77 year old woman with cuff tear arthropathy wishing to avoid a reverse total shoulder.

 A 77 year old woman with rotator cuff tear arthropathy of the right shoulder and retained active elevation to 90 degrees presented for surgical management. She wished to avoid a reverse total shoulder because of concerns about complications and limitations.

Preoperative imaging showed femoralization of the proximal humerus, a thin acromion and superior decentering of the humeral head without anterosuperior escape.

At surgery her supraspinatus and infraspinatus were irreparably torn. Her subscapularis tendon was detached.

Her procedure included a CTA hemiarthroplasty with an extended humeral head articular surface and an impaction grafted smooth standard length stem along with subscapularis reconstruction.

At five years after surgery (age 82) she returned for followup. She had active forward flexion to 130 and internal rotation to her back pocket. Strength: thumb down elevation 4/5, external rotation 4+/5, belly press 4+/5.

She had experienced no problems with glenohumeral instability or acromial/scapular spine fracture.

Her preoperative and five year postoperative x-rays are seen below showing a good fit of the humeral prosthesis in the coracoacromial arch/glenoid and no evidence of stress shielding.

Comment: As described in a recent post, CTA hemiarthroplasty is a safe and effective procedure for the management of rotator cuff tear arthropathy in shoulders with preoperative retained active elevation. It patients, such as this woman with a thin acromion, it has the particular advantage of avoiding the risk of acromial stress fracture.

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Contact: shoulderarthritis@uw.edu

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).