Sunday, February 4, 2018

Cuff tear arthropathy, is there an alternative to a reverse total shoulder?

The reverse total shoulder is often used in the management of rotator cuff tear arthropathy that has been unresponsive to a trial of non-operative management. While commonly successful, this procedure can be associated with complications such as baseplate failure, glenosphere/baseplate dissociation, failure of the polyethylene liner, and dislocation(see link, link, link, link, and link. In patient with cuff tear arthropathy who can still actively elevate their arm, we have found that a less complex surgical approach - the CTA arthroplasty (see this link) - can safely restore shoulder comfort and function. 

Here are two examples, both in patients in their 70s.

Preoperative and postoperative x-rays

Shoulder function at two years after surgery

Preoperative and postoperative x-rays

Shoulder function at nine years after surgery.

Comment: There are cases in which a reverse total shoulder arthroplasty may be the preferred procedure for rotator cuff tear arthropathy, including those with pseudoparalysis, anterosuperior escape, and glenohumeral instability. However in shoulders with preserved active motion and stability of the humeral head provided by an intact coracoacromial arch, the extended head CTA humeral arthroplasty may enable patients to realize improved comfort and function without the potential complexities of a reverse total shoulder.

The reader may also be interested in these posts:

Consultation for those who live a distance away from Seattle.

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Click here to see the new Rotator Cuff Book

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