Grant: Project Grant

Shoulder replacement surgeries are increasing worldwide at a rate three times faster than either hip or knee replacements. This is largely due to the advent of the reverse total shoulder replacement (RTSA). This surgery treats more conditions than a regular shoulder replacement. One key question that remains unanswered is whether one of the muscles of the rotator cuff, specifically the subscapularis muscle, should be repaired or not. Surgeons who support the subscapularis repair argue it reduces the risk of shoulder dislocation after RTSA. While this was historically true, new shoulder implants have very low dislocation rates, leaving many to question if repairing the subscapularis makes outcomes worse. Some studies have shown that repair may limit shoulder motion, reduce function, prolong operating time, and increase surgical costs. No high-level studies have been conducted to answer this important question. The aim of our study is to conduct a high-quality, randomized trial comparing outcomes of RTSA with and without subscapularis repair. Patients requiring RTSA will be randomly assigned to one of two groups: 1) RTSA with a subscapularis repair or 2) RTSA without a repair. Patients will be followed for 2 years after their surgery. The main objective is to compare pain, shoulder movement and strength experienced by patients, and number of dislocations. A cost-benefit analysis of operating room resources and the need for additional surgeries will also be performed. This ground-breaking study will provide evidence to support or negate the ongoing use of subscapularis repair in RTSA in order to optimize patient outcomes and manage scarce health care resources.