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Scientific Articles   |    
Reverse Shoulder Arthroplasty for the Treatment of Irreparable Rotator Cuff Tear without Glenohumeral Arthritis
Philip Mulieri, MD, PhD1; Page Dunning, BA1; Steven Klein, MD1; Derek Pupello, MBA1; Mark Frankle, MD1
1 Florida Orthopaedic Institute (P.M., S.K., and M.F.) and Foundation for Orthopaedic Research and Education (P.D. and D.P.), 13020 North Telecom Parkway, Tampa, FL 33637. E-mail address for M. Frankle: frankle@pol.net
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from DJO Surgical. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DJO Surgical).

Investigation performed at the Foundation for Orthopaedic Research and Education, Tampa, Florida

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Nov 03;92(15):2544-2556. doi: 10.2106/JBJS.I.00912
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Abstract

Background: 

The purpose of the present study was to evaluate the indications for, and outcomes of, reverse shoulder arthroplasty in patients with massive rotator cuff tears but without glenohumeral arthritis.

Methods: 

From December 1998 to December 2006, sixty-nine patients (seventy-two shoulders) were managed with reverse shoulder arthroplasty for the treatment of irreparable rotator cuff dysfunction without glenohumeral arthritis. The indications for reverse shoulder arthroplasty were persistent shoulder pain and dysfunction despite a minimum of six months of nonoperative treatment, the presence of at least a two-tendon tear, and Hamada stage-1, 2, or 3 changes in a patient for whom a non-arthroplasty option did not exist. Fifty-eight patients (sixty shoulders) had a minimum of two years of follow-up. Thirty-four shoulders had had no previous surgery (Group A), and twenty-six shoulders had had at least one previous surgical procedure (Group B). Postoperatively, patients were prospectively followed both clinically and radiographically. Survival analysis was performed, with the end points being removal or revision of the implant, radiographic loosening, and declining American Shoulder and Elbow Surgeons score.

Results: 

Common characteristics of patients managed with reverse shoulder arthroplasty in this study were pain and (1) <90° of arm elevation at the shoulder without anterosuperior escape (n = 40; 66.6%); (2) <90° of elevation with anterosuperior escape (n = 16; 26.7%); or (3) irreparable rotator cuff tear and pain with >90° of elevation (n = 4; 6.7%). The average duration of follow-up was fifty-two months (range, twenty-four to 101 months). All measured outcomes improved postoperatively. For all patients, the average American Shoulder and Elbow Surgeons score improved from 33.3 to 75.4 (p < 0.0001), the average Simple Shoulder Test score improved from 1.6 to 6.5 (p < 0.0001), the average visual analog score for pain improved from 6.3 to 1.9 (p < 0.0001), the average visual analog score for function improved from 3.2 to 7.1 (p < 0.0001), the average forward flexion improved from 53° to 134° (p < 0.0001), the average abduction improved from 49° to 125° (p < 0.0001), the average internal rotation improved from S1 to L2 (p < 0.0001), and the average external rotation improved from 27° to 51° (p = 0.001). There were a total of twelve complications in eleven patients (prevalence, 20%). The survivorship at a mean of fifty-two months (range, twenty-four to 101 months) was 90.7% for all patients, 91.8% for Group A, and 87% for Group B.

Conclusions: 

When non-arthroplasty options either have failed or have a low likelihood of success, reverse shoulder arthroplasty provides reliable pain relief and return of shoulder function in patients with massive rotator cuff tears without arthritis at the time of short to intermediate-term follow-up.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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