Reverse Total Shoulder Arthroplasty for Massive Cuff Tear and Cuff Tear Arthropathy in Elderly Patients

Bong Gun Lee; Nam Su Cho; Il Hoen Choi; Yong Girl Rhee

doi:10.4055/jkoa.2011.46.3.212

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Lee, Cho, Choi, and Rhee: Reverse Total Shoulder Arthroplasty for Massive Cuff Tear and Cuff Tear Arthropathy in Elderly Patients

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(3): 212-221.

Published online: 30 June 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.3.212

Reverse Total Shoulder Arthroplasty for Massive Cuff Tear and Cuff Tear Arthropathy in Elderly Patients

Bong Gun Lee, M.D., Nam Su Cho, M.D.^*, Il Hoen Choi, M.D.^*, Yong Girl Rhee, M.D.^*

Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.

^*Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

Correspondence to: Yong Girl Rhee, M.D. Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, # 1 Hoegi-dong, Dongdamun-gu, Seoul 130-702, Korea. TEL: +82-2-958-8370, FAX: +82-2-964-3865, shoulderrhee@hanmail.net

Received 19 May 2010 Accepted 21 February 2011

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

We wanted to assess the short term clinical outcomes and the effectiveness of reverse total shoulder replacement for massive rotator cuff tears with cuff tear arthropathy in elderly patients.

Materials and Methods

Between September 2007 and January 2009, 17 reverse total shoulder arthroplasties were performed on patients with an average age of 69.3 (58-80) years. The follow up period was an average of 17.9 (12-32) months. The outcomes were evaluated using the visual analogue scale, the range of motion, the muscle strength, the Constant score, the UCLA score and the Korea shoulder score. We performed radiological measurements of medialization of the center of rotation, distalization of the humerus, and tilting of the inferior glenoid on the preoperative and postoperative radiographs.

Results

The VAS improved from 7.2±3.6 preoperatively to 1.6±1.0 postoperatively. The average preoperative active forward fl exion was 51.5±28.4 degrees, which improved to 131.5±20.7 degrees at the final follow-up. The internal rotation was deteriorated from L2 to L5 (p<0.001, 0.001, 0.011). The average Constant score improved from 23.9±5.1 points before surgery to 62.2±9.1 points at the time of follow-up and the UCLA score and KSS score also rose from 7.6±2.4 and 27.0±7.5 points to 26.3±3.6 and 69.2±10.4 points respectively, which were statistically significant. For the radiological measurements, the medialization of rotation of the center was a mean of 20.6 mm±4.3 and the distalization of the humerus was a mean 22.8 mm±5.56. The glenoid inferior tilting increased a mean of 12.1±4.3 degrees. Inferior scapular notching was observed in two cases.

Conclusion

The reverse total shoulder arthroplasty produced good results when used for the treatment of massive rotator cuff tear and cuff tear arthropathy. Forward fl exion was significantly improved, but on the contrary internal rotation was deteriorated. Considering the technical difficulties and the possibility of complications, the reverse total shoulder arthroplasty should be judiciously used by expert surgeons.

Keywords: reverse shoulder arthroplasty, rotator cuff, massive tear, cuff tear arthropathy

Figures and Tables

Figure 1

Measurement of medialization of center of rotation. (A) Preoperative center of rotation is defined as a center of the circle which is formed by extension of humeral articular surface. (B) Postoperative center of rotation is defined as a midpoint on flat surface of glenoid hemisphere.

Figure 2

Pre-operative x-ray (A) shows proximally located humeral head where as post-operative x-ray (B) shows humeral distalization.

Figure 3

Glenoid tilting increased comparing pre-operative x-ray(A) to postoperative x-ray.

Figure 4

Scapular notching occurred inferior to the glenoid hemisphere at 6 months postoperatively. In postoperative 12 month radiograph, bony erosion and sclerosis inferior to glenoid neck are more apparent.

Table 1

Patients Summary

Sx (M), symptom duration (months); OP, number of previous operations; SSP, supraspinatus; ISP, infraspinatus; FF, angle of active forward flexion.

