MANAGEMENT OF ROTATOR CUFF ARTHROPATHY WITH SHOULDER RESURFACING AND SUBSCAPULARIS Z-PLASTY

Abstract

Introduction: Glenohumeral arthritis secondary to chronic cuff deficiency not only leads to serious compromise in shoulder function but also poses a surgical challenge. There is no consensus regarding management of this problem although different arthroplasty options have been tried with variable results. We present our experience with managing this difficult problem using a shoulder resurfacing and subscapularis Z-plasty in order to improve shoulder movements, pain and function.

Patient and Methods: This study was conducted on 30-patients with rotator cuff arthropathy operated by a single surgeon at a district general hospital. There were 21 female and 9 male patients with mean age 73 years (range 62–85 years). The average duration of symptoms prior to treatment was 5.45 years (range 2–15 years). Twenty patients had uncemented shoulder resurfacing while remaining ten patients had cemented resurfacing procedure. The mean follow-up was 21 months (range 36–18 months). The patients were assessed at 3 months, 6 months, 12 months and 24 months postoperatively with European Society for shoulder and Elbow Surgery Score (ESSES) and radiograph at each visit.

Results: The ESSES score significantly improved from a mean of 47.5 preoperatively to 77.5 postoperatively, with most improvement being in subjective scoring (pain and ADL) followed by improvement in external rotation and forward flexion movement due to lengthening of subscapularis by Z-plasty. The VAS score for pain improved from average 7.4 preoperatively to 0.9 at 6 months postoperatively. On subjective scoring most patients reported good to excellent result at 6 months following surgery. There was no difference in outcome scores between cemented and uncemented resurfacing groups. No intraoperative or postoperative complications were encountered.

Our early results with shoulder resurfacing in management of rotator cuff arthropathy are encouraging. This bone conserving surgery may serve as an alternative to major procedures like reverse shoulder arthroplasty in selected group of patients.