Document Type : RESEARCH PAPER
Johns Hopkins Department of Orthopedic Surgery, Charter Drive, Columbia, USA
Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington DC, USA
Massachusetts General Hospital, Department of Orthopedic Surgery, Boston, MA, USA
Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA
Objectives: Traditionally used to treat rotator cuff tear arthropathy (CTA), reverse total shoulder
arthroplasty (RTSA) is becoming increasingly utilized for the treatment of proximal humeral fractures
(PHF). The purpose of this study was to use a matched cohort analysis to assess differences in 90 -day
complications as well as 2-year and 5-year implant survival between patients undergoing RTSA for CTA
and patients undergoing RTSA for PHF.
Methods: Patients with at least a 5-year follow-up who underwent primary RTSA for either PHF or CTA were
identified in a national database (PearlDiver Technologies) using current procedural terminology (CPT) and
international classification of diseases (ICD) 9 and 10 codes. Patients with a surgical indication of PHF were matched
with patients with a surgical indication of CTA based on age, sex, Charlson Comorbidity Index, smoking status, and
obesity (body mass index (BMI)>30). All-cause revision at the 2-year and 5-year postoperative time intervals were
assessed. Reimbursements for the surgical care episode up to the 30-day, 90-day, and 1-year postoperative
intervals were also assessed. Bivariate analysis was performed with a significance set at P<0.05.
Results: In total, 802 PHF patients were matched with 802 CTA patients. Compared to CTA patients, PHF patients
undergoing RTSA were significantly at increased risk of atrial fibrillation, anemia, and heart failure within 90 days of
surgery. Notably, there was no significant difference in all-cause revision surgery at 2-year and 5-year postoperative
intervals or hospital reimbursements at the 30-day, 90-day, and 1-year postoperative intervals.
Conclusion: Preoperative indication appears to be an important driver of healthcare utilization for RTSA, as PHF
patients undergoing RTSA have a higher risk of short-term postoperative complications compared to CTA patients.
However, there is no difference in hospital reimbursement for the two indications of RTSA, suggesting that current
payment modalities may not appropriately adjust for risk based on the surgical indication.
Level of evidence: III