Should we avoid shoulder surgery in wheelchair users? A systematic review of outcomes and complications.

INTRODUCTION: The prevalence of shoulder pathology in wheelchair dependent patients is high. The shoulder joint is critical for maintaining independence but traditionally there has been reluctance to offer surgical intervention in view of perceived poor outcomes. The aim of this study was to provide patients and surgeons with a realistic overview of outcomes following surgical intervention for shoulder pathology in wheelchair dependent patients.

METHODS: A systematic review of the online databases Medline and Embase was performed in September 2017. Studies reporting functional outcomes, complications or rate of revision surgery after shoulder surgery in patients' dependent on wheelchair for mobility were included. A narrative synthesis of the studies and appraisal using the MINORS tool was performed.

RESULTS: The search strategy identified 11 eligible studies; 7 assessed rotator cuff repair and 4-shoulder arthroplasty. Six of the seven studies reporting on rotator cuff repairs demonstrated improvement in pain, range of motion and functional outcomes with a retear rate between 12 and 39%. Although total shoulder arthroplasty and hemiarthroplasty reportedly improved pain and function, the subsequent risk of rotator cuff failure was reported up to 100%. The two studies assessing reverse arthroplasty demonstrated significant improvement in function and pain with the largest series reporting a 15.8% failure rate.

CONCLUSION: Rotator cuff repairs and reverse shoulder arthroplasties performed in wheelchair users are associated with significant functional improvement and a slightly higher complication profile to those performed in ambulatory patients. This review provides a resource to aid surgeons and patients in holding realistic expectations following shoulder surgery in wheelchair users.