Cuff tear arthropathy is a condition in which a massive rotator cuff defect is accompanied by glenohumeral arthritis.
This condition commonly managed with a reverse total shoulder arthroplasty (RTSA) particularly when there is pseudo paralysis or anterosuperior escape resulting from deficiency of the coracoacromial arch.
A humeral hemiarthroplasty with an extended humeral head (see example below) may provide a less invasive alternative for selected patients with cuff tear arthropathy if the shoulder has preserved active elevation.
Because evidence regarding the clinical effectiveness of this procedure is limited, these authors investigated its safety and efficacy in treating patients with cuff tear arthropathy and retained active elevation.
Some of the key technical aspects of this procedure are preserving the stabilizing clavipectoral fascia exending inferiorly from the coracoacromial arch
and matching the prosthetic head diameter of curvature to that of the resected humeral head.
The height of the head is selected to restore the physiological tension in the deltoid muscle
The extended head enables smooth passive of the humeral head beneath the preserved coracoacromial arch.
These authors analyzed the preoperative characteristics, surgical findings, and clinical outcomes for patients selected for extended head hemiarthroplasty.
For 42 patients with 2-year follow-up, there were no complications or revisions. The Simple Shoulder Test score improved from a median of 3.0 to 8.0 (P < .001). The median percentage of maximal possible improvement was 50% (P < .001). The percentage of patients able to perform each of the functions of the Simple Shoulder Test was significantly improved; for example, the ability to sleep comfortably increased from 19% to 71%, and the ability to place a coin on the shelf at shoulder level increased from 38% to 86% (P < .001). The improvements in the individual functions of the SST are shown below.
The authors concluded that there are circumstances in which RTSA is clearly the preferred procedure for cuff tear arthropathy, including 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 humeral arthroplasty can enable selected patients to realize improved comfort and function without the potential risks of RTSA. Extended humeral head hemiarthroplasty can provide a safe and effective alternative for the management of selected patients with rotator cuff tear arthropathy and preserved active motion.
Interested readers can find more detail in this post: Cuff tear arthropathy, is there an alternative to a reverse total shoulder? (see this link).
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Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
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