scholarly journals Previous Rotator Cuff Repair Is Associated With Inferior Clinical Outcomes After Reverse Total Shoulder Arthroplasty

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773031 ◽  
Author(s):  
Edward J.W. Shields ◽  
Denise M. Koueiter ◽  
Tristan Maerz ◽  
Adam Schwark ◽  
J. Michael Wiater
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Rotator Cuff Repair ◽  
Total Shoulder Arthroplasty ◽  
Shoulder Surgery ◽  
Reverse Total Shoulder Arthroplasty ◽  
Cuff Tear ◽  
Reverse Total Shoulder ◽  
Cuff Repair

Background: Although recent evidence suggests that any prior shoulder surgery may cause inferior shoulder arthroplasty outcomes, there is no consensus on whether previous rotator cuff repair (RCR) is associated with inferior outcomes after reverse total shoulder arthroplasty (RTSA). Purpose: To retrospectively compare outcomes in patients who underwent RTSA with and without previous RCR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with prior RCR and those without previous shoulder surgery (control) who underwent RTSA for cuff tear arthropathy or irreparable cuff tear were retrospectively identified from a prospective database. Exclusion criteria included revision arthroplasty, fractures, rheumatoid arthritis, dislocations, infection, prior non-RCR procedures, less than 12 months of follow-up, and latissimus dorsi tendon transfer. The American Shoulder and Elbow Surgeons (ASES) score, ASES Activities of Daily Living (ADL) score, visual analog scale (VAS) score for pain, Subjective Shoulder Value (SSV), and range of motion (ROM) were compared between groups. Results: Patients with previous RCR (n = 83 shoulders) were younger (mean ± SD, 67 ± 10 vs 72 ± 8 years; P < .001) and more likely to be male (46% vs 32%, P = .033) than controls (n = 189 shoulders). No differences were found in follow-up duration (25 ± 13 vs 26 ± 13 months, P = .734), body mass index, or any preoperative outcome variable or ROM measure. At final follow-up, patients with previous RCR had significantly lower ASES (76.5 [95% CI, 71.2-81.7] vs 85.0 [82.6-87.5], P = .015), lower SSV (76 [72-81] vs 86 [83-88], P < .001), worse pain (2.0 [1.4-2.6] vs 0.9 [0.6-1.1], P < .001), and less improvement in the ASES, ASES ADL, VAS, SSV, and forward elevation measures than controls. Multivariable linear regression analysis demonstrated that previous RCR was significantly associated with lower postoperative ASES score ( B = –9.5, P < .001), lower ASES improvement ( B = –7.9, P = .012), worse postoperative pain ( B = 0.9, P = .001), worse improvement in pain ( B = –1.0, P = .011), lower postoperative SSV ( B = –9.2, P < .001), lower SSV improvement ( B = –11.1, P = .003), and lower forward elevation ROM improvement ( B = –12.7, P = .008). Conclusion: Patients with previous RCR attempts may experience fewer short-term gains in functional and subjective outcome scores after RTSA compared with patients with no history of shoulder surgery who undergo RTSA. However, the differences between groups were small and below the minimal clinically important differences for the outcome measures analyzed.

scholarly journals Reverse Total Shoulder Arthroplasty in the Massive Rotator Cuff Tear

2014 ◽  
Vol 17 (3) ◽  
pp. 145-150 ◽  
Author(s):  
Jin Young Jeong ◽  
Hong Eun Cha
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Biceps Tenotomy ◽  
Reverse Total Shoulder

In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis.

scholarly journals Reverse Total Shoulder Arthroplasty as Treatment for Rotator Cuff-Tear Arthropathy and Shoulder Dislocations in an Elderly Male with Parkinson’s Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
John G. Skedros ◽  
James S. Smith ◽  
Tanner D. Langston ◽  
Micheal G. Adondakis
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Cuff Tear Arthropathy ◽  
Cuff Tear ◽  
Reverse Total Shoulder

We report the case of a 70-year-old male with Parkinson’s disease (PD) and recurrent traumatic left shoulder dislocations. This case is rare because (1) he had a massive irreparable rotator cuff tear and end-stage arthritis (i.e., rotator cuff-tear arthropathy) of the same shoulder and (2) his shoulder was ultimately reconstructed with a reverse total shoulder arthroplasty (RTSA). His first dislocation occurred after a fall. Recurrent shoulder dislocations occurred despite successful closed reduction and physical therapy. Initial surgical treatment included an open capsular-labral reconstruction; RTSA was not an ideal option because of the presumed risk of failure from PD-related dyskinesias. However, the capsular-labral reconstruction failed after he lost balance and stumbled but did not fall. A RTSA was then done which restored the patient’s shoulder stability and greatly improved his pain. At final follow-up two years later, he reported pain relief and improved function. This was partially attributed to the fact that he had moved to an assisted living center. He also began using an electric wheelchair one year after the RTSA. We report this case because of the unusual set of conditions and circumstances, namely, the implantation of a RTSA in a patient with PD and shoulder instability.

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