Managing cuff tear arthropathy in an active farmer / physician - the simple and safe approach, 11 year followup.

 A 77 year old muscular retired physician, active rancher from the opposite corner of the U.S. presented with pain and loss of function of the left shoulder, thirteen years after a prior rotator cuff procedure. 

His functional deficits at that time are shown on his Simple Shoulder Test 

His x-rays at presentation are shown below.

He did not want a reverse total shoulder because of his active lifestyle caring for his farm and farm animals, clearing fallen trees, and landscaping. Instead he elected a CTA hemiarthroplasty (see this The cuff tear arthropathy arthroplasty). The procedure was performed eleven years ago without preoperative CT or MRI scans, 3D planning or interscalene block. His supraspinatus and infraspinatus tendons were absent. His subscapularis was detached, but reconstructed at the end of the case.

Seven years after surgery he returned for routine followup with these x-rays

and this shoulder function,

Now eleven years after surgery at the age of 88 he reports a mild increase in shoulder discomfort with active use, but that he is still working on his farm, sometimes tripping over tree stumps or falling when stepping in hidden holes

His current x-rays (11 years after his arthroplasty) are show below.

Comment: The CTA hemiarthroplasty is a durable, cost-effective and safer alternative to a reverse total shoulder for patients who have cuff tear arthropathy and retained active elevation (see Managing rotator cuff tear arthropathy: a role for cuff tear arthropathy hemiarthroplasty as well as reverse total shoulder arthroplasty).  

Managing cuff tear arthropathy in the active woman rancher

Cuff tear arthropathy in an active 72 year old woman - options?

What if the patient with an irreparable cuff tear and arthritis doesn't want a reverse total shoulder?

Cuff tear arthropathy in a young 60 year old woman managed with the CTA hemiarthroplasty

The versatile, inexpensive and safe CTA hemiarthroplasty for patients with preserved active elevation

70 year old active woman with irreparable rotator cuff tear and arthritis

60 year old active man with massive irreparable rotator cuff tear and arthritis

Unfortunately, in spite of their value to the patient, these implants are becoming less and less available, perhaps related to the fact that their use generates less revenue for the surgeon and for the orthopaedic company vendor than the more complex reverse total shoulder

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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).