Reverse Shoulder Arthroplasty for the Treatment of Rotator Cuff Deficiency

Cuff, Derek; Pupello, Derek; Virani, Nazeem; Levy, Jonathan; Frankle, Mark
June 2008
Journal of Bone & Joint Surgery, American Volume;Jun2008, Vol. 90-A Issue 6, p1244
Academic Journal
Background: Early designs of reverse shoulder arthroplasty components for the treatment of glenohumeral arthritis associated with severe rotator cuff deficiency in some cases have been associated with mechanical failure. The purpose of this study was to perform a prospective outcomes study of reverse shoulder arthroplasty performed with use of 5.0-mm peripheral locking screws for baseplate fixation and a lateralized center of rotation for the treatment of a rotator cuff deficiency. Methods: From February 2004 to March 2005, 112 patients (114 shoulders) were treated with a reverse shoulder arthroplasty as part of a United States Food and Drug Administration Investigational Device Exemption study. Ninety-four patients (ninety-six shoulders) were available for a minimum follow-up of two years. Of the ninety-six shoulders, thirty-seven had a primary rotator cuff deficiency, thirty-three had a previous rotator cuff operation, twenty-three had a previous arthroplasty, and three had a proximal humeral nonunion. The patients were prospectively followed clinically (the American Shoulder and Elbow Surgeons [ASES] score, the Simple Shoulder Test [SST], and self-reported satisfaction) and radiographically (mechanical failure, loosening, and notching). Patients were videotaped while performing a standard active range-of-motion protocol before and after treatment. These videos were then analyzed in a blinded fashion by three independent observers using a digital goniometer. Results: At two years, the average total ASES scores had improved from 30 preoperatively to 77.6; the average ASES pain scores, from 15 to 41.6; and the average SST scores, from 1.8 to 6.8 (p < 0.0001 for all). Blinded analysis of range of motion showed that average abduction improved from 61° preoperatively to 109.5° (p < 0.0001); average flexion, from 63.5° to 118° (p < 0.0001); and average external rotation, from 13.4° to 28.2° (p < 0.0001). The patients rated the outcome as excellent in fifty-three shoulders (55%), good in twenty-six (27%), satisfactory in eleven (12%), and unsatisfactory in six (6%). There was no evidence of mechanical failure of the baseplate or scapular notching in any of the patients. Six of the ninety-four patients in this study had a complication. Conclusions: Recent advances in reverse shoulder arthroplasty have allowed for improvement in patient outcomes while minimizing early mechanical failure and scapular notching and decreasing the overall complication rate at short- term follow-up. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • A Radiographic Classification of Massive Rotator Cuff Tear Arthritis. Hamada, Kazutoshi; Yamanaka, Kaoru; Uchiyama, Yoshiyasu; Mikasa, Takahiko; Mikasa, Motohiko // Clinical Orthopaedics & Related Research;Sep2011, Vol. 469 Issue 9, p2452 

    Background: In 1990, Hamada et al. radiographically classified massive rotator cuff tears into five grades. Walch et al. subsequently subdivided Grade 4 to reflect the presence/absence of subacromial arthritis and emphasize glenohumeral arthritis as a characteristic of Grade 4....

  • Repair of Tears of the Subscapularis. Edwards, T. Bradley; Walch, Gilles; Sirveaux, François; Molé, Daniel; Nové-Josserand, Laurent; Boulahia, Aziz; Neyton, Lionel; Szabo, Istva; Lindgren, Bruce; O'Connor, Danil P. // Journal of Bone & Joint Surgery, American Volume;Mar2006 Supplement 1, Vol. 88-A, p1 

    BACKGROUND: Rotator cuff tears involving the subscapularis are less common than those involving the superior aspect of the rotator cuff. The purpose of the present study was to report the results of repair of isolated tears of the subscapularis. METHODS: The records on eighty-four shoulders that...

  • Long-term Clinical and MRI Results of Open Repair of the Supraspinatus Tendon. Nich, Christophe; Mütschler, Céline; Vandenbussche, Eric; Augereau, Bernard // Clinical Orthopaedics & Related Research;Oct2009, Vol. 467 Issue 10, p2613 

    Abstract  Open repair of full-thickness tears of the rotator cuff generally improves function, although anatomic failures are not uncommon. We asked whether the presence or absence of an anatomic repair influenced outcomes. We retrospectively analyzed 47 patients (49 shoulders) treated by...

  • Optimal management of shoulder impingement syndrome. Escamilla, Rafael F.; Hooks, Todd R.; EWilk, Kevin // Open Access Journal of Sports Medicine;2014, Vol. 5, p13 

    Shoulder impingement is a progressive orthopedic condition that occurs as a result of altered biomechanics and/or structural abnormalities. An effective nonoperative treatment for impingement syndrome is aimed at addressing the underlying causative factor or factors that are identified after a...

  • Internal rotation resistance test at abduction and external rotation: a new clinical test for diagnosing subscapularis lesions. Lin, Lin; Yan, Hui; Xiao, Jian; Ao, Yingfang; Cui, Guoqing // Knee Surgery, Sports Traumatology, Arthroscopy;Apr2015, Vol. 23 Issue 4, p1247 

    Purpose: A new clinical test for evaluating subscapularis (SSC) integrity was described, and its diagnostic value was compared with the present SSC tests (the lift-off, belly-press, IRLS and bear-hug tests). The new test is called internal rotation resistance test at abduction and external...

  • Association between pre-operative magnetic resonance imaging and reparability of large and massive rotator cuff tears. Dwyer, Tim; Razmjou, Helen; Henry, Patrick; Gosselin-Fournier, Simon; Holtby, Richard // Knee Surgery, Sports Traumatology, Arthroscopy;Feb2015, Vol. 23 Issue 2, p415 

    Purpose: It is recognized that a percentage of large and massive rotator cuff tears (RCTs) cannot be anatomically repaired. We hypothesized that factors identified on pre-operative MRI would be associated with rotator cuff reparability. Methods: A single-surgeon retrospective study was performed...

  • Prosthesis design and placement in reverse total shoulder arthroplasty. Ackland, David C; Patel, Minoo; Knox, David // Journal of Orthopaedic Surgery & Research;Jul2015, Vol. 10 Issue 1, p1 

    The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty (RSA) was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy....

  • Massive Rotator Cuff Tears without Arthropathy. Harreld, Kevin L.; Puskas, Brian L.; Frankle, Mark // Journal of Bone & Joint Surgery, American Volume;5/18/2011, Vol. 93-A Issue 10, p973 

    The article focuses on the history, indications, and outcomes related to the application of reverse shoulder arthroplasty in managing irreparable massive rotator cuff tears without arthritis. It states that the reverse shoulder arthroplasty was established to enhance the clinical outcomes for...

  • SHOULDER HEMIARTHROPLASTY FOR GLENOHUMERAL ARTHRITIS ASSOCIATED WITH SEVERE ROTATOR CUFF DEFICIENCY. Sanchez-Sotelo, Joaquin; Cofield, Robert H.; Rowland, Charles M. // Journal of Bone & Joint Surgery, American Volume;Dec2001, Vol. 83-A Issue 12, p1814 

    Determines the clinical and radiographic results of hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency. Patient demographics; Reconstruction of humerus with a Cofield implant; Evaluation of progression of bone loss and subluxation of the prosthesis using...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics