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

The cuff tear arthropathy (CTA) hemiarthroplasty - using an extended humeral articular surface that articulates with the coracoacromial arch - is a versatile, effective and inexpensive reconstructive procedure for shoulders with cuff deficiency, arthritis and active elevation beyond 90 degrees. See Treating cuff tear arthropathy in the active patient - the CTA prosthesis. The technical details for this procedure are shown in this link.  In contrast to the reverse total shoulder arthroplasty, the CTA hemiarthroplasty avoids the risks of dislocation, acromial and scapular spine fractures, notching, baseplate loosening, glenoid fracture, and dissociation of the glenosphere from the baseplate.

Yesterday, we saw three patients in followup after this procedure demonstrating its application for different shoulder pathologies.

Case 1.

A man in his sixties had a proximal humeral fracture treated previously with plate fixation. This was complicated by loss of fixation and avascular necrosis. Preoperatively he had active flexion >90 degrees and the x-rays shown below.

At surgery the supraspinatus and infraspinaturs were absent. The plate and humeral head were removed and a CTA hemiarthroplasty with reconstruction of his subscapularis was performed. Eight years after surgery he returned for routine followup. His x-rays at that time are shown below.

His shoulder comfort and function were good with active elevation of 150 degrees as shown below.

Case 2. 

A man in his seventies presented with pain and stiffness of the left shoulder after a failed rotator cuff repair. He had active elevation above 90 degrees. His preoperative images showed cuff tear arthropathy, heterotopic bone and retained suture anchors.

At surgery he was found to have no supraspinatus or infraspinatus. He had a CTA hemiarthroplasty with debridement of unwanted bone and suture anchors. His subscapularis was reconstructed.

He returned six weeks after surgery with good comfort of the shoulder and active elevation greater than 90 degrees at this early stage of his rehab. His x-ray at that time is shown below.

Case 3.

A man in his seventies presented with pain and loss of function in his right shoulder. He had active elevation greater than 90 degrees. His preoperative x-rays are shown below.

At surgery he had no supraspinatus or infraspinatus. His subscapularis was reconstructed.

Three years after surgery he returned for routine followup. His x-rays at that time are shown below.

He had comfortable active elevation of 160 degrees as shown below.

Comment: As reported by the authors of  Clinical effectiveness and safety of the extended humeral head arthroplasty for selected patients with rotator cuff tear arthropathy, the CTA hemiarthroplasty is a safe and effective treatment for patients with cuff tear arthropathy and retained active elevation. It is substantially less expensive than a reverse total shoulder and does not require preoperative CT scans or 3D planning.

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

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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).

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

A 70 year old woman presented with a failed rotator cuff repair and shoulder pain.

On physical examination, she had 140 degrees of active elevation, but it was painful.

Her plain radiograph showed superior translation of the humeral head on the glenoid with joint space narrowing and a retained suture anchor.

An outside MRI showed a retracted rotator cuff tear.

Because of her desire to be physically active, she elected a cuff tear arthropathy hemiarthroplasty (see this link) rather than a reverse total shoulder.

She was able to return to her activities with a comfortable and functional shoulder.

Six years after her surgery, her comfort and function remained. Her x-ray at that time is shown below.

Her range of motion is shown below.

The cuff tear arthropathy hemiarthroplasty can yield improved comfort and function without major complications. 

See Clinical effectiveness and safety of the extended humeral head arthroplasty for selected patients with rotator cuff tear arthropathy

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

Follow on twitter: https://twitter.com/shoulderarth

Follow on facebook: click on this link

Follow on facebook: https://www.facebook.com/frederick.matsen

Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/

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).

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

An active 60 year old man had a 7 anchor rotator cuff repair for a massive cuff tear four years prior to presentation. Three years later was climbing out of a truck and slipped off a stair and lost his left hand grip.  He held on by his right shoulder and felt like he pulled his arm out of the socket.  One year after this he presented with shoulder pain and weakness, but with active elevation to 100 degrees.

His AP radiograph showed superior displacement of an arthritic humeral head. 

His axillary truth view showed a centered humeral head centered on the glenoid with loss of the cartilage space

His MRI showed a full-thickness tear of the supraspinatus tendon. The torn tendon end was retracted to the level of the glenoid. There was severe thinning of the nearly absent infraspinatus tendon. There was a full-thickness tear of the subscapularis tendon. Thinned torn tendon end was retracted approximately 1 cm from the lesser tuberosity footprint. Fatty infiltration was seen in all cuff muscles.

Our colleague Philippe Collin requested some a saggital images. 

Here they are

After discussion of the alternatives, the patient declined a reverse total shoulder, electing instead to proceed with a CTA arthroplasty (see this link).

At the time of surgery complete irreparable tears of the subscapularis, supraspinatus and infraspinatus were verified along with an arthritic humeral head.

At six months after surgery he had a comfortable stable shoulder with 160 degrees of active elevation.

And these radiographs showing a humeral head supported superiorly by the coracoacromial arch

and centered on the axillary truth view.

Comment: This case is of interest because of the retained stability of the CTA arthroplasty in spite of the subscapularis deficiency.

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.

Follow on twitter: https://twitter.com/shoulderarth

Follow on facebook: click on this link

Follow on facebook: https://www.facebook.com/frederick.matsen

Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/

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).