Reverse Total Shoulder Arthroplasty for Massive Cuff Tear and Cuff Tear Arthropathy in Elderly Patients / 대한정형외과학회잡지

ABSTRACT

PURPOSE: We wanted to assess the short term clinical outcomes and the effectiveness of reverse total shoulder replacement for massive rotator cuff tears with cuff tear arthropathy in elderly patients. MATERIALS AND METHODS: Between September 2007 and January 2009, 17 reverse total shoulder arthroplasties were performed on patients with an average age of 69.3 (58-80) years. The follow up period was an average of 17.9 (12-32) months. The outcomes were evaluated using the visual analogue scale, the range of motion, the muscle strength, the Constant score, the UCLA score and the Korea shoulder score. We performed radiological measurements of medialization of the center of rotation, distalization of the humerus, and tilting of the inferior glenoid on the preoperative and postoperative radiographs. RESULTS: The VAS improved from 7.2+/-3.6 preoperatively to 1.6+/-1.0 postoperatively. The average preoperative active forward fl exion was 51.5+/-28.4 degrees, which improved to 131.5+/-20.7 degrees at the final follow-up. The internal rotation was deteriorated from L2 to L5 (p<0.001, 0.001, 0.011). The average Constant score improved from 23.9+/-5.1 points before surgery to 62.2+/-9.1 points at the time of follow-up and the UCLA score and KSS score also rose from 7.6+/-2.4 and 27.0+/-7.5 points to 26.3+/-3.6 and 69.2+/-10.4 points respectively, which were statistically significant. For the radiological measurements, the medialization of rotation of the center was a mean of 20.6 mm+/-4.3 and the distalization of the humerus was a mean 22.8 mm+/-5.56. The glenoid inferior tilting increased a mean of 12.1+/-4.3 degrees. Inferior scapular notching was observed in two cases. CONCLUSION: The reverse total shoulder arthroplasty produced good results when used for the treatment of massive rotator cuff tear and cuff tear arthropathy. Forward fl exion was significantly improved, but on the contrary internal rotation was deteriorated. Considering the technical difficulties and the possibility of complications, the reverse total shoulder arthroplasty should be judiciously used by expert surgeons.