Purpose: The purpose of this study was to analyse outcome of shoulder prostheses after radiotherapy, to define a specific clinicoradiological entity, and evaluate incidence of complications.

Material and methods: Fourteen shoulder prostheses were implanted in 13 women who had been treated for breast cancer with complementary radiotherapy and one man treated for Hodgkin’s lymphoma. The time from radiothearpy to implantation was 16 years, seven months. Two forms were identified on the preoperative x-rays: seven cases with typical avascular osteonecrosis according to the Arlet and Ficat classification, and seven cases with a radiographic presentation of arthritis or degenerative disease. Humeral prostheses were used in five cases and a total shoulder arthroplasty in nine.

Results: Four implants had to be removed, three for sepsis, and five patients required revision surgery. The mean postoperative Constant score for the ten prostheses still in place was 53.1 points with a mean elevation of 111° at three years seven months follow-up. The gain in pain score was 8.5 points with a mean result of 10.9 points. The results were different depending on the initial radiological form, with less favourable outcome observed in typical osteonecrosis.

Discussion: This study demonstrated a particular radio-clinical entity independent of classical osteonecrosis of the humeral head. The surgical procedure was more difficult and the outcome was less satisfactory than in the classical forms with a high rate of complications.

Leakage after simple suture repair of rotator cuff tears depends on the overall preoperative fatty degeneration index (FDI) of the muscles and preoperative fatty degeneration (FD) of the infraspinatus. When the FDI is = 2, cuff leakage is always observed after repair. The risk of recurrent tears of the supraspinus is high if the FD of the infraspinatus is > 1. However if the FDI is very low or nil, the rate of recurrent tears is 15%. These tears can be explained by tension on sutures in macroscopically and histologically abnormal tendons.

Purpose: The purpose of this study was to determine whether repair of rotator cuff tears using sutures without tension after removal of abnormal tendon stumps, a technique requiring tendon plasty, can improve the leakage rate.

Material and methods: Total repair of 24 rotator cuff tears was performed without tension on the sutures after resection of at least one centimetre of the supraspinatus tendon stump. This consecutive series was studied prospectively. The tears involved the supraspinatus and the infraspinatus in ten cases, all three tendons in 13 cases and only the supraspinatus in one case. Mean preoperative FDI was 1.18 (0.5–2.16); pre-operative FD of the infraspinatus was a mean 1.19 (0–2). The supraspinatus stump was resected from the trochiter in 14 cases, on the apex of the head of the humerus in seven and facing the glenoid cavity in three. Repair required translation advancement of the supraspinatus in 24 cases, translation advancement of the infraspinatus in six (associated with a rhomboid flap) and a trapezeal flap in three cases. Postoperative leakage was assessed with arthroscan (n=23) and ultrasonography (n=1) at one year.

Results: No leakage was observed in 20 of the 24 cuffs (83%). Recurrent tear of the supraspinatus was observed in three cases and in the supraspinatus and infraspinatus in one case each. The FDI of cuffs with recurrent tears (1.31) was not significantly greater than the FDI of cuffs without leakage (1.15) (p = 0.085). Preoperative FD of the infraspinatus of cuffs with recurrent tears (1.5) was significantly higher than that for cuffs without leakage (1.12) (p = 0.16). For the supraspinatus and the subscapularis, there was no significant difference between preoperative fatty degeneration of cuffs with recurrent tears and cuffs without leakage. The number of repaired tendons had a statistically significant effect (p = 0.012) on postoperative leakage: 23% of the recurrent tears after repair of three tendons showed no leakage compared with 9% after repair of one or two tendons (there was no significant difference for preoperative FDI, p = 0.33).

Discussion: Resection of macroscopically abnormal tendon stumps which requires tendinomuscular plasty, gives better anatomic results than simple suture. For an equivalent FDI, this allows fewer cases of leakage (83% without leakage compared with 50% after simple suture). Results were also better for an equivalent number of tendons repaired: 77% and 50% for three tendons and 91% and 55% for two tendons respectively).

Conclusion: Despite the almost constant need for plasty, rotator cuff repair using sutures without tension after resection of macroscopically abnormal tendon stumps gives, for an equivalent preoperative degree of fatty degeneration and an equivalent number of tendon repairs, better anatomic results than simple suture.