Objective: This study evaluates the preoperative conventional anteroposterior radiography in non-operated patients with cuff tear arthropathy. It analyses the radiological findings in relation to the status of the rotator cuff and clinical outcome. The aim of the study is to define the usefulness of this radiographical examination in cuff tear arthropathy. Methodology: This study analyses the preoperative radiological (AP-view, (Artro-)CT-scan or MRI-scan) and clinical characteristics (Constant-Murley-score plus active and passive mobility testing) and the peroperative findings in a cohort of 315 patients of which 282 had eccentric omarthrosis according to the classification of Hamada and 33 patients with centered omarthrosis who have at least two irreparable tendon tears. Those patients were part of a multicenter, retrospective, consecutive study of the French Orthopaedic Society (SOFCOT-2006). All patients had no surgical antecedents and were all treated with prosthetic shoulder surgery for a painful irreparable cuff tear arthropathy (reverse -(84%) or hemi-(8%) or double cup prosthesis (8%)). Results: Fatty degeneration of a rotator cuff muscle decreases its strength (p < 0.0001). In the presence of tendons lesser bony wear is seen at the acromion (acetabularisation, (p< 0.005), the glenoid (superomedial wear p=0.005) as well as the humeral head (femoralization, p=0.002). The radiological classifications according to Hamada and Favard seem not to be as appropriate to reflect accurately the location and extent of the tendino-muscular degeneration as the acromial acetabularization and humeral sphericity. The acromio-humeral distance is a good indicator for the location and the extend of the cuff tear arthropathy. A smaller acromio-humeral distance (95% CI: 4mm + 1) is only present if the postero-superior muscles are fatty degenerated (Goutallier stade III & IV) and a larger distance is calculated (95% CI: 7mm + 3) when only the antero-superior muscles are diseased. The coracoid tip in cuff tear arthropathy-patients is almost always positioned in the inferior half of the glenoid (84%). A bigger supero-inferior distance of the glenoid in relation to the radius of the humeral head indicates more structural destruction of rotator cuff status (tendinous and muscular) and a worse clinical outcome. Conclusion: This study defines the use of a conventional radiological antero-posterior view to evaluate eccentric omarthrosis as very useful. The direction of eccentricity in the scapular plane of the body and type of wear, situated either at the glenoïd, acromion or humeral head are determined by the location and extent of the tendinous lesion and the degree of fatty degeneration of the rotator cuff muscle

Most common current surgical treatment options for cuff tear arthropathy (CTA) are hemiarthroplasty and reverse total shoulder replacement. At our unit we have been using Reverse Total shoulder replacement (TSR) for CTA patients since 2001. We present our results of Reverse TSR in 64 patients (single surgeon) with a mean follow up of 2 years (Range 1 to 8 years). There were 45 males and 19 females in the study with a mean age of 70 years. Preoperative and postoperative Constant scores were collected by a team of specialist shoulder physiotherapists. Preoperatively plain radiographs were used to evaluate the severity of arthritis and bone stock availability. 90% patients showed an improvement in the Constant score post operatively. The mean improvement in Constant score was 25 points. The mean Pain Score (max 15) improved from 6.3 to 11.8; the mean ADL Score (max 20) improved from 6.8 to 12.3; the mean Range of Motion score (max 40) improved from 10.8 to 20.2; but the mean Power Score (max 25) only improved from 0.9 to 4.9. The differences in improvement were statistically significant in each category. A total 6 patients (10%) required 10 revision surgeries for various reasons. Two patients dislocated anteriorly who were treated by open reduction. Two patients required revision of the glenoid component due to loosening after a mean of 2 years. One patient required revision of the humeral component with strut grafting secondary to severe osteolysis. Only one patient required revision of both humeral and glenoid components secondary to malpositioning. Three patients died for reasons unconnected with their shoulder problems and surgery. Radiographic analysis at the latest follow up (mean 24 months) showed inferior glenoid notching in 40% cases. Heterotrophic ossification was not seen in our series. We conclude that reverse TSR is a viable option for treatment of cuff tear arthropathy however glenoid loosening and scapular notching remains an issue