Table 2

Range of Motion

aFF, active forward flexion; pFF, passive forward flexion; aERs, active external rotation at the side, aERa, active external rotation at 90 degree of abduction; aIRa, active internal rotation at 90 degree of abduction; IR, internal rotation to the back.

Table 3

Muscle Strength (kg)

FF, forward flexion; ERs, external rotation at side; IRs, internal rotation at side.

Table 4

Constant Score

ADL, activity of daily living; ROM, range of motion.

Table 5

UCLA Score

Table 6

Korean Shoulder Score

ROM, range of motion.

References

1. Neer CS 2nd, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg Am. 1983. 65:1232–1244.

2. Burkhart SS. Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale. Clin Orthop Relat Res. 1991. (267):45–56.

3. Gartsman GM. Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am. 1997. 79:715–721.

4. Gerber C. Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. Clin Orthop Relat Res. 1992. (275):152–160.

5. Kempf JF, Gleyze P, Bonnomet F, et al. A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy. 1999. 15:56–66.

6. Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr. Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am. 1995. 77:857–866.

7. Neer CS 2nd, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg Am. 1982. 64:319–337.

8. Franklin JL, Barrett WP, Jackins SE, Matsen FA 3rd. Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. J Arthroplasty. 1988. 3:39–46.

9. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993. 16:65–68.

10. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br. 2004. 86:388–395.

11. Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005. 87:1697–1705.

12. Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005. 87:1476–1486.

13. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990. (254):92–96.

14. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994. (304):78–83.

15. Warner JJ, Higgins L, Parsons IM 4th, Dowdy P. Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg. 2001. 10:37–46.

16. Gerber C, Pennington SD, Nyffeler RW. Reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2009. 17:284–295.

17. Fenlin JM Jr, Chase JM, Rushton SA, Frieman BG. Tuberoplasty: creation of an acromiohumeral articulation-a treatment option for massive, irreparable rotator cuff tears. J Shoulder Elbow Surg. 2002. 11:136–142.

18. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A. Partial repair of irreparable rotator cuff tears. Arthroscopy. 1994. 10:363–370.

19. Zuckerman JD, Scott AJ, Gallagher MA. Hemiarthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg. 2000. 9:169–172.

20. Sarris IK, Papadimitriou NG, Sotereanos DG. Bipolar hemiarthroplasty for chronic rotator cuff tear arthropathy. J Arthroplasty. 2003. 18:169–173.

21. Matsen Iii FA, Boileau P, Walch G, Gerber C, Bicknell RT. The reverse total shoulder arthroplasty. Instr Course Lect. 2008. 57:167–174.

22. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005. 14:1 Suppl S. 147S–161S.

23. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 2006. 88:1742–1747.

24. Frankle MA, Teramoto A, Luo ZP, Levy JC, Pupello D. Glenoid morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elbow Surg. 2009. 18:874–885.

25. Wierks C, Skolasky RL, Ji JH, McFarland EG. Reverse total shoulder replacement: intraoperative and early postoperative complications. Clin Orthop Relat Res. 2009. 467:225–234.

26. Edwards TB, Williams MD, Labriola JE, Elkousy HA, Gartsman GM, O'Connor DP. Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009. 18:892–896.

27. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006. 15:527–540.

28. Rockwood CA Jr. The reverse total shoulder prosthesis. The new kid on the block. J Bone Joint Surg Am. 2007. 89:233–235.

29. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007. 89:588–600.

30. Levigne C, Boileau P, Favard L, et al. Scapular notching in reverse shoulder arthroplasty In reverse shoulder arthroplasty: problems related to the glenoid in reverse shoulder arthroplasty clinical results, complications, revision. 2006. Montpellier: Sauramps médical;353–372.

31. Boileau P, Rumian AP, Zumstein MA. Reversed shoulder arthroplasty with modified L'Episcopo for combined loss of active elevation and external rotation. J Shoulder Elbow Surg. 2010. 19:2 Suppl. 20–30.

32. Mole D, Navez G, Garaud P. Revese shoulder prosthesis: problems related to the glenoid in reverse shoulder arthroplasty clinical results, complications, revision. 2006. Montpellier: Sauramps médical;289–302.

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