Purpose— to evaluate mid-term outcomes of reverse joint replacement in patients with shoulder arthropathy and massive rotator cuff tear.Material and Methods. Reverse shoulder arthroplasty with delTa xTeNd (depuy) was performed in 38 patients in the period from december 2010 to december 2016 by the same surgical team. patients’ age ranged from 38 to 82 years. Indications for replacement were pain syndrome and pseudoparalysis of the upper limb in presence of a large or massive Rc tear as well as shoulder arthropathy of various severity degree. Outcomes were evaluated by standard aSeS, cS and ucla scales. Roentgenological examination included ap and axial x-rays during follow up from 1 to 6 years after the surgery with analysis of implants positioning. Mean follow up was 24,2±6,6 months.Results. good outcomes were reported in 6 (15,8%) patients. average functional scores were: aSeS 87,4±2,1, ucla 29,7±1,5 and cS 14,0±2,3. Satisfactory outcomes were observed in 27 (14,2%) patients: aSeS 76,2±2,3, ucla 26,8±1,3 and cS 22,0±1,4 scores. poor outcomes were reported in 5 (14,2%) patients with persisting pain syndrome.Conclusion.To avoid significant and multiple complications after reverse shoulder replacement a precise preoperative planning considering particular destructive changes of glenoid fossa is required. For young and physically active patients the authors recommend to use alternative treatment options aiming at restoration of normal shoulder biomechanics and prophylaxis of arthropathy.

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Actual principles of implant associated infection treatment require determined approach already in early symptoms stage. The paper describes a clinical case of infectious complication treatment after bone-tendon repair of supraand infraspinous muscles with anchors. Following conservative treatment with no positive dynamics the authors performed two stage surgical treatment of implant associated shoulder infection. First stage included radical debridement, removal of implants and filling the defect in left humeral head with antibacterial spacer. Following infection eradication, the second stage included arthroscopy of the left shoulder, spacer removal, grafting of defect and revision left rotator cuff repair using anchors.The present clinical case demonstrates a lack of alertness in respect of possible postoperative infection, insufficient treatment experience of general orthopaedic surgeons and overall complexity of radical surgical procedure for treatment of such patients.

Purpose of the study – to identify incidence rate of recurrent rotator cuff (RC) tears, to evaluate outcomes of arthroscopic bone-tendon anchor suture, to determine the factors influencing arthroscopic treatment outcomes.Materials and methods. Medical history data, pre-operative x-rays and MRI of shoulder joints of 305 patients (main group) who underwent arthroscopic bone-tendon anchor suture repair of large or massive RC tears during 2010-2016 were included in the study. Follow up period ranged from 1 to 6 years postoperatively with mean value of 25,6±4,5 months. Telephone survey of patients was conducted after the surgery as well as a single examination of patients with evaluation by functional scales – UCLA, ASES, CS, VAS, DN4. Preoperative standard x-rays in AP and axial views were done in all patients. Arthropathy severity was evaluated by K.Hamada classification. Comparison of patient specific data, features of RC lesions and surgical treatment was made by Kruskal-Wallis test.Results. Good outcomes by ASES, CS and UCLA functional scales were obtained in 15 (5%) of patients, satisfactory – in 213 (69.8%), poor – in 77 (25.2%). Postoperative MRI data provided the following sub-distribution of patients: 49 (41.1%) patients with complete repair of RC tendons lesions, 38 (31.9%) patients with partial repair and 33 (27.0%) patients with recurrent tear of reconstructed tendon. Correlation analysis allowed to establish the limits for achieving good outcomes of arthroscopic bone-tendon anchor suturing for significant association with infraspinatus muscle atrophy (not exceeding 40%) and fatty infiltration of supraspinatus muscle (not exceeding 23.5%).

The purpose of the study was to evaluate the nearest clinical, functional and structural (according to MRI) results of arthroscopic reconstruction of the shoulder upper capsule using an acellular dermal collagen matrix and auto-tissue of the ileotibial band in the patients with shoulder arthropathy after a massive rotator cuff tear. Material and Methods. The study included 30 patients with stage I-IV shoulder arthropathy according to K. Hamada classification. All of them were undergone the arthroscopic reconstruction of the upper part of the shoulder capsule in 2017-2018. The orthopedic procedures were performed by the same surgical team using an acellular dermal collagen matrix as a biological material (group 1) and auto-tissue of the iliotibial band (group 2). Results. The proportion of the patients with good -8 (26.7%), satisfactory -14 (46.6%) and poor -8 (26.7%) surgical outcomes was determined according to the ASES functional assessment scales. Transplant ruptures were recorded in one (3.3%) patient in the group with an acellular dermal collagen matrix and in two (6.6%) patients in the group with the iliotibial autograft. Conclusion.Arthroscopic reconstruction of the upper part of the shoulder capsule is a promising method for the surgical treatment of physically active working age patients with shoulder arthropathy after massive rotator cuff tear. The main goals are restoration of the shoulder vertical stability, centered position of the humeral head towards the glenoid, and improvement of the shoulder biomechanics as a whole.