Purpose
To describe the national rates of failed primary rotator cuff repair (RCR) requiring
revision repair, using numerous patient characteristics previously defined in orthopaedic
literature, including smoking history, diabetes mellitus (DM), hyperlipidemia (HLD),
vitamin D deficiency, and osteoporosis to determine which factors independently affect
the success of primary RCR.
Methods
A combined public and private national insurance database was searched from 2007 to
2016 for all patients who underwent RCR. Current Procedural Terminology codes were
used to identify RCRs. Laterality modifiers for the primary surgery were used to identify
subsequent revision RCRs. All patients who did not have a linked laterality modifier
for the RCR Current Procedural Terminology code were excluded from the study. Basic
demographics were recorded. International Classification of Diseases Ninth Revision codes were used to identify patient characteristics including Charlson Comorbidity
Index, smoking status, DM, obesity, HLD, vitamin D deficiency, and osteoporosis. Patient
age categorized as <60, 60-69, 70-74, or 75+ years old. Dichotomous data were analyzed
with χ2 testing. Multivariable logistic regression was used to characterize independent associations
with revision RCR.
Results
Included in the study were 41,467 patients (41,844 shoulders, 52.7% male patients)
who underwent primary arthroscopic RCR. Of all arthroscopic RCRs, 3072 patients (3463
shoulders, 53.5% male patients) underwent revision RCR (8.38%). In both primary and
revision RCR, patients age 60 to 69 years were most prevalent, accounting for 38.4%
and 37.6% of the cohorts, respectively. The average time from primary RCR to revision
was 414.9 days (median 214.0 days). Increasing age and male sex (odds ratio [OR] 1.10,
P = .019, 95% confidence interval [CI] 1.02-1.19) were significantly predictive of
revision RCR. Of the remaining patient characteristics, smoking most strongly predicted
revision RCR (OR 1.36, P < .001, CI 1.23-1.49). Obesity (OR 1.32, P < .001, CI 1.21-1.43), hyperlipidemia (OR 1.09, P = .032, CI 1.01-1.18), and vitamin D deficiency (OR 1.18, P < .001, CI 1.08-1.28) also increased risk of revision RCR significantly. DM was found
to be protective against revision surgery (OR 0.84, P < .001, CI 0.76-0.92). Overall comorbidity burden as measured by the Charlson Comorbidity
Index was not predictive of revision RCR.
Conclusions
Smoking, obesity, vitamin D deficiency, and HLD are shown to be independent risk factors
for failure of primary RCR requiring revision RCR. However, despite the suggestions
of previous studies, DM, osteoporosis, and overall comorbidity burden did not demonstrate
independent associations in this study.
Level of Evidence
IV, Case Series
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Article Info
Publication History
Published online: July 09, 2020
Accepted:
May 12,
2020
Received:
November 14,
2019
See commentary on page 2389Footnotes
The authors report the following potential conflicts of interest or sources of funding: J.S.D. reports personal fees from Arthrex , Thieme, and Wolters Kluwer Health – Lippincott, Williams & Wilkins, outside the submitted work. In addition, he has a patent with Linvatec, with royalties paid. D.M.D. reports personal fees from Biomet , Thieme, and Wright Medical Technology, outside the submitted work. In addition, he has a patent with Zimmer with royalties paid. L.V.G. reports grants and personal fees from Biomet , other from Imagen, other from Responsive Arthroscopy, personal fees from Smith & Nephew, outside the submitted work. In addition, he has a patent with Exactech, with royalties paid. S.A.T. reports personal fees from DJ Orthopaedics and personal fees from Mitek, outside the submitted work. R.F.W. reports other from OrthoNet, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America