Progressive arthritis can occur in association with massive tears of the rotator cuff. Altered joint kinematics are commonly proposed as the principle causative factor but this does not explain the absence of arthropathy in some patients. We have investigated the role of the ANKH gene in patients with cuff tear arthropathy. The transmembrane protein ANKH promotes intracellular to extracellular inorganic pyrophosphate channelling which regulates calcium pyrophosphate dihydrate and hydroxyapatite crystal deposition. Genomic DNA was prepared from peripheral blood leucocytes from 20 patients with cuff tear arthropathy diagnosed clinically and radiologically and 24 healthy matched controls. All 12 exons and exon-intron boundaries from the ANKH gene were PCR amplified and sequenced with BigDye version 3.1 terminator kit (ABI), and analysed using ABI PRISM ® 3100 Genetic Analyser. We have identified 5 single nucleotide polymorphisms (SNPs) including 4 that have previously been identified in patients with chondrocalcinosis. These are in exon 2 (GCC†’GCT 294), intron 2 (G†’A +8), exon 8 (GCA†’GCG 963) and intron 8 (T†’G +15). We also identified an A†’G variant in 3′-UTR, 30 base pairs after the stop codon which has not been reported before in crystal deposition diseases, and is also not seen in any of the healthy controls. Further elucidation is necessary to demonstrate a causal relationship between these ANKH mutations and cuff tear arthropathy, which will add to our understanding of pathogenic mechanisms in this condition

Before reverse shoulder replacement was an option for rotator cuff tear arthropathy the treatment modalities were limited to injections and physical therapy for pain control, arthroscopic debridement with or without biceps tenodesis/tenotomy and hemiarthroplasty. Functional improvement was limited with these treatment options and success for pain control was moderate at best. The destructive nature of the rotator cuff deficient shoulder continued with medialization of the glenoid and erosion of the acromion seen even after replacement with hemiarthroplasty. The end result usually left the patient with a pseudo paralysis of the shoulder region functionally and uncontrolled pain that made later revision with a reverse implant difficult or impossible. Reverse arthroplasty was released for use in United States in 2004 for rotator cuff tear arthropathy. This initial procedure had a number of related complications that have been improved on over time with changes in implant design and better operative techniques. The long term results with reverse total shoulder arthroplasty have made this the procedure of choice for contained cuff tear arthropathy

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

Cuff tear arthropathy represents a challenge to the shoulder arthoplasty surgeon. The poor results of conventional total shoulder arthroplasty in cuff deficient shoulders secondary to glenoid component loosening have meant hemiarthroplasty has traditionally been the preferred surgical option. Recently reverse total shoulder arthroplasty (RSA) has gained increasing popularity due to a clinical perception of an improved functional outcome, despite the absence of comparative data. The aim of this study was to compare the early functional results of Hemiarthroplasty versus RSA in the management of cuff-tear arthropathy. 102 primary hemiarthroplasties performed for cuff tear arthropathy were compared against 102 RSAs performed for the same diagnosis. Patients were identified from the New Zealand National Joint Registry and matched for age, sex, and American Society of Anesthesiologists (ASA) scores. Oxford shoulder scores (OSS) were collected at 6 months and 5 years post operatively and were compared between the two groups, together with mortality and re-revision rates. 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 mean OSS was 31.1 in the hemiar-throplasty group and 38.1 in the RSA group. 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. This study provides the first direct evidence of a improved functional outcome of RSA compared to Hemiarthroplasty in the treatment of patients with cuff tear arthropathy. Longer term follow up is needed to confirm that the improved function is maintained, and that late complications such as component loosening remain comparable between the two groups

Cuff Tear Arthropathy is characterised by massive rotator cuff tears, glenohumeral joint destruction and joint effusions containing basic calcium phosphate and calcium pyrophosphate dihydrate crystals. We have investigated the role of the ANKH gene in patients with cuff tear arthropathy and the effect of mutations on protein function. The transmembrane protein ANKH transports inorganic pyrophosphate (PPi) from the intracellular to extracellular space. Control of the extracellular levels of PPi is crucial in preventing calcium crystal formation. Genomic DNA was prepared from peripheral blood leucocytes from 22 patients with cuff tear arthropathy diagnosed clinically and radiologically. All 12 exons and exon-intron boundaries from the ANKH gene were PCR amplified and sequenced with BigDye version 3.1 terminator kit (ABI), and analysed using ABI PRISM ® 3100 Genetic Analyser. ANKH complementary DNA (cDNA) was ligated with mammalian expression vector pcDNA3 and site directed mutagenesis was used to make the ANKH mutation detected in the cases. Human articular chondrocytes were transfected with the cDNA variants and PPi concentrations measured. A G-to-A single nucleotide polymorphism in the 3′ untranslated region (3′UTR) of ANKH was identified. The G/A genotype was seen more frequently in the cases (45%) when compared to controls (20%) (p= 0.0008). We observed altered levels of extracellular PPi in human chondrocytes transfected with ANKH cDNA with the 3′ UTR variant when compared with control cells and normal ANKH cDNA. Cuff Tear Arthropathy appears to be heritable via a G-to-A transition in the 3′UTR of ANKH that alters extracellular PPi concentrations in chondrocyte cells. This supports a hypothesis of a primary crystal mediated arthropathy in patients with Cuff Tear Arthropathy

