title: Reverse total shoulder arthroplasty with combined deltoid reconstruction in patients with anterior and/or middle deltoid tears.
abstract: OBJECTIVE
  Deltoid disruption has traditionally been an absolute contraindication to performing a reverse total shoulder arthroplasty (RTSA), and options available to patients have been limited. We present a series of patients with deltoid tears that underwent concomitant RTSA with deltoid reconstruction. We hypothesize that this combined procedure provides an acceptable, functional alternative for this complex patient population.
  
  
  METHODS
  We retrospectively identified all patients who were treated by a single surgeon with a concomitant RTSA and deltoid reconstruction from 2004 to 2012 with minimum 24-month follow-up. Six shoulders in 5 patients met these criteria. The mean age was 69 years (range, 61-79 years), and the mean follow-up period was 76.8 months (range, 24-133 months). We compared preoperative and postoperative range of motion and Penn Shoulder Scores, including subscores, using paired t tests.
  
  
  RESULTS
  Mean forward elevation and external rotation increased from 48° and 12°, respectively, to 120° and 22°, respectively. Penn scores increased from 45.2 to 77.8 postoperatively (P = .03). The Penn satisfaction subscore, in particular, improved from 1.1 (of 10) to 9.0 (P = .005). There was a low rate of recurrent deltoid failure (1 of 6 shoulders), and there were no infections or revisions.
  
  
  CONCLUSIONS
  Deltoid reconstruction at the same time as RTSA is a viable treatment option as a salvage procedure for patients with deltoid deficiency who otherwise need RTSA for treatment of massive rotator cuff deficiency. In this small series, simultaneous RTSA and deltoid reconstruction resulted in a functional shoulder with a high level of satisfaction and good motion.
  
  
  METHODS
  Level IV; Case Series; Treatment Study.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA. Electronic address: marinep@ccf.org.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Marinello
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Amini
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Peers
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: O'Donnell
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Iannotti
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder; D057645:Deltoid Muscle / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D057234:Preoperative Period; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012399:Rotation; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Deltoid deficiency; RTSA; contraindication; cuff tear arthropathy; deltoid; reverse total shoulder arthroplasty