Abstract
In recently, reverse shoulder arthroplasty for rotator cuff deficient arthritis is widely used in the world. However, a high complication rate was reported and worried about long-term results after reverse shoulder arthroplasty. From 2001, we performed a novel strategy for these cases such as rotator cuff reconstruction w/ or w/o muscle transfer and a humeral head replacement with using smallest head to decrease joint volume. The aim of this study was to investigate with clinical outcomes after this surgery more than two years follow-up.
Materials & methods
Fifty six shoulders underwent humeral head replacement (HHR) with or without tendon transfer for cuff tear arthropathy was able to follow-up more than two years. The mean age was 74 years (60 to 83 years). 42 cuff tear arthropathy, 6 RA, 5 re-tear after cuff repair with arthritis, and 1 arthritis after infection were included. Coracoacromial arch preserved Superior approach with preserving coracoacromial arch was used for replacement the humeral stem and head. Almost of the cases could be repaired with using a smallest head because of the height of humeral head and joint volume were decreased. However, when rotator cuff remained in irreparable condition, a latissimus dorsi tendon or a pectoralis major tendon from same shoulder was transferred for cuff reconstruction. The patients were divided by 2 groups; 36 shoulders of HHR without tendon transfer and 20 shoulders of HHR with tendon transfer. Each patient was evaluated with Japan Orthopaedic Association score (JOA score) and modified Neer's limited goals rating scale after a least 2 year of follow-up.
Results
In all cases, preoperative severe pain was dramatically improved. JOA score improve from 40.2 preoperatively to 80.2 postoperatively. Twelve shoulders estimated as excellent in modified Neer's classification, 34 in satisfactory and 10 in unsatisfactory. Half of cases with RA were unsatisfactory results. Postoperative active flexion statistically improved compared to preoperative range of motion. Averaged postoperative flexion was 136 degrees (preop.;68.8) and postoperative external rotation was 28.6 degrees (preop.;13.2). However, there was no significant difference of external rotation in the HHR group between pre and postoperative evaluation. The radiographic evaluation showed four cases of glenoid erosion. One case had arthroscopic Suprascapular nerve release eight years after surgery.
Conclusions
The current results were consistent with the prior studies. Our novel strategy is considered as one of useful procedure for cuff tear arthropathy. However, the case which classified with Seebauer type IIB should not be recommended.
