Shoulder arthritis and complete cuff deficiency - the CTA prosthesis

Here's an instructive case.
These x-rays are those of a 77 year old physician from the Southeastern United States who came to Seattle for treatment.

Preoperative evaluation demonstrated a detached subscapularis along with massive cuff deficiency involving the supraspinatus and infraspinatus. We suspect that many surgeons would recommend a reverse total shoulder for him.

However, in spite of his age he is, in addition to his physician occupation, he is also a hands-on 'big spread' muscular rancher, dedicated to getting back to full on ranching ASAP.

So instead of a reverse he elected an impaction grafted CTA arthroplasty at which time we were able to reconstruct his subscapularis. Here are the x-rays he sent from one month after our surgery.

This email was received from him today:

"Now four months post op and (in my opinion!) doing extraordinarily well. "H" exercises now with a 1 pound weight. Overhead graded relaxation with same 1 pound weight and able to raise my arm straight up with some mild discomfort. Meanwhile, climbing on and off tractors, in and out skid steer loader. We are about to begin feeding cows but that is done with 1750 lb. bales handled with equipment. 50
calves all born without difficulty. (At least no difficulty came to my attention. I suppose the momma cows might feel differently.) Able to get my shirt on and tucked in. My left shoulder continues to
surprise me with unexpectred ease of movement and little pain. Most recently I discovered I could reach around to the back side of my right shoulder. Cannot do that with my right arm. My plan is to continue those exercises with increasing weight as tolerated. Please give me any guidance and direction as you see appropriate."

In our view this 77 year old is not by any stretch an 'older man' and is better suited to the CTA procedure after which we impose no activity restrictions in contrast to the more fragile reverse total shoulder.

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