Characteristics of Rotator Cuff Repairs Revised to Shoulder Arthroplasty

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.