These authors reviewed 203 patients having reverse total shoulder arthroplasty (RTSA) is a treatment option for massive irreparable rotator cuff tears (MIRCTs) without glenohumeral arthritis
with a mean follow-up of 50 months.
Patients were divided into 4 groups based on preoperative shoulder active forward elevation (aFE) (<60°, <90°, 90°, >120°). Patients in each group had significant improvements in patient reported outcomes. Patient satisfaction was highest in the group with >120° preoperative aFE (44/44, 100%). There were 3 complications that required 2 revision surgeries.
113 of the shoulders demonstrated pseudoparalysis (active forward elevation <90 degrees while 75 had retained active elevation ≥ 90 degrees.
The pseudoparalytic shoulders had the highest improvements in patient reported outcomes (SST score change averaging 6.3 from 3.1 to 9.0, while the non-pseudoparalytic group improved by 4.8 from 5.4 to 10.2).
The pseudoparalytic shoulders had the highest improvements in active forward elevation (77 degrees from 50 to 128 degrees in comparison to the non-pseudoparalytic group that improved 12 degrees from 125 to 139 degrees).
Comment: This study demonstrates that amoung shoulder with massive irreparable cuff tears without arthritis, those with preoperative pseudoparalysis derive the highest benefit from a reverse total shoulder. Those having better preoperative comfort and function (no pseudoparalysis) have better postoperative comfort and function.
These observations challenge surgeons to determine the "tipping point" for reverse total shoulder: how bad does a shoulder need to be before considering surgery. See this link and this link, Earlier intervention for less involved shoulders yields better outcomes, but less improvement.
For patients with massive irreparable cuff tears without arthritis and without pseudoparalysis, a less invasive procedure - the smooth and move - can allow immediate return to activities without the risks and down time associated with a reverse - see this link.
How you can support research in shoulder surgery Click on this link.