We present a retrospective analysis of 50 cases of cuff tear arthropathy, treated over past seven year period by use of reverse geometry shoulder prosthesis. 98% follow-up was achieved with average follow up of 3 years. Mean (SD) age was 81.3 (9.2) years and female to male ratio was 5:1. Six patients had bilateral reverse geometry shoulder replacements. Patients were assessed with preoperative Oxford and American Shoulder and Elbow Scores Society score (pre-op ASES) and post-operative American Shoulder and Elbow Society Score (post-op ASES), Oxford, Constant and SF36 scores. Mean pre-op ASES was 22.29 (95%CI: 9.1 – 37.9) and post-op ASES score was 65.2 (95%CI: 48.5 – 81.9), (P< 0.001, Paired t-test). Mean post operative Oxford score was 27.25 (95% CI: 18.4 – 27.6). Mean post operative Constant score was 63.2 (95% CI: 52.6 – 79.6). X-ray review was performed to assess scapular notching and Sirveaux score was used to grade extent of notching. 11 patients had Sirveaux grade 0, 5 had grade 1, 6 had grade 2, 12 had grade 3 and 8 had grade 4 notching. Intra-operative complications included 2 glenoid fractures. Post-operative complications included 2 acromion fractures and 2 episodes of subsidence with dislocation. None of the patients developed post operative haematoma. There was one episode of infection in one patient that required further surgery. Iteration of approach with increasing experience over the years will be discussed. Ours is the biggest series of reverse geometry prosthesis used for irreparable rotator cuff tear arthropathy published so far in the literature and our results have shown superior results in terms of improvement in function and complications. We conclude reverse geometry shoulder replacement provides reasonable improvement in pain and function in elderly population with massive cuff tear arthropathy of shoulder

We present a retrospective analysis of 50 cases of cuff tear arthropathy, treated over a seven year period by use of reverse geometry shoulder prosthesis. 98% follow-up was achieved with average follow up of 3 years. Mean (SD) age was 81.3 (9.2) years and female to male ratio was 5:1. Six patients had bilateral reverse geometry shoulder replacements. Patients were assessed with pre-operative American Shoulder and Elbow Score (pre-op ASES) and post-operative American Shoulder and Elbow Scores (post-op ASES), Oxford, Constant and SF36 scores. Mean pre-op ASES was 22.29 (95%CI: 9.1 – 37.9) and post-op ASES score was 65.2 (95%CI: 48.5 – 81.9), (P< 0.001, Paired t-test). Mean post operative Oxford score was 27.25 (95% CI: 18.4 – 27.6). Mean post operative Constant score was 63.2 (95% CI: 52.6 – 79.6). X-ray review was performed to assess scapular notching and Sirveaux score was used to grade extent of notching. 11 patients had Sirveaux grade 0, 5 had grade 1, 6 had grade 2, 12 had grade 3 and 8 had grade 4 notching. Intra-operative complications included 2 glenoid fractures. Post-operative complications included 2 acromion fractures and 2 episodes of subsidence with dislocation. None of the patients developed post operative haematoma. There was one episode of infection in one patient that required further surgery. Iteration of approach with increasing experience over the years will be discussed. Ours is the biggest series of reverse geometry prosthesis used for irreparable rotator cuff tear arthropathy published so far in the literature and our results have shown superior results in terms of improvement in function and complications. We recommend reverse geometry shoulder replacement is the way forward to treat irreparable cuff tear arthropathy of shoulder

