Reverse total shoulder arthroplasty improves function in cuff tear arthropathy

Abstract

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).

Questions/purposes: 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.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Figures

Fig. 1

A diagram of measurement of prosthesis-scapular border angle (PSBA) is shown.

Fig. 2A–E

Preoperative AP views of the (A) right and (B) left shoulders in a 69-year-old woman demonstrate bilateral cuff tear arthropathy with glenohumeral joint degeneration and severe narrowing of the acromiohumeral distance, allowing articulation of the humeral head with the acromion. Acetabularization of the acromion is seen. A right acromial insufficiency fracture is noted preoperatively. Postoperative AP views demonstrate reverse total shoulder prostheses in good position. Postoperative radiographs of the patient following bilateral RTSA for bilateral show improved alignment of the (C) right and (D) left shoulder. (E) After bilateral RTSA, the patient demonstrates improved forward elevation despite a right acromial fracture.