RESEARCH ARTICLE


Irreparable Rotator Cuff Tears Without Arthritis Treated With Reverse Total Shoulder Arthroplasty



Mandeep S. Virk1, Gregory P. Nicholson2, Anthony A. Romeo2, *
1 Department of Orthopaedic Surgery, Division of Shoulder & Elbow, New York University Hospital for Joint Diseases, 301 East 17th street, New York, NY, 10003, USA
2 Department of Orthopaedic Surgery, Division of Shoulder & Elbow, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA


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© Virk et al. ; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopedic Surgery Section Head, Shoulder and Elbow Surgery, Rush University Medical Center, 1611 W Harrison, Suite 300, Chicago, IL 60612, USA; Tel: 312-432-2377; Fax: 708-492-5377; E-mail: Anthony.Romeo@rushortho.com


Abstract

Background:

Irreparable rotator cuff (RC) tears without arthritis is a challenging clinical problem in young adults. Reverse total shoulder arthroplasty (RTSA) has been proposed as one of the surgical treatment options for this condition.

Methods:

In this review, we discuss the current understanding of the role of RTSA for the management of irreparable RC tears without arthritis based on authors personal experience and available scientific literature.

Results:

Reverse total shoulder arthroplasty (RTSA) is a constrained arthroplasty system that can allow the deltoid and remaining rotator cuff to substitute for the lost function of irreparable RC. Furthermore, the pain relief is consistent with often a dramatic improvement in patient comfort, shoulder function and stability. In patients with pseudoparalysis of the shoulder without advanced arthritis, RTSA effectively restores forward elevation above the shoulder but may not dramatically improve external (ER) or internal rotation (IR). However, due to concerns over implant longevity, caution has to be exercised when using RTSA for symptomatic irreparable RC tears with preserved active forward elevation (AFE) and in patients less than 65 years of age.

Conclusion:

RTSA is a reasonable surgical option for irreparable rotator cuff repair without arthritis. However, caution should be exercised when offering RTSA to young patients and patient without pseudoparalysis because they can have a higher complication and dissatisfaction rate. In addition, longevity of RTSA and subsequent need for revision surgery remains a significant concern in this population.

Keywords: Irreparable rotator cuff tears without arthritis, pseudoparalysis of shoulder, reverse total shoulder arthroplasty, rotator cuff tears, shoulder arthritis.