Background. Degeneration of the shoulder joint is a frequent problem. There are two main types of shoulder degeneration: Osteoarthritis and cuff tear arthropathy (CTA) which is characterized by a large rotator cuff tear and progressive articular damage. It is largely unknown why only some patients with large rotator cuff tears develop CTA. In this project, we investigated CT data from ‘healthy’ persons and patients with CTA with the help of 3D imaging technology and statistical shape models (SSM). We tried to define a native scapular anatomy that predesignate patients to develop CTA. Methods. Statistical shape modeling and reconstruction:. A collection of 110 CT images from patients without glenohumeral arthropathy or large cuff tears was segmented and meshed uniformly to construct a SSM. Point-to-point correspondence between the shapes in the dataset was obtained using non-rigid template registration. Principal component analysis was used to obtain the mean shape and shape variation of the scapula model. Bias towards the template shape was minimized by repeating the non-rigid template registration with the resulting mean shape of the first iteration. Eighty-six CT images from patients with different severities of CTA were analyzed by an experienced shoulder surgeon and classified. CT images were segmented and inspected for signs of glenoid erosion. Remaining healthy parts of the eroded scapulae were partitioned and used as input of the iterative reconstruction algorithm. During an iteration of this algorithm, 30 shape components of the shape model are optimized and the reconstructed shape is aligned with the healthy parts. The algorithm stops when convergence is reached. Measurements. Automatic 3D measurements were performed for both the healthy and reconstructed shapes, including glenoid version, inclination, offset and critical shoulder angle. These measurements were manually performed on the mean shape of the shape model by a surgeon, after which the point-to-point correspondence was used to transfer the measurements to each shape. Results. The critical shoulder angle was found to be significantly larger for the CTA scapulae compared to the references (P<0.01). When analyzing the classified scapulae significant differences were found for the version angle in the scapulae of group 4a/4b and the critical shoulder angle of group 3 when compared to the references (P<0.05). Conclusion. Patients with CTA have a larger critical shoulder angle compared with reference patients. Some significant differences are found between the scapulae from patients in different stages of CTA and healthy references, however the differences are smaller than the accuracy of the SSM reconstruction. Therefore, we are unable to conclude that there is a predisposing anatomy in terms of glenoid version, inclination or offset for CTA

Background. Absence of rotator cuff allows unbalanced muscle forces of the shoulder to cause vertical migration of the humeral head. The translation of the humerus causes impaction of articular surface against the acromion. The purpose of the study is to assess outcome of Cuff tear arthropathy (CTA) Hemiarthroplasty prosthesis in this group of patients. Methods. Retrospective review was undertaken in 42 patients who underwent Global CTA Hemiarthroplasty between Jan 2001-Jan 2009. The mean length of follow up was 6 years. Results. The patients at review showed statistically significant improvement in Forward Flexion, Abduction and Numerical Pain Rating. There were four revision surgeries and the overall survival rate at ten years was 89 %. There was statistically significant improvement (p < 0.05) in forward flexion abduction and Numerical rating scale (p 0.02). Although improvement was noted in external and internal rotation this was not statistically significant. There was one perioperative humerus fracture which required plating at the same time of surgery. The fracture went on to heal uneventfully. There was also one post-operative haematoma which required arthroscopic washout. One patient underwent further arthroscopic debridement for poor ROM which improved from 20 Abd 20 FF to 90, 90 FF, Abd. There were four revision surgeries; 3 revisions to reverse geometry replacement; and one patient had removal of implant because of persistant dislocation of implant and patient did not want another major surgery. Patients who required revision had further erosion of acromion and poor ROM of < 20 Abd, FF, and Pain 8–10/10. Conclusion. This study shows that significant improvement in pain, and movements are achieved with this device. Acromial and glenoid erosion is a potential issue with this prosthesis and three revisions were required for this this problem. The results are better than standard hemiarthroplasty when used in this setting

