Reverse total shoulder arthroplasty improves function in cuff tear arthropathy.
BACKGROUND
Early failure due to glenoid loosening with anatomic total shoulder arthroplasty in patients with severe rotator cuff deficiency led to the development of the reverse ball-and-socket shoulder prosthesis. The literature reports improved short-term pain and function scores following modern reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy (CTA).


OBJECTIVE
We therefore sought to confirm previously reported short-term improvements in pain, function scores, and range of motion, in patients treated with RTSA for CTA and to identify clinical complications and radiographic notching.


METHODS
We retrospectively reviewed 67 patients who underwent 71 primary RTSAs for CTA. The average age was 74 years (range, 54-92 years). All were preoperatively and postoperatively assessed using Constant-Murley and American Shoulder and Elbow Society (ASES) scores. We identified complications and examined radiographs for notching. The minimum followup was 12 months (average, 24 months; range, 12-58 months).


RESULTS
Average Constant-Murley scores improved from 28 preoperatively to 62 postoperatively. Average ASES scores improved from 26 to 76. Subjective Shoulder Value (SSV) improved from 23 to 77. Active forward flexion improved from 61° preoperatively (range, 0°-137°) to 121° postoperatively (range, 52°-170°). Active external rotation was not affected. Thirty-five of the 71 shoulders (49%) showed radiographic notching. The overall complication rate was 23%. No patient required reoperation. One patient required closed reduction of a perioperative dislocation.


CONCLUSIONS
RTSA for CTA results in functional improvement, with a low complication rate. However, the longevity of the device is currently unknown.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Indiana University School of Medicine, Indiana University, 541 Clinical Drive, Suite 600, Indianapolis, IN 46202, USA. shoulderandelbowdoc@gmail.com
Betsy M
BM
Nolan
Elizabeth
E
Ankerson
J Michael
JM
Wiater
D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008824:Michigan; D008875:Middle Aged; D053580:Muscle Strength; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome