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Scientific Article   |    
The Influence of Rotator Cuff Disease on the Results of Shoulder Arthroplasty for Primary Osteoarthritis Results of a Multicenter Study
T. Bradley Edwards, MD; Aziz Boulahia, MD; Jean-Francois Kempf, MD; Pascal Boileau, MD; Chantal Nemoz, PhD; Gilles Walch, MD
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Investigation performed at the Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, Lyon, France

T. Bradley Edwards, MD
Minneapolis Sports Medicine Center, 7201 Washington Avenue South, Edina, MN 55439. E-mail address: bradedwards@ocpamn.com

Aziz Boulahia, MD
Gilles Walch, MD
Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, 85 Cours Albert Thomas, 69003 Lyon, France

Jean-François Kempf, MD
Department of Orthopaedic Surgery, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg, France

Pascal Boileau, MD
Department of Orthopaedic Surgery, Hôpital de l'Archet, 151 Route de Saint Antoine de Ginestière BP 79, 06202 Nice CEDEX, France

Chantal Némoz, PhD
Department of Biostatistics, Hôpitaux de Lyon, 162 Avenue Lacassagne, 69424 Lyon CEDEX 03, France

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Association pour le Développement de la Pathologie de l'Epaule. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Tornier Company). Also, a commercial entity (Tornier Company) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2002 Dec 01;84(12):2240-2248
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Abstract

Background: Rotator cuff disease is uncommon in primary glenohumeral osteoarthritis. Consequently, the prognostic implications of rotator cuff disease in patients undergoing prosthetic replacement for the treatment of primary glenohumeral osteoarthritis are uncertain. The purpose of this study was to report the effects of the condition of the supraspinatus tendon and the rotator cuff musculature on the results of shoulder arthroplasty in the treatment of primary osteoarthritis.

Methods: Five hundred and fifty-five shoulders in 514 patients who had an arthroplasty for the treatment of primary glenohumeral osteoarthritis as part of a multicenter study were evaluated. Forty-one shoulders had a partial-thickness tear of the supraspinatus, and forty-two had a full-thickness tear. Ninety shoulders had moderate (stage-2) fatty degeneration of the infraspinatus, and nineteen had severe (stage-3 or 4) degeneration. Eighty-four shoulders had moderate fatty degeneration of the subscapularis, and fifteen had severe degeneration. The influence of the condition of the supraspinatus tendon and the infraspinatus and subscapularis musculature on the postoperative outcome was evaluated with respect to the scores according to the system of Constant and Murley, active mobility, subjective satisfaction, radiographic result, and rate of complications.

Results: The shoulders were evaluated at a mean of 43.1 months postoperatively. With the numbers available, supraspinatus tears were not found to influence the postoperative outcome with respect to the total Constant score, active mobility, subjective satisfaction, radiographic result, or rate of complications. Additionally, the treatment of these tears did not markedly influence the outcome parameters. Conversely, both shoulders with moderate fatty degeneration and those with severe degeneration of the infraspinatus were associated with poorer results than those with no degeneration with respect to the total Constant score (p < 0.0005), active external rotation (p < 0.0005), active forward flexion (p = 0.001), and subjective satisfaction (p = 0.031). Similar although less dramatic results were seen with fatty degeneration of the subscapularis.

Conclusions: This study demonstrates that minimally retracted or nonretracted rotator cuff tears that are limited to the supraspinatus tendon do not appreciably affect most shoulder-specific outcome parameters in shoulder arthroplasty performed for the treatment of primary osteoarthritis. Conversely, fatty degeneration of the infraspinatus and, less importantly, subscapularis musculature adversely affects many of these parameters.

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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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