These authors point out that traditional RSA may be unable to restore active external rotation in the presence of massive posterosuperior cuff tears with non-functional infraspinatus and teres minor muscles.
They reviewed their experience with 17 patients having the Arrow reverse shoulder arthroplasty (RSA) combined with modified L’Episcopo procedure at long-term follow-up (5 to 12 years).
All patients (16) demonstrated a significant improvement in all clinical and functional parameters. VAS pain scores improved from 6 ± 2.6 to 1 ± 1; SSV improved from 35 ± 14 to 72 ± 10; active forward elevation increased from 66° ± 34 to 125°± 29; and active external rotation arm at the body increased from −11° ± 22 to 21° ±11 and in 90° of abduction from −10° ± 17 to 37° ± 24. The mean Constant score improved from 25 ± 11 to 59 ± 8.
A total of six complications (35%) were identified in the study. Five cases were revised, and one was offered a revision surgery but refused any further surgical intervention. These cases consisted of five major complications including two infections, one case of inferior subluxation of the prosthesis, one traumatic dislocation with polyethylene disengagement, one superior migration of the baseplate, and one minor complication consisting of soft tissue irritation caused by a metaphyseal cerclage wire.
Comment: While this is a small series, the length of followup makes it of interest. While the complication rate was high, management of the complications yielded improvement over the preoperative condition.
