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Irreparable rotator cuff tears are common conditions seen by shoulder surgeons, characterized by a torn and retracted tendon associated with muscle atrophy and impaired mobility. Direct fixation of the torn tendon is not possible due to the retracted tendon and lack of healing potential which result in poor outcome. Several treatment options are viable but correct indication is mandatory for a good result, pain improvement, and restoration of shoulder function. Patient can be treated either with a conservative program or surgically when necessary, by different available modalities like arthroscopic debridement, partial reconstruction, subacromial spacer, tendon transfer, and shoulder replacement with reverse prosthesis. The aim of this study was to review literature to give an overview of the available possible solutions, with indications and expected outcomes.

Background: We report here on the results, stratified by diagnosis, of a multicenter prospective study by surgeons unaffiliated with the design team of reverse shoulder arthroplasty (RSA) performed using a lateralized glenosphere. We hypothesized that outcomes would be comparable to those reported previously. Methods: A total of 245 patients underwent RSA for cuff tear arthropathy or glenohumeral arthritis with rotator cuff tear, rotator cuff tear with instability or escape and without glenohumeral arthritis, or failed shoulder arthroplasty. Clinical, radiographic, and self-assessed outcome measures were obtained preoperatively and at standardized time points postoperatively. At 2 years, 173 patients were available as 23 patients were deceased, 12 had undergone revision, and 37 were unavailable. Results: Range of motion and outcomes improved, irrespective of diagnosis. Active forward flexion, abduction, and external rotation improved (73-127 , 65-109 , and 24-37 , respectively, P <.0001 for all). Simple Shoulder Test (3.2-8.5) and American Shoulder and Elbow Surgeons scores (45-86) also improved. Scapular notching occurred in 13.3%; scapular spine/ acromial fractures in 6.5%. Patients undergoing revision shoulder arthroplasty improved more modestly. Conclusion: In this multicenter study, surgeons unaffiliated with the design team obtained clinical improvements comparable to those reported previously and that exceeded minimal clinically important differences for RSA. Improvements in external rotation and low scapular notching rates potentially relate to the lateralized design.

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Background: The Bundled Payment for Care Improvement initiative is a program designed by Center for Medicare and Medicaid Services in an attempt to increase the value of care delivered to Medicare recipients by rewarding providers who can deliver more cost-efficient, high-value care. This article reports the results of a coordinated care redesign program in an independent, medium-sized private-practice orthopedic group. Methods: A committee of stakeholders worked to redesign care protocols for patients receiving upper and lower joint replacement procedures. These protocols included preoperative, intraoperative, and postoperative care. Baseline metrics for post-acute care and readmissions were compared to the same metrics after initiating care redesign. Results: Incidence of discharge to inpatient facilities decreased as did length of stay at these facilities. Home health utilization and readmission rates were lowered. Average cost of the 90-day episodes decreased to a statistically significant degree. Conclusions: These initial results indicate that coordinated care redesign in the private practice setting can yield higher value care with decreased utilization of high-cost care, particularly in the post-acute period.