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
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.
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.
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.