Surgical management of complex irreparable rotator cuff deficiency

• Published in: The Journal of arthroplasty Vol. 6; no. 4; pp. 363 - 370
• Main Authors: Arntz, Craig T., Matsen, Frederick A., Jackins, Sarah
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.1991
• Subjects: Aged; Aged, 80 and over; arthrodesis; Arthrodesis - adverse effects; Female; glenoid loosening; hemiarthroplasty; Humans; humeral prosthesis; Joint Prosthesis; Male; Methods; Middle Aged; Postoperative Complications; Prosthesis Failure; Radiography; Reoperation; rotator cuff deficiency; Rotator Cuff Injuries; shoulder; Shoulder Joint - diagnostic imaging; Shoulder Joint - surgery; Space life sciences; humeral prosthesis; arthrodesis; glenoid loosening; rotator cuff deficiency; shoulder; hemiarthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/S0883-5403(06)80189-0

The authors surgically treated 23 shoulders in 23 patients with disabling pain associated with irreparable tears of the musculotendinous cuff. In a total of 12 shoulders with preserved passive motion, normal deltoid function, loss of glenohumeral joint surfaces, and sculpturing of the coracoacromial arch, a standard or oversized Neer II humeral prosthesis without glenoid replacement was selected. A total of 11 shoulders that failed to meet these prerequisites or demanded heavy use after operation underwent arthrodesis. Twenty-two patients (12 from the hemiarthroplasty group and 10 from the arthrodesis group) were available for evaluation at an average follow-up period of 37.5 months. Comfort level and overall function were improved in both groups. Active for-ward elevation improved an average of 44° in the hemiarthroplasty group and an average of 15° in the arthrodesis group. The success of hemiarthroplasty and the problems of glenoid loosening in the presence of cuff deficiency with upward head displacement have led to the conclusion that humeral hemiarthroplasty is the preferred method for managing complex irreparable tears of the rotator cuff in which the articular surface is destroyed, yet the deltoid muscle is functional. Shoulder arthrodesis is reserved for those patients who have both irreparable tears of the rotator cuff and irreparable deficiencies of the deltoid muscle, or the younger patient with demands for substantial strength at low angles of flexion.