Dataset Information

Reverse Shoulder Arthroplasty in the Management of Irreparable Rotator Cuff Tears without Arthritis.

ABSTRACT:

Introduction

The ability to provide reliable outcomes in treatment of patients with degenerative rotator cuff tears has become increasingly complicated, as a result of more advanced disease and the increased array of treatment choices.

Step 1 preoperative planning

Develop and communicate with a consistent team of interdisciplinary physicians both preoperatively and postoperatively; utilize advanced imaging modalities to evaluate muscle atrophy as well as glenoid and humeral bone stock.

Step 2 patient positioning

Place the patient in a beach-chair position, check the abdominal strap, and position yourself facing the axilla.

Step 3 surgical approach

Develop the subdeltoid and subacromial spaces and take care to avoid vigorous over-retraction of the deltoid.

Step 4 humeral exposure and preparation

Perform the head cut utilizing the 135° resection guide, broach the humerus, and ream the humeral socket.

Step 5 glenoid exposure and preparation glenosphere insertion

Ream the inferior surface to bleeding subchondral bone; bleeding subchondral bone on the inferior 50% of the prepared glenoid surface indicates a sufficient depth.

Step 6 final humeral preparation

At final reaming, the edge of the reamer should sit flush with the cut surface of the humerus.

Step 7 trialing

Proper soft-tissue balance is frequently achieved by positioning the humeral component so that the rim of the socket lies just above the humeral osteotomy site at the anatomic neck.

Step 8 component implantation and closure

When cementing the humeral component, the socket should match the reamed proximal part of the humerus.

Results

Initially, reverse shoulder arthroplasty was primarily used to treat osteoarthritis of the glenohumeral joint resulting from chronic rotator cuff deficiency or for true rotator cuff tear arthropathy.

What to watch for

Indications Contraindications Pitfalls & Challenges.

SUBMITTER: Harreld KL

PROVIDER: S-EPMC8453596 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundHumeral rotation often remains compromised after nonlateralized reverse shoulder arthroplasty (RSA). Reduced rotational moment arms and muscle slackening have been identified as possible reasons for this impairment. Although several clinical studies suggest lateralized RSA may increase rotation, it is unclear whether this is attributable to preservation of rotational moment arms and muscle pretension of the remaining rotator cuff.Questions/purposesThe lateralized RSA was analyzed to determine whether (1) the rotational moment arms and (2) the origin-to-insertion distances of the teres minor and subscapularis can be preserved, and (3) their flexion and abduction moment arms are decreased.MethodsLateralized RSA using an 8-mm resin block under the glenosphere was performed on seven cadaveric shoulder specimens. Preimplantation and postimplantation CT scans were obtained to create three-dimensional shoulder surface models. Using these models, function-specific moment arms and origin-to-insertion distances of three segments of the subscapularis and teres minor muscles were calculated.ResultsThe rotational moment arms remained unchanged for the middle and caudal subscapularis and teres minor segments in all tested positions (subscapularis, -16.1 mm versus -15.8 mm; teres minor, 15.9 mm versus 15.3 mm). The origin-to-insertion distances increased or remained unchanged in any muscle segment apart from the distal subscapularis segment at 0° abduction (139 mm versus 145 mm). The subscapularis and teres minor had increased flexion moment arms in abduction angles smaller than 60° (subscapularis, 2.7 mm versus 8.3 mm; teres minor, -6.6 mm versus 0.8 mm). Abduction moment arms decreased for all segments (subscapularis, 4 mm versus -11 mm; teres minor, -3.6 mm versus -19 mm).ConclusionsAfter lateralized RSA, the subscapularis and teres minor maintained their length and rotational moment arms, their flexion forces were increased, and abduction capability decreased.Clinical relevanceOur findings could explain clinically improved rotation in lateralized RSA in comparison to nonlateralized RSA.

Project description:PurposeThe purposes of this study were to investigate the difference in value (benefit to cost ratio) of dermal allograft superior capsular reconstruction (SCR) versus reverse total shoulder arthroplasty (rTSA) for the treatment of massive rotator cuff tears (MRCTs) without arthritis; to compare the patient populations selected for the operations and report pre- and postoperative functional data; and to understand other characteristics of the 2 operations, including operating time, use of institutional resources, and complications.MethodsA retrospective, single-institution analysis during the study period 2014-2019 with MRCT treated with SCR or rTSA by 2 surgeons with complete institutional cost data and minimum 1-year clinical follow-up with American Shoulder and Elbow Surgeons (ASES) score. Value was defined as ΔASES/(total direct costs/$10,000).ResultsThirty patients underwent rTSA and 126 patients SCR during the study period with significant differences noted in patient demographics and tear characteristics between the groups (patients who underwent rTSA were older, less male, had more pseudoparalysis, had greater Hamada and Goutallier scores, and had more proximal humeral migration). Value was 25 and 29 (ΔASES/$10,000) for rTSA and SCR, respectively (P = .7). The total costs of rTSA and SCR were $16,337 and $12,763, respectively (P = .7). Both groups experienced substantial improvements in ASES scores: 42 for rTSA vs 37 for SCR (P = .6). The operative time for SCR was much longer (204 vs 108 minutes, P < .001) but complication rate lower (3% vs 13%, P = .02) versus rTSA.ConclusionsIn a single institutional analysis of the treatment of MRCT without arthritis, rTSA and SCR demonstrated similar value; however, the value calculation is highly dependent on institution specific variables and duration of follow-up. The operating surgeons demonstrated different indications in selecting patients for each operation. rTSA had an advantage over SCR in shorter operative time, whereas SCR demonstrated a lower complication rate. Both SCR and rTSA are demonstrated to be effective treatments for MRCT at short-term follow-up.Level of evidenceIII, retrospective comparative study.