Monday, November 7, 2016

Is hemiarthroplasty an effective procedure for selected patients with rotator cuff tear arthropathy?

What Factors are Associated With Clinically Important Improvement After Shoulder Hemiarthroplasty for Cuff Tear Arthropathy?

These authors reviewed 42 patients having 2 or more years (range, 24-132 months) of followup after a hemiarthroplasty for rotator cuff tear arthropathy.

The indications for this approach were glenohumeral arthritis with superior decentering of the humeral head. 

33 of 42 patients achieved a clinically important percentage of maximum possible improvement (%MPI) in the Simple Shoulder Test (SST) score, defined as an improvement of 30% of the total possible improvement on the 12-point scale.

Intraoperative findings of a rotator cuff tear limited to the supraspinatus and infraspinatus and limited preoperative external rotation were associated with achieving the defined minimum functional improvement (30% of MPI) on multivariate analysis. Preoperative active elevation (p = 0.679) and use of a CTA-specific implant (p = 0.707) were not significantly associated with achievement of 30% of MPI.

The authors conclude that patients with intact teres minor and subscapularis tendons and patients with lower preoperative external rotation had a better prognosis for achieving a clinically important percentage of MPI at short-term followup.

Comment: This is an important article that emphasizes the utility of a conservative surgery for rotator cuff tear arthropathy.

In our practice, we discuss the option of a CTA prosthesis with patients having rotator cuff tear arthropathy if they have active glenohumeral elevation over 90 degrees, no anterosuperior escape, and an intact coracoacromial arch (i.e. no prior acromioplasty). This procedure is of particular interest to patients who which to avoid the risks of dislocation and glenoid failure associated with a reverse total shoulder, such as those who are physically active or those at risk for falls.

Because the technique preserves humeral and glenoid bone stock and because the humeral component is inserted with impaction autografting (i.e. non-cemented, non-ingrowth), it is easily converted to a reverse total shoulder should that become necessary in the patient's future.

Our surgical technique is shown in this post:
Cuff tear arthropathy - the use of a CTA prosthesis 

Additional information can be found in these links:

Rotator cuff tear arthropathy and the CTA prosthesis