Background: Patients who have pain and dysfunction from glenohumeral
arthritis associated with severe rotator cuff deficiency have few treatment
options. The goal of this study was to retrospectively evaluate the short-term
results of arthroplasty with use of the Reverse Shoulder Prosthesis in the
management of this problem.
Methods: We report the results for sixty patients (sixty shoulders)
with a rotator cuff deficiency and glenohumeral arthritis who were followed
for a minimum of two years. Thirty-five patients had no previous shoulder
surgery, whereas twenty-three had had either an open or arthroscopic rotator
cuff repair, one had had a subacromial decompression, and one had had a biceps
tendon repair. All patients were assessed preoperatively and postoperatively
with the American Shoulder and Elbow Surgeons scoring system for pain and
function and with visual analog scales for pain and function. They were also
asked to rate their satisfaction with the outcome. The shoulder range of
motion was measured preoperatively and postoperatively.
Results: The average age of the patients was seventy-one years. The
average duration of follow-up was thirty-three months. All measures improved
significantly (p < 0.0001). The mean total score on the American Shoulder
and Elbow Surgeons system improved from 34.3 to 68.2; the mean function score,
from 16.1 to 29.4; and the mean pain score, from 18.2 to 38.7. The score for
function on the visual analog scale improved from 2.7 to 6.0, and the score
for pain on the visual analog scale improved from 6.3 to 2.2. Forward flexion
increased from 55.0° to 105.1°, and abduction increased from 41.4°
to 101.8°. Forty-one of the sixty patients rated the outcome as good or
excellent; sixteen were satisfied, and three were dissatisfied. There were a
total of thirteen complications in ten patients (17%). Seven patients (12%)
had eight failures, requiring revision surgery to another Reverse Shoulder
Prosthesis in five patients (one shoulder had two revisions) and revision to a
hemiarthroplasty in two patients because of deep infection.
Conclusions: The data from this study suggest that arthroplasty with
the Reverse Shoulder Prosthesis may be a viable treatment for patients with
glenohumeral arthritis and a massive rotator cuff tear. However, future
studies will be necessary to determine the longevity of the implant and
whether it will provide continued improvement in function.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.