Rotator cuff degeneration and osteoarthritis are two common age-related conditions of the shoulder.
These authors sought to determine the medium term results of anatomic total shoulder replacement (TSR) for OA in patients with established preoperative partial thickness rotator cuff tears demonstrated on MRI scans.
Thirty-six patients (14 Male, 22 Female), who underwent TSR had a partial thickness rotator cuff tears on MRI, preoperatively, all demonstrated mild to moderate fatty infiltration. The mean age of patients was 79.2 years (75-88); Mean follow-up was 5.8 years (4-9). Significant improvements in pain, ROM, were reported in all cases. At the final follow-up, the Oxford Shoulder Score was 42 (32-46) with minimum 14 points improvement (p=0.001).
Lucencies were observed in 8 glenoids. 6 at Grade1 Lazarus score, 2 at Grade 2 & none seen at Grade 3. There were no cases of implant loosening.
Clinically four patients had rotator cuff weakness but only 2 showed evidence of proximal migration. One remained satisfied whilst the other, with a moderate grade Torchia classification for proximal migration, was revised for rotator cuff failure; one further patient had débridement, antibiotics, and implant retention for infection.
Comment: While the authors concluded that “the presence of a partial cuff tear on preoperative MRI does not significantly affect function after anatomical TSR in the medium term”, this study did not compare the outcomes of total shoulder arthroplasty in patients with and without partial cuff lesions.
Further clinical research is needed to determine the advantages and disadvantages of anatomic and reverse total shoulders in individuals over 75 years of age and to determine whether it is of value to assess the status of the cuff with a preoperative MRI in making this determination.