We present a retrospective review of 50 cases of cuff tear arthropathy treated over past seven years by the use of reverse geometry shoulder prosthesis. 98% follow-up was achieved with average follow up of 3.04 years. Mean age was 81.3 (SD 9.2) years, female to male ratio was 5:1 and seven patients had bilateral procedures. Pre-operatively patients were assessed with American Shoulder and Elbow Surgeons Scores (ASES) and Oxford Scores and pos-operatively with ASES, Oxford and Constant scores. SF36 score was used to assess functional health status. Mean pre-op ASES was 22.29 (95%CI: 9.1 – 37.9) and post-op ASES score was 65.2 (95%CI: 48.5 – 81.9), (P< 0.001, Paired t-test). Mean post-operative Oxford score was 27.25 (95% CI: 18.4 – 27.6) and mean post operative Constant score was 63.2 (95% CI: 52.6 – 79.6). Sirveaux score was used to grade extent of glenoid notching on AP and lateral glenohumeral views, that showed 69% had notched. Complications included two acromion fractures, two episodes of subsidence with dislocation, one episode of infection and one patient with unexplained pain in axilla. We found reverse geometry shoulder replacement provides reasonable improvement in pain and function in elderly patients with massive cuff tear arthropathy

Cementless surface replacement arthroplasty (CSRA) is an established treatment for glenohumeral osteoarthritis. Few studies however, evaluate its role in cuff tear arthopathy. The purpose of this study is to compare the outcomes of CSRA for both glenohumeral osteoarthritis and cuff tear arthopathy.

42 CSRA with the Mark IV Copeland prosthesis were performed for glenohumeral osteoarthritis (n=21) or cuff tear arthopathy (n=21). Patients were assessed with Oxford and Constant scores, patient satisfaction, range of motion and radiologically with plain radiographs.

Mean follow-up and age was 5.2 years and 74 years in both groups. Functional outcomes were significantly higher in OA compared with CTA with OSS improving from 18 to 37.5 and 15 to 26 in both groups respectively. Forward flexion improved from 60° to 126° and 42° to 74° in both groups. Three patients in the CTA group had a deficient subscapularis tendon, two of whom dislocated anteriorly.

Humeral head resurfacing arthroplasty is a viable treatment option for glenohumeral osteoarthritis. In patients with CTA, functional gains are limited. We suggest CSRA should be considered in low demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis due to the high risk of dislocation.

Purpose

The purpose of this study was to evaluate the short to mid-term results after hemiarthroplasty with extended head prosthesis (CTA head) for patients with cuff tear arthopathy.

Rotator cuff arthropathy is a challenging problem to treat in many patients whose function remains intact despite pain from arthritis. In recent years, the introduction of reverse shoulder arthroplasty has improved the function and pain in pseudoparalytic shoulders with rotator cuff deficiency. However, significant evidence exists to support the use of alternative surgical and non-surgical treatments for those patients who suffer from the pain of arthritis while maintaining an intact force-couple of the rotator cuff and relatively well preserved function.

The treatment of patients with arthritis of the glenohumeral joint with an associated massive irreparable cuff tear is challenging. Since these patients usually have proximal migration of the humerus, the CTA extended head allows a surface with a low coefficient of friction to articulate with the acromion.

Between 2001 and 2006 a total of 48 patients with arthritis of the shoulder joint associated with a massive cuff tear, were treated with a CTA head. The indications for use being Seebauer Type 1a and 1b appearances on x-ray and active abduction of the arm to more than 60° with appropriate analgesia. Preoperatively, a Constant score and an ASES pain and function score were completed as well as standard radiological assessment. These were repeated at follow up. Paired t tests were carried out for all the variables. A Kaplan-Meier survival analysis was performed.

Follow up varied between 2 and 8 years. Improvements in pain, function and all movement parameters were significant at p< 0.001. There was no change in the strength component. Survival analysis showed 94% survival at 8 years (95% CL 8%) there were 2 revisions and 5 deaths. Radiological assessment at follow up revealed no evidence of humeral stem loosening. In 5 (17%) cases however there was evidence of erosion in the surface of the acromion and in 13 (45%) erosion of the glenoid. Finally one component was also seen to have subluxed anteriorly.

This head design has been in use for a number of years. To date there appears to be no reported outcome of their use. This series shows that in an appropriately selected patient a satisfactory clinical outcome can be maintained in the short to medium term. The presence of erosion of the glenoid but also the under surface of the acromion does require continuing monitoring.

