Current Concepts of Arthroplasty for the Treatment of Massive Rotator Cuff Tears

Joo Han Oh; Jun Ha Choi

doi:10.4055/jkoa.2013.48.1.78

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Oh and Choi: Current Concepts of Arthroplasty for the Treatment of Massive Rotator Cuff Tears

Instructional Course Lecture

Management of Massive Rotator Cuff Tear

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2013; 48(1): 78-87.

Published online: 26 February 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.1.78

Current Concepts of Arthroplasty for the Treatment of Massive Rotator Cuff Tears

Joo Han Oh, M.D., Ph.D., Jun Ha Choi, M.D.

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

Joint Disease Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Korea.

Correspondence to: Jun Ha Choi, M.D. Joint Disease Reconstruction Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. TEL: +82-31-787-4869, FAX: +82-31-787-4056, junha78@gmail.com

Received 17 January 2013 Revised 24 January 2013 Accepted 25 January 2013

(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

The purpose of this article was to explore current concepts of arthroplasty as a treatment for massive rotator cuff tears. Pubmed was searched using the words 'massive rotator cuff tears' and 'arthroplasty' for suitable articles, which were then reviewed and investigated with respect to history, indications, clinical outcomes, and treatment algorithms of arthroplasty in patients of massive rotator cuff tear. Arthroplasty can be considered a primary surgical treatment for patients with irreparable massive rotator cuff tears and hemiarthroplasty may be the treatment of choice in younger patients with an intact coracoacromial arch and no pseudoparalysis. Reverse total shoulder arthroplasty is the best surgical treatment for pain relief and the restoration of active forward flexion in elderly patients with cuff tear arthropathy and pseudoparalysis. Proper selection of arthroplasty can provide pain relief and functional improvement in patients with massive rotator cuff tears. However, complication rates remain high, and emphasize the importance of appropriate patient selection and careful operative technique.

Keywords: shoulder, massive rotator cuff tears, arthroplasty

Figures and Tables

Figure 1

True anteroposterior radiograph of a shoulder with cuff tear arthropathy demonstrating glenohumeral arthritis, superior glenoid wear, proximal humeral migration, and acetabularization of the acromion.

Figure 2

(A) Mechanical and (B) nutritional factors have been hypothesized to contribute to joint destruction in rotator cuff tear arthropathy.4)

Figure 3

Assembled constrained prosthesis: 1, metal glenoid cup; 2, tightened metal locking ring; 3, Series-I1 humeral head; 4, position of eccentric screw holes on the back plate; 5, central metal stem.16)

Figure 4

Semiconstrained Dana shoulder prosthesis.17)

Figure 5

Hemiarthroplasty with a laterally extended cuff tear arthropathy (CTA) head. (A) CTA prosthesis, (B) diagram of installed prosthesis.22)

Figure 6

Grammont's original reverse total shoulder arthroplasty.25)

Figure 7

(A) Earlier reverse total shoulder prosthesis design, with a small glenosphere component and a lateralized center of rotation. (B) The modern design with a large glenosphere, a non-anatomic valgus angle of the humeral implant, and medial and distal positioning of the center of rotation.26)

Figure 8

(A) Severe fatty infiltration of the infraspinatus and teres minor (B) loss of active external rotation of the right shoulder.

Figure 9

Plain radiograph (A) showing scapular notching at the lateral pillar of the inferior glenoid neck and a polyethylene insert (B) attrited by the scapular notching phenomenon.

Figure 10

A proposed treatment algorithm for the management of massive, irreparable rotator cuff tears. RTC, rotator cuff; GH, glenohumeral; RTSA, reverse total shoulder arthroplasty; CTA, cuff tear arthropathy.46)

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