
JA, Denard PJ, et al. Cost-effectiveness of arthroscopic
rotator cuff repair versus reverse total shoulder
arthroplasty for the treatment of massive rotator cuff
tears in patients with pseudoparalysis and nonarthritic
shoulders. Arthroscopy: The Journal of Arthroscopic &
Related Surgery. 2017; 33(4):716-25.
2. Shamsudin A, Lam PH, Rubenis I, Peters KS, Murrell
GA. Primary versus Revision Arthroscopic Rotator
Cuff Repair-An Analysis in 350 Consecutive Patients.
Orthopaedic Journal of Sports Medicine. 2014; 2(3_
suppl):2325967114S00016.
3. Sherman SL, Lyman S, Koulouvaris P, Willis A, Marx
RG. Risk factors for readmission and revision surgery
following rotator cuff repair. Clinical orthopaedics
and related research. 2008; 466(3):608-13.
4. Boileau P, Gonzalez JF, Chuinard C, Bicknell R, Walch
G. Reverse total shoulder arthroplasty after failed
rotator cuff surgery. Journal of shoulder and elbow
surgery. 2009; 18(4):600-6.
5. Boileau P, Brassart N, Watkinson DJ, Carles M,
Hatzidakis AM, Krishnan SG. Arthroscopic repair of
full-thickness tears of the supraspinatus: does the
tendon really heal? JBJS. 2005; 87(6):1229-40.
6. Chalmers PN, Salazar DH, Steger-May K, Chamberlain
AM, Stobbs-Cucchi G, Yamaguchi K, et al. Radiographic
progression of arthritic changes in shoulders with
degenerative rotator cuff tears. Journal of shoulder
and elbow surgery. 2016; 25(11):1749-55.
7. Keener JD, Hsu JE, Steger-May K, Teefey SA,
Chamberlain AM, Yamaguchi K. Patterns of tear
progression for asymptomatic degenerative rotator
cuff tears. Journal of shoulder and elbow surgery.
2015; 24(12):1845-51.
8. Mall NA, Kim HM, Keener JD, Steger-May K, Teefey
SA, Middleton WD, et al. Symptomatic progression of
asymptomatic rotator cuff tears: a prospective study
of clinical and sonographic variables. The Journal
of Bone and Joint Surgery. American volume. 2010
92(16):2623.
9. Paxton EW, Inacio MC, Kiley ML. The Kaiser
Permanente implant registries: effect on patient
safety, quality improvement, cost effectiveness, and
research opportunities. The Permanente Journal.
2012; 16(2):36.
10. Dillon MT, Ake CF, Burke MF, Singh A, Yian EH,
Paxton EW, et al. The Kaiser Permanente shoulder
arthroplasty registry: results from 6,336 primary
shoulder arthroplasties. Acta orthopaedica. 2015;
86(3):286-92.
11. Frank JB, ElAttrache NS, Dines JS, Blackburn A, Crues
J, Tibone JE. Repair site integrity after arthroscopic
transosseous-equivalent suture-bridge rotator cuff
repair. The American journal of sports medicine.
2008; 36(8):1496-503.
12. Park JS, Park HJ, Kim SH, Oh JH. Prognostic factors
affecting rotator cuff healing after arthroscopic repair
in small to medium-sized tears. The American journal
of sports medicine. 2015; 43(10):2386-92.
13. Diebold G, Lam P, Walton J, Murrell GA. Relationship
between age and rotator cuff retear: a study of
1,600 consecutive rotator cuff repairs. JBJS. 2017;
99(14):1198-205.
14. Harreld KL, Puskas BL, Frankle M. Massive rotator cuff
tears without arthropathy: when to consider reverse
shoulder arthroplasty. JBJS. 2011; 93(10):973-84.
15. Berglund DD, Kurowicki J, Giveans MR, Horn B, Levy
JC. Comorbidity effect on speed of recovery after
arthroscopic rotator cuff repair. JSES open access.
2018; 2(1):60-8.
16. Cho NS, Moon SC, Jeon JW, Rhee YG. The influence of
diabetes mellitus on clinical and structural outcomes
after arthroscopic rotator cuff repair. The American
journal of sports medicine. 2015; 43(4):991-7.
17. Werner B, Cancienne J, Brockmeier S, Rodeo S.
Perioperative Serum Lipid Status and Statin Use Affect
Revision Surgery Rate after Arthroscopic Rotator Cuff
Repair. Arthroscopy. 2017; 33(6):e26.
18. Galatz LM, Ball CM, Teefey SA, Middleton WD,
Yamaguchi K. The outcome and repair integrity 
of completely arthroscopically repaired large and
massive rotator cuff tears. JBJS. 2004; 86(2):219-24.
19. Mascarenhas R, Chalmers PN, Sayegh ET, Bhandari
M, Verma NN, Cole BJ, et al. Is double-row rotator
cuff repair clinically superior to single-row rotator
cuff repair: a systematic review of overlapping metaanalyses.
Arthroscopy: The Journal of Arthroscopic &
Related Surgery. 2014; 30(9):1156-65.
20. Moosmayer S, Tariq R, Stiris M, Smith HJ. The natural
history of asymptomatic rotator cuff tears: a three-year
follow-up of fifty cases. JBJS. 2013; 95(14):1249-55.
The Archives of Bone and Joint Surgery
Volume 8, Issue 5
September 2020
Pages 575-580

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History

  • Receive Date: 09 July 2019
  • Accept Date: 05 February 2020

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