The treatment of rotator cuff arthropathy due to irreparable massive rotator cuff tear is still challenging. We performed reverse total shoulder arthroplasties for 2 cases of cuff tear arthropathy. The short term follow-up after the surgery reveal excellent results by ASES and UCLA score. However, these results still require long term follow-up and the study about implant design for the shoulder anatomy of the Koreans

Purpose. Glenoid version has been correlated with tears within the rotator cuff. Cuff tear arthropathy is an evolution of multiple unhealed tendons ultimately resulting in pseudoparalysis. Although several factors are critical to allow tendon healing, we have observed that there is less glenoid version in patients with cuff tear arthropathy. This was compared to those with osteoarthritis where rotator cuff tears are uncommon. We hypothesize that patients undergoing inverse prosthesis generally have a near neutral glenoid. Method. A single surgeons practice (JPW) was retrospectively reviewed for all cuff tear arthropathy and osteoarthritis patients undergoing primary shoulder arthroplasty. (Zimmer, Warsaw, IN). Glenoid version was measured by 2 fellowship trained shoulder surgeons. Inter and intra-class correlation was measured. Results. The axial CT scans of 84 patients (cuff tear arthropathy and osteoarthritis) were evaluated. Inter and intra-class correlation was excellent (0.96, 0.97). Glenoid version was between 4.1 +/− 3.6 and 16.5 +/− 8.6 degrees for cuff tear arthropathy and osteoarthritis, respectively (p < 0.0001). Conclusion. Our observation of near neutral glenoid version in patients with cuff tear arthropathy has not been reported in the literature. The anatomical version of the glenoid may be a risk factor in patients undergoing rotator cuff repair. This may predispose certain individuals to cuff tear arthropathy compared to those with increased retroversion

Introduction: Glenohumeral arthritis with a massive rotator cuff tear is a devastating condition that seriously compromises the comfort and function of the shoulder. Cuff tear arthropathy presents a unique surgical challenge and many arthroplasty options were used for its treatment. The purpose of this study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with cuff tear arthropathy and intact subscapularis function. Patients and Methods: The study was conducted on twenty five shoulders in twenty five patients with cuff tear arthropathy with the subscapularis tendon still intact. The patients were prospectively followed up clinically and radiologically for a mean of 26 months (range, 15–38 months). There were 16 female and 9 male shoulders. The mean age was 69.04 years (range,53–83years). The mean operative time was 38 minutes (range, 28–56minutes). The clinical assessment was performed with the Constant score. Results: The constant score significantly improved from a mean of 14.04 points preoperatively to 53.17 points postoperatively. Of the patients, 88% considered the shoulder to be much better or better as a result of the operation. Radiologically, the humeral offset, the lateral gleno-humeral offset (coracoid base to the greater tuberosity), height of center of instant rotation and the acromio-humeral distance were significantly increased. No intra-or postoperative complications encountered. Conclusion: Our early results with the use of Copeland surface replacement in selected cases with cuff tear arthropathy were encouraging. The patients showed significant clinical (pain and range of motion) and radiological improvements. Moreover, if the surface replacement were to fail for any reason, it can be revised to a reverse prosthesis type as there is no lack of bone stock

Introduction. Reverse shoulder replacement is a surgical option for cuff tear arthropathy. However scapular notching is a concern. Newer designs of glenospheres are available to reduce scapular notching. Eccentric glenosphere with a lowered centre of rotation have been shown to improve range of adduction in vitro. We hypothesize that the eccentric glenosphere improve clinical outcomes and reduce scapular notching. Method. This is an ongoing randomized controlled double blind prospective clinical trial. Patients 70 years or older at North Shore hospital who have a diagnosis of cuff tear arthropathy and require surgery were consented for this study. Patients were allocated a concentric or eccentric 36 mm glenosphere intraoperatively, using a computer generated randomization contained in a sealed envelope. The surgical technique and post operative rehabilitation were standardized. Patients were followed up by a research nurse and postoperative radiographs were also taken at regular intervals. Clinical assessment include a visual analogue pain score, subjective shoulder rating, American Shoulder and Elbow Society Score, and Oxford shoulder score. Complications were checked for and radiographs were assessed for scapular notching. Results. There were 23 patients in the concentric and 24 patients in the eccentric glenosphere group. Average age and duration of follow up were comparable. There was no statistical significant difference but there was a trend towards better functional outcome and better range of motion in the eccentric glenosphere group. There was no scapular notching in the eccentric and three cases of scapular notching in the concentric glenosphere group. Conclusions. Reverse shoulder replacement significantly improve pain, function and range of motion in patients with cuff tear arthropathy. Eccentric glenosphere prevents scapular notching in the SMR reverse prosthesis