Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Abstract

Background Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA's approval in 2004, the appropriateness in patients with rotator cuff disease is unclear. Questions/purposes We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy.Methods We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease.Results Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short-and mediumterm followup studies. Conclusions In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA. Clinical Relevance For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction. Level of Evidence Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Does Reverse Shoulder Arthroplasty for Tumors of the Proximal Humerus Reduce Impairment?

“…To improve shoulder function in these patients, we introduced the use of a reverse total shoulder prosthesis [18]. In patients with a functional deltoid, active glenohumeral abduction to an average of 143°w as achieved in the short term [15,19]. To establish whether this is a reasonable surgical treatment, we therefore determined (1) whether RSA restores function and (2) improves motion, (3) the complications associated with the surgery, and (4) whether RSA with autologous grafting is associated with bone resorption.…”

“…These latter patients are frequently treated with reverse total shoulder arthroplasty (RSA). With this treatment, in the short term, an active shoulder function with abduction and forward flexion of more than 140°can be expected [17][18][19], whereas this is limited to less than 90°with resection arthroplasty, biologic reconstruction, or hemiarthroplasty. All limb-sparing treatments of the shoulder have similar disease-free survival, but the complication rate for resection arthroplasty and biologic reconstruction is higher than that for arthroplasty (Table 1).…”

Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

“…Complication rates have been reported as high with open reduction and internal fixation (ORIF) despite technologic improvements such as locked plating [14,17,18,25,31]. Although surgeons now are using hemiarthroplasty of the humeral head and reverse total shoulder replacement in an attempt to improve functional outcomes after treatment of comminuted three-or four-part fractures and fractures that have a head-split component [3,6,10,15,23], these arthroplasty techniques for fracture care also have associated complications [3,39].…”

Reverse Total Shoulder Arthroplasty in the Massive Rotator Cuff Tear

“…35) Also, large (>5 cm) tears that involve two or more rotator cuff tendons with atrophy and a high degree of fatty infiltration (Goutallier stage 3 or 4) are unlikely to benefit from attempts of surgical repair. 27,36,37) Like this, patients who have irreparable massive rotator cuff tear lesions are to take reverse total shoulder arthroplasty into consideration. Eligible candidates for reverse total shoulder arthroplasty should demonstrate forward elevation of less than 90 degree, and have weakness of the rotator cuff musculature on physical examination.…”