FIXED-FULCRUM TOTAL SHOULDER ARTHROPLASTY (FFTSA) FOR ROTATOR CUFF DEFICIENT SHOULDER WITH AND WITHOUT ARTHRITIS.

Abstract

Aim: To evaluate the role and outcome of FFTSA in shoulders with arthritis and/or irreparable rotator cuff tears.

Materials. The records of 60 consecutive patients with FFTSA were retrospectively reviewed. Primary FFTSA (group 1) was performed in 29 (48%), revision FFTSA (group 2) in 26 (43%), and re-revision FFTSA (group 3) in 5 (9%) patients. The mean age at primary FFTSA was 70 years (37 – 82), and at revision FFTSA, 67.6 years (38 – 89) at a mean interval of 38 months after primary intervention. In re-revision FFTSA the interval between the primary (mean age 64 years) and final (mean age 68.4 years) interventions varied from 20 to 148 months. Primary FFTSA was performed for cuff arthropathy in 18 (62%) and after trauma in 5 (17%): all 29 patients had rotator cuff insufficiency. Revision FFTSA was performed for failure of humeral head replacement (HHR) after fracture in 17 (65%) of which 14 had rotator cuff insufficiency. All those in group 3 had rotator cuff insufficiency. The dominant indication for intervention was pain in 59 cases. The glenoid component was uncemented in all cases. The humeral component was cemented in 27 of the 29 Primary FFTSA. CADCAM variations of the standard humeral design were used in 8 cases.

Results. At a mean follow-up of 25 months, 81% of primary FFTSA had no or mild pain, and 87.5% were satisfied or very satisfied with the outcome: both outcomes were independent of the original rotator cuff defect. At a mean follow-up of 41 months, 69% of revision FFTSA had no or mild pain, and 68 % were satisfied or very satisfied: the least satisfied patients were those in which a previous HHR for fracture had been the primary intervention. There were 3 complications in group 1, 2 in group 2, and 2 in group 3. In 4 patients with deficient deltoid function, 3 were satisfied with the eventual outcome

Conclusion. FFTSA has a clear role in the management of shoulders in which the rotator cuff has failed and a joint replacement is required for pain relief.