Abstract
Introduction
We performed humeral head replacement (HHR) with smaller head for closing the cuff defect in patients of cuff tear arthropathy (CTA). And also, if the cuff defect could not close by decreasing the head size, we add muscle tendon transfer such as latissimus dorsi transfer for posterosuperior defect and pectoralis major transfer for anterosuperior defect.
Aim
The purpose of this study was to investigate clinical and functional outcomes of this procedure for CTA according to Hamada-Fukuda classification.
Methods
76 shoulders in 77 patients with CTA underwent HHR based on our strategy at average age of 74 years. Hamada-Fukuda classification was classified into five categories. There were 13 type 1, 24 type 2, 26 type 3, 9 type 4, 5 type 5. Clinical outcomes (JOA score) were evaluated at an average of 25 months.
Results
The average Japanese Orthopaedic Association shoulder score all improved significantly. Forward elevation improved from 57° to 146.5° in type 1, 65.5° to 132.1° in type 2, 82° to 123.9° in type 3, 90.6° to 122.1° in type 4 and 91° to 130° in type 5. Improvement of External rotation 25° in type 1, 23.1° in type 2, 10.89°in type 3, 11.3° in type 4 and −7.3° in type 5. Internal rotation similarly improved between Hamada-Fukuda classification.
Conclusion
In patients of type 1 and 2, our procedure could get a good ER recovery. However, in patients of type 3, 4, and 5, functional outcomes were partly inferior to type 1 and 2. Our procedure for type 1 and 2 CTA is one of useful methods.
