Abstract
Background
Cuff tear arthropathy represents a challenging problem to the shoulder arthoplasty surgeon. Poor results of conventional total shoulder arthroplasty in cuff deficient shoulders due to glenoid component loosening have meant hemiarthroplasty has been the traditional preferred option. Recently reverse total shoulder arthroplasty (RSA) has gained increasing popularity due to a clinical perception of an improved functional outcome. This is despite the lack of comparative data, particularly in relation to modern hemiarthroplasty prostheses. The aim of this study was to compare the early functional results of Hemiarthroplasty versus RSA in the management of cuff-tear arthropathy.
Material and Methods
Patients were identified from the New Zealand National Joint Registry and matched for age, sex, and American Society of Anesthesiologists scores.102 primary hemiarthroplasties performed for cuff tear arthropathy were compared with 102 RSAs performed for the same diagnosis. Oxford shoulder scores (OSS) were collected prospectively at 6 months and five years post operatively together with mortality and revision rates.
Results
There were 51 males and 51 females in each group, with a mean age of 71.6 in the Hemiarthroplasty group and 72.6 in the RSA group. The mean ASA score was 2.2 in both groups. The median OSS was 31.1 in the hemiarthroplasty group and 41.1 in the RSA group. This difference was maintained at five years. At follow up, there were 7 revisions in the hemiarthroplasty group and 5 in the RSA group. No difference in mortality was seen between the two groups.
Conclusion
This study provides the first direct evidence of improved functional outcome of RSA compared to Hemiarthroplasty in patients with cuff tear arthropathy. Longer-term follow up is needed to confirm that the improved function is maintained and that complications such as component loosening remain comparable.
