Managing cuff tear arthropathy in the active woman rancher

An active woman rancher in her early 60's, presented with pain in her right shoulder that prevented her from carrying out the necessary activities on her ranch. She had retained active elevation to 120 degrees. Her AP radiograph showed cuff tear arthropathy.

Wishing to avoid the risks and activity limitations associated with a reverse total shoulder, she elected a hemiarthroplasty with an extended humeral articular surface that articulates with the undersurface of the acromion - the CTA hemiarthroplasty (see this link for the technique).

At surgery the proximal humerus was completely devoid of articular cartilage, the long head biceps tendon, subscapularis, supraspinatus and upper infraspinatus were detached and irreparable.


Her postoperative x-ray is shown below.

At two years after her CTA hemiarthroplasty, her active motion was comfortable and full as shown below (including reach up the back).

Fifteen years after her arthroplasty, she kindly shared this series of photos showing her activities on the ranch.

Notably, in spite of her high level of daily activities, she has not experienced instability or acromial/spine fracture.

The chart below shows the minimum two year followup data for 45 patients having CTA hemiarthroplasty for cuff tear arthropathy with retained active elevation.



None of these patients experienced the complications associated with reverse total shoulder arthroplasty.

For more information, see this related post;
Treating cuff tear arthropathy in the active patient - the CTA prosthesis

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).