Friday, May 4, 2018

Reverse total shoulder for rotator cuff deficiency and pseudo paralysis

Longitudinal observational study of reverse total shoulder arthroplasty for irreparable rotator cuff dysfunction: results after 15 years

These authors investigated the hypothesis that functional outcomes remain significantly improved over the preoperative state beyond 15 years of reverse total shoulder arthroplasty (RTSA) for irreparable rotator cuff dysfunction. 

Between 1997 and 2001, 52 consecutive patients (23 men, 29 women) with a mean age of 71 years (range, 53-87 years) with an irreparable rotator cuff tear and secondary pseudoparalysis of active anterior elevation (AAE) were treated with the Delta III prosthesis. Rotator cuff tears were considered irreparable if pseudoparalysis was chronic (ie, >3 months), if the acromiohumeral distance was <7 mm on a plain anteroposterior radiograph, or if the fatty infiltration of the supraspinatus and infraspinatus or supraspinatus and subscapularis muscles was greater than stage 2 according to Goutallier. Pseudoparalysis was defined as active anterior elevation of <90° with preserved, free passive anterior elevation. 

22 shoulders included in the analysis had RTSA at a mean age of 68 (range, 54-77) years. Patients were reviewed clinically and radiographically at no less than 15 years (mean, 16.1; range, 15-19 years). The RTSA was a primary procedure in 7 procedures, and 15 patients had undergone at least 1 previous nonarthroplasty procedure.

The Constant and pain scores were significantly improved. Active anterior elevation (53° to 101°; P = .001), abduction (55° to 86°; P = .005). The mean scores did not significantly deteriorate over 15 years, but mean active abduction was significantly reduced over time (P = .018). 

One or more complications were recorded in 13 patients (59%), with 6 failed RTSAs (27%).

This early series of RTSA showed a substantial complication and failure rate. If, however, complications were treated without removal of the implants, the authors felt the outcome was not compromised.
Comment: This paper provides an important and encouraging longitudinal perspective on reverse total shoulder arthroplasties performed for pseudoparalysis in patients without prior arthroplasty or fracture.